Seventeen Times Hip Hop Schooled me on Neurology

I'm interested in ways to integrate my two great loves for Hip-Hop and neurology. For this article I searched the rap genius database for lyrics related to neurologic illness and then wrote responses that highlight interesting concepts in medicine. The words I chose were ‘neurology,’ ‘stroke,’ ‘seizure,’ and ‘headache.’ I filtered the results by hand, excluding unrelated lyrics and less familiar artists, and then I actually posted all of these responses on the rapgenius platform for other users to vote up or down, and reply to. Finally I built a playlist of the songs included in this exercise on spotify and embedded it here for you to enjoy while you read. There's plenty of profanity so hide your kids!

#1 - M.I. Abaga - Do you know who

You cannot build each other up?
How would you build economy
How you think is how you are
It’s just basic neurology

A version of Emerson’s ‘you are what you think all day long’ or the Buddha’s ‘what you think you become.’ Basic neurology because the brain is the interface through which we interact with the world. M.I. Abaga is a nigerian rapper who studied at Calvin College in Michigan briefly.

#2 - The Roots - It just don’t stop (Malik B verse)
You and your sorry-a** style needs an apology
Cause an earthquake and make you shake, you need neurology
These n**** kill me, actin' like stars, f*** they astrology

Malik B of the Roots (you may know them as the studio band for Jimmy Fallon) has got it figured out: tremor is a symptom for which one might visit a neurologist. Treatment of both essential tremor and Parkinson’s disease has been revolutionized by the development and subsequent improvements in deep brain stimulation technology. We are able to insert an electrode that temporarily halts activity in a part of the brain that generates unwanted movements.
#3 - Slaughterhouse - Yall ready know (Crooked I Verse)

The double entendre is well taken here that the neurologists tend to be brainiacs. Takes one to know one, I suppose. I don’t think he’s calling doctors money chasers, rather he is saying that you have to be smart and have your gun with you if you want to make money in his game.

#4 - Hamilton - Take a Break

The meaning here is a stroke of the pen but it could also be he is concerned a friend suffered a devastating neurologic ailment. I don’t know which it is referring to because I can’t afford Hamilton tickets.

#5 - Travis Scott - Mamacita (Young Thug Verse)
She look the best with a 'fro, natural nat-nat on go (Woo)
Damn, Quan, turn on the stove (Woo), whip it 'til I have a stroke (Woo)

Young thug is really getting creative here discussing his technique for manufacturing crack cocaine. One of the steps in the process must be stirring, and there is some braggadocio here where Thug is claiming he stirs his product so vigorously that he is at risk of reducing blood flow to his brain.

#6 - MF Doom - Beef Rap
I suggest you change your diet
Or even a stroke, heart attack, heart disease

MF Doom is an enigmatic character in the hip hop world. He lives in London and wears a mask at his shows. He flexes his intelligence in these four bars that I would be tempted to print out and hand to patients in my clinic. The connection between blood pressure and fried food seems self-evident. However a publication in 9000 Korean adults found a 2-4 fold chance of high blood pressure in the fast food eaters only for the women and no association among the men. The connection between dietary cholesterol and the toxic plaque on the inside of arteries and arterioles that causes both heart attack and stroke is not straightforward, as Joe Rogan will be happy to inform you. In fact dietary cholesterol is essential for the construction of steroid hormones such as testosterone. It may be that the individuals that are more likely to eat several fried meals a week are less likely to live an active lifestyle, a significant potential confounder. Finally, Doom’s warning that there is ‘no starting back’ in the pathway towards atherosclerotic disease is mostly true. Once the plaques calcify, fish oil and a jog in the park are unlikely to reverse the course.  

#7 - Lil Pump - Smoke my Dope
Cocaine on the boat (yeah, ooh)
I just had a stroke

Pump’s wise words show he knows abusing cocaine can cause stroke. Cocaine causes stroke by at least five different mechanisms. First it causes blood vessels to constrict and that’s bad if your job is to get blood somewhere if you suddenly become skinny. This effect is mediated both by preventing the reuptake of norepinephrine, serotonin and dopamine, as well as by directly acting on calcium channels that constrict the smooth muscle cells that are in the wall of blood vessels.This mechanism is called ‘vasospasm’ and is one of the properties of cocaine that makes it such an effective anesthetic for ENT procedures. 

In addition to constricting blood vessels cocaine is thought to cause stroke by activating platelets, the blood components responsible for banding together to stop bleeding in normal circumstances and the same components that go rogue and plug up blood vessels in ischemic stroke. Animal studies on how platelets are activated in acute stroke are conflicted but it might have something to do with chemicals with names like arachidonic acid and thromboxane. 

A much more common cause relates to cocaine causing dysregulated cerebral pressures and chronic elevated blood pressure which places users at risk of both ischemic and hemorrhagic strokes. High blood pressure is an important mediator of stroke because it is easily managed with medications and also is often silent, meaning people walk around without knowing they have it. The risk of ischemic stroke if you had normal blood pressure in the Framingham heart study was half as high as it was for individuals with high blood pressure. Interventions like ‘strike out stroke’ where our department goes to minor league baseball games to measure blood pressures in the community could help to deal with the problem of a lack of awareness regarding the risks of untreated hypertension. Fire departments have blood pressure cuffs, as do most grocery store entrances.

The fourth mechanism of cocaine induced stroke which lil pump may very well have been alluding to is vasculitis. More common with amphetamines, cocaine can also cause the blood vessel walls to die because of inflammation which leads to stroke. 

