Lisa asked- >I went to a Richard Miller workshop this past summer, and I seem to remember >him saying that it was not good for a singer to take a Beta-blocker. Can one >of the Drs. tell me why? My doctor just added a beta-blocker to my other >bloodpressure med. He thinks it may help with my severe migraine headaches.
Judy replied- ><< I'm certainly no doctor, but I believe that some singers use beta blockers to > counteract stage fright (as opposed to a strictly medical reason, like > yours)--a practice that many physicians disapprove. >>
and mike suggested-- > i had a student whose nerves affected her physically. i suggested to >her mother to get her on beta-blockers long enough to see what calm was like >and then dump them. although she was never as calm as when she had been >taking the beta-blockers, she did have a better idea in her mind of what she >was aiming for. [snip] > if you are suffering from high blood pressure, ask you doctor about >avapro. it is expensive if you don't have prescription insurance but, there >are few, if any, side effects.
Dear Lisa, Judy, mike, and fellow Vocalisters--
As a cardiologist, I have used beta blockers quite frequently in singers and non-singers alike. As with any medicine, it's important to discuss with the patient the indications, risks, benefits and potential side effects of this class of drug at least to the extent which he can follow. Beta blockers (which can be easily identified by the characteristic "--olol" ending of their generic names) competitively block the receptor sites of tissues to adrenaline (epinephrine) - like hormones produced in the body in response to stress. Doctors may use them to treat a variety of conditions including hypertension, dysrhythmias, palpitations, so-called benign tremors, migraine headaches, alcohol/drug withdrawel, and, more recently, cardiomyopathies (in which the heart muscle may be either very thick, or weakened, or both). Still other patients may have an "anxiety-palpitation" complex in which a nervous state may lead to palpitations which, in turn, may lead to more anxiety and hence, even more palpitations. Beta-blockers can provide real symptomatic relief in this latter condition.
As already mentioned, they can, in small doses, help with "stage fright" w/o dulling the intellect. They are non-addictive and may actually "calm" a speaker or performer. By this same token, they can also dull a performer's "edge", especially if a little stage fright is helpful for that little "boost" one gets just before entering the stage. As an anecdote, I once took a tiny dose of atenolol (aka "Tenormin") before giving a lecture to the Dept of Medicine at UCLA. A couple of my slides were put in backwards. I just stared at them for a sec and went on without a single hitch. You might think that good; but normally, I'd use that as an opportunity to make a joke. So overall, I thought my talk suffered. Contrary to the opinion expressed in the post above, I don't think many of my colleagues disdain the use of small doses of beta blockers in these settings in SELECTED patients (ie-where there are no potential contraindications). However, for me, I like the "edge" which I think gives both my singing and lectures a boost.
Reasons to avoid beta-blockers include the usual--allergies, bad reaction to them before, etc. Other situations to avoid them may include asthma, tendency to abnormally slow heart beat, low blood pressure, history of psychiatric depression.. Relative (mild) contraindications to beta-blockers may included diabetes.
So, I wouldn't worry if your doctor prescribed a beta blocker for you, Lisa. Presumably, s/he's thought about all of the above and decided this is the right therapy for you. If you find that it makes you feel a little "apathetic" or even "fatigued", know that this side-effect will likely dissipate after 1-2 weeks of continuous use. Your body will acclimate to it. If after a month of continuous use, you find that it impairs your vocal performance, please discuss it with your doctor. He has other anti-migraine medications available (which may have their own side effects).
As for the suggestion regarding "Avapro" (irbesartan). This is a member of the class of angiotensin receptor blockers (including Atancand, Diovan, Cozaar, and many others), is one of a very useful class of agents for treatment of hypertension and congestive heart failure; but not migraine. It is, IMHO, a second-line agent for hypertension as they do not, as yet, have an established record for prolonging life as do ACE inhibitors. But then, I'm only one of them "roto-rooter" guys. Please check with your own doctor; your individual mileage may vary....
GWendel, DT (developing tenor)
PS--Our ("Camerata") website <http://www.camerata-singers.org/> is taking shape. We now have a picture of us. I'm the little guy in the front row on the right side, wearing a blue sweater-vest and red turtleneck (We were asked to wear bright colours) standing next to Julia in a bright red coat.
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