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Tuesday, November 12, 2002

By Byron Spice, Post-Gazette Science Editor

Music has always played a big role in the life of composer and pianist Terese Kaptur. Yesterday, music also played the role of anesthesia for Kaptur as she underwent surgery to remove a small, cancerous tumor from her bladder.

	Terese Kaptur, left, and her daughter, Lauren Houlik, 13, talk about the surgery while sitting on the couch in their home in Bakerstown. (Joyce Mendelsohn, Post-Gazette)

During the 20-minute, minimally invasive procedure at Allegheny General Hospital, Pittsburgh Symphony Orchestra violist Penny Anderson Brill sat to Kaptur's left, playing long, sustained tones, or "drones," while music therapist Debbie Benkovitz sat to her right, humming and chanting along with Kaptur.

"We were, like, making music together," said Kaptur, 51, of Bakerstown.

"It really sounded like a New Age, ethereal type of piece," agreed Benkovitz.

Artistic considerations aside, the music didn't block the pain.

"Oh yeah, it was not pain free," Kaptur said. "There definitely was pain and perception of pain. It didn't obliterate that." But the music gave her "a euphoric feeling that is stronger than the perception of pain."

Normally, patients undergoing the procedure would be placed under general anesthesia or sedated, said Dr. Ralph Miller, the urologic surgeon who performed the procedure. "It's a fairly painful thing," he said, noting Kaptur only received a local anesthetic. She nevertheless seemed to tolerate the procedure well. "She was perfectly still and seemed perfectly relaxed."

Tolerating a little pain, with the help of her music, seemed like a good deal to Kaptur, who said she suffered long-lasting nausea, sore throat and shoulder pain from general anesthesia after previous procedures. Not only was she able to avoid those side effects yesterday, but she was able to forgo most of the pre-operative tests required for anesthesia. She also recuperated so quickly that she was able to leave the hospital two hours after the procedure.

Substituting music therapy for painkillers is not for everybody and not for every procedure, but music therapy's benefits are well-documented, said Dr. Bruce Rabin, medical director of the UPMC Healthy Lifestyle program.

"Music therapy is becoming more popular and is being used more in hospitals," said Rabin, noting UPMC is establishing a systemwide music therapy program and hopes to have a music therapy director hired within 30 days. "There's an emerging recognition of the importance of the patient's anxiety and emotional state in influencing healing."

Music, combined with the reassurance of a therapist, can lower anxiety levels and distract patients, he explained. It may not relieve pain, but it affects the perception of pain.

"There often is less need for analgesic medication, which is excellent because there are side effects to these medications," Rabin said.

Kaptur was diagnosed with bladder cancer five years ago. As is typical for most recovering bladder cancer patients, she is monitored regularly to check for the reappearance of tumors in her bladder, so they can be removed safely while still small. She has lost count of the number of times she has undergone the procedure, which involves inserting a tube-like viewing scope through the urethra, then removing the tumor and cauterizing the site.

Kaptur -- who lives here while serving as executive director of the National Repertory Orchestra, a Colorado-based training orchestra -- has taken the lead in introducing music to her treatment, Miller said. It began 18 months ago, when she invited Brill to play for her during her most recent procedure.

Music therapy often is provided using recorded music, but having a live performer makes it possible to adjust the music to coincide with what the patient is experiencing.

"We can fine tune it to whatever is going on at the time," Benkovitz said.

Kaptur took Percocet, a pain-killer and sedative, during that previous procedure. But she found certain tones played by Brill to be very calming. Based on the experience, she thought she could eliminate even the Percocet for yesterday's procedure.

"It went very smoothly," Brill said. "She is very responsive to the music. ... It kind of puts her in a different place, removed from the sensation of pain."