A fifth mechanism is a bit of a stretch but cocaine shrinks the blood vessels that fuel the heart which causes heart disease and can produce changes in the heart rhythm that leads to strokes. Basically if you have blood flowing smoothly it doesn’t clot but when dead heart tries to conduct electricity it does so poorly which can cause blood clots to form inside the heart we call thrombi. These thrombi can be ejected out of the heart up to the brain causing strokes, so individuals with known heart rhythm problems are often prescribed blood thinners such as coumadin and eliquis to prevent them from forming in the first place.

#8 - Biggie Smalls - Dead Wrong
Smell the Indonesia, beat you to a seizure

Here Mr. Wallace demonstrates the knowledge that head trauma is a major cause of provoked seizures. Distinguishing between provoked and unprovoked seizure is an important element of my job. Seizure medicines should be reserved for patients with epilepsy and in whom a provoking stimulus can not be removed. An example would be a patient with blood in their head that cannot be removed safely with surgery. Of course most epilepsy patients have a cause for their seizures as well, usually a little piece of brain tissue that didn’t make it all the way to its home during the development of the brain called dysplasia. This fact is clinically relevant as abnormal pieces of brain tissue can sometimes be removed in a procedure that can cure epilepsy and allow some patients to live normal lives even without the need for epilepsy medicines.

#9 - Kendrick Lamar - Kush and Corinthians (BJ the Chicago Kid verse)

Apparently one of BJs friends took an unidentified drug and seized before ultimately dying. Seizure can be very frightening especially to folks who don’t live with seizures every day. Most of the time seizure when encountered in public can be dealt with by keeping the seizing individual away from hard objects and turning them on their side so they can breathe and clear secretions more easily. Unfortunately epilepsy can also be fatal in the form of SUDEP or sudden unexpected death in epileptic patients. Frequent seizures involving the whole body are the most important risk factor for SUDEP and working with a neurologist or epileptologist to control and limit the number of seizures a year, a month, or a week should be an important goal.

#10 - Kanye West - Roses

Here the Walt Disney of our generation provides a succinct representation of what it feels like to have a sick relative at the hospital. He addresses a number of common issues that family members face in this song. This quote centers around a physician declining to operate on his dying grandmother because of her comorbidities and medical risk factors. This is a common dilemma patients face where a physician may not want to operate because there is likely to be a poor outcome. Physicians are graded and sometimes even compensated based on complication rates from their procedures and may be less interested to operate on someone who has a higher chance of doing poorly not just because the patient is more likely to suffer a bad outcome but because it could affect their numbers in a negative way and impact their reputation or reimbursements. Later Ye addresses conflicting motives when he asks the nurse if she’s read the latest research and she asks him for an autograph.
#11 - YG - Sorry Momma
You gon' treat me like this? And you know I have seizures
You know I take pain pills for headaches and fevers"

Another song dealing with health issues of a loved one. This time YG raps about his mother's health issues. Ultimately we may never know which drug YG is rapping about but my money is on acetaminophen or Tylenol which would be expected to have some efficacy for both headache and fever.

#12 - Lil Wayne - Hot Revolver
She say she pray she have Weezy F's baby
#13 - Rick Ross - Family Ties
Playin' for keeps, and that's just to say at the least

Both Lil Wayne and Rick Ross have been hospitalized for seizures at various times during their careers. It is not clear that either have epilepsy rather the stories that have leaked point towards provoked seizures for both in the setting of constant touring; polysubstance abuse, and dehydration. Speaking of Ross it seems he’s been thinking about the possible triggers for his seizures and is working to prevent them.

#14 - Future and young thug - Patek Water

Here the claim is straightforward; that a necklace has so many diamonds on it that the refracted light you see in it will elicit head pain. Photophobia is a common feature of migraine and bright lights can certainly trigger head pain in individuals who are vulnerable.
#15 - Eminem - Underground

Here the Goat demonstrates his penchant for inner rhymes (anesthetic/pathetic, medic/headache) as well as launching a reasonable critique of the medical field for undertreating pain. While the president and state officials are clamoring for doctors to stop prescribing unnecessary pain meds, patients with indications for narcotics still need treatment. Importantly there seem to be racial biases present in our pattern of prescribing opioids. A recent study showed African American patients are prescribed on average half the opioid dose and have half the likelihood of having opioids chosen for their treatment compared to caucasians.

#16 - Missy - Gossip Folks
 have to clear these rumors

Ms. Elliot references the classic kindergarten cop scene. The scene is a beautiful representation of the danger of ‘a little bit of information.’ Our patients are often bombarded with too much information and the wrong type of information on the internet. Still the internet era has created the best informed patients that have ever existed. We should focus on the benefits of a well-informed patient body that often know as much about their health conditions as we do and are prepared to evaluate new treatments risks and benefits instead of worrying that we will be replaced by the machines.

#17 - Ice Cube and Dr. Dre - Natural Born Killaz
Now they stiff and cold and they pupils won't dilate
It's so much pain, migraine headache
I can hear his bones break

Cube is describing the effects of strychnine poisoning. This rhyme is good enough to teach to medical students. It also helps to remember one of the symptoms of migraine: phonophobia or increased sensitivity to sounds. 

Isaac “B-Tips” Goldszer is a physician training in neurology in Charleston, SC. He is interested in auditory processing and studies how music therapy can help us connect with loved ones with memory impairments. He was born in Detroit and was a Hip Hop DJ who built an entertainment business in New York prior to becoming a doctor. He has shared the stage with the likes of Snoop Dogg and Kid Cudi and had a teaching role in digital media at the Dwight school on Manhattan’s Upper West Side.  He is a husband and a father and when he is not DJing or doctoring he enjoys yoga, chess, and photography. Follow him on instagram and twitter @DJBTIPS.


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