Pets and our Health--The Good, the Bad, the Ugly: Part 1

The U.S. is a pet-loving country, with around two-thirds of all households reporting owning a dog or cat. To put this into perspective, this amounts to approximately 78.2 million dogs and 86.4 million cats owned by Americans. A cancer specialist affiliated with the Mayo Clinic once noted that "a pet is a medication without side effects…." Indeed there are many ways that pets can contribute to our health and well-being. The following are research-based benefits of pet ownership, broken down into their effect on children, adults, and the elderly.

Children:

• Lowered rates of respiratory disease in children. Children who are around dogs and cats during the first year of life have been shown to have fewer respiratory infections, especially ear infections, than children without exposure to these animals. The strongest protective effect was seen in children whose families allowed their dogs to spend time indoors.
  
  
• Reduced risk of developing allergies. Research has shown that children growing up in a home with a dog or cat are less likely to develop allergies. This also applies to children who live on a farm or ranch with large animals.
  
  
• Improved sense of responsibility. Children who accept responsibility for pet care learn important organizational skills as well as respect for other living beings.

Adults:

• Help with meeting daily exercise recommendations. People who own dogs tend to be more physically active than those who don't. Walking briskly with a dog for 30 minutes a day will help meet the current cardiorespiratory exercise recommendation from the American College of Sports Medicine. By encouraging their owners to walk, dogs can also be a tool for weight loss. As a weight-bearing exercise, walking has the additional benefit of maintaining bone integrity to help prevent osteoporosis.
  
  
• Better blood pressure control. Being around a pet appears to provide a "calming effect" in people with medication-controlled hypertension. One study has demonstrated that the presence of a pet reduces blood pressure rises associated with psychological stress. Another study has shown that borderline hypertension can be controlled with a pet dog, without the need for drug therapy.
  
  
• Enhanced mental health. Spending time with a pet--walking, grooming, and playing--can boost levels of the mood-enhancing brain chemicals serotonin and dopamine. Some psychotherapists "prescribe" pets as a way of dealing with depression. Pets also encourage interaction with others, since most pet owners love to talk about their pets.
  
  
• "Serving" pet owners with medical problems. Service animals are used to assist people with various diseases or disabilities. The best known examples are the specially trained dogs that serve as the eyes or ears for people who are visually or hearing impaired. A "seizure dog" is one that has been trained to bark and alert others that their owner is having a seizure. In some cases, the dog can detect that a seizure is getting ready to occur, giving the person time to lie down or move away from a dangerous place. Specially trained dogs can also assist people with neurological diseases, such as Parkinson's or Alzheimer's disease to help them live more independently. Some dogs are even able to alert diabetics of a sudden drop in their blood sugar in time for them to eat a snack and avoid becoming severely hypoglycemic.

Seniors:

• Easing the effects of bereavement. People with a strong relationship with their pets experience less depression after the loss of their spouse.
  
  
• Improving general health. It has been reported that elderly dog owners visit the doctor less often and require less medical attention for minor health issues as compared to non-dog owners. Older people who walk dogs are more likely than those who walk with a human companion to engage in regular exercise. Improved psychological well-being and higher one-year survival rates following coronary heart disease have also been reported in seniors with companion animals.
  
  
• Assisting in the treatment of Alzheimer's disease. The use of a therapy dog with persons with Alzheimer's disease can result in increased socialization, improved social behaviors, and decreased agitation.
  
  
• Help with feelings of loneliness. Pets promote social interaction and help seniors to become more involved in daily activities and socializing. Many nursing homes have opened their doors for animal visitation with their residents.

While there are numerous benefits to pet ownership, there are drawbacks also. Next week we'll look at the "Bad" and the "Ugly" of pet ownership--animals that should be discouraged as pets and some of the medical issues that can develop as a result of living with animals.

PSA Screening for prostate cancer

A few years ago, there was marked disparity among experts as to whether and how screening for prostate cancer should be performed. At that time, the American Cancer Society recommended that the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) should be done yearly, beginning at age 50, assuming the man had at least a 10-year life expectancy. The US Preventive Services Task Force, on the other hand, believed that the potential harm from PSA testing that included complications from unnecessary biopsies outweighed the potential benefits of detecting early cancer.

There are a number of explanations for why the PSA test is not an ideal screening test for men who are at average risk for developing prostate cancer and who have no symptoms suggesting that they have prostate cancer:

• Prostate-specific antigen (PSA) is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. PSA is created when the prostate becomes inflamed from a number of causes other than cancer, such as prostatitis and benign prostatic hypertrophy.
  
• An elevated PSA without the presence of prostate cancer (false positive) often leads to medical procedures with potential risks, worry, and significant financial costs. In particular, the prostate biopsy used to diagnose cancer can cause bleeding and infection.
  
• Not all men with prostate cancer will have an elevated PSA. Approximately 15% of men with a level below 4 will have prostate cancer on biopsy. Furthermore, if the PSA is in a borderline range between 4 and 10 there is only a 25% chance of having prostate cancer.
  
• Even when the PSA has accurately detected prostate cancer, the eventual outcome is not necessarily improved. For example, the PSA test may detect small cancers that would never become life threatening since prostate cancer is often slow-growing.
  
• The reduction in prostate cancer deaths from PSA screening appears to be small, at best. A large U.S. study showed no benefit from screening. A large European study that found the highest reported benefit suggests that no more than 1 man in 1,000 avoids death from prostate cancer because of screening.

With the recent announcement of guidelines from the American Urological Association, the major organizations that are involved with the detection and treatment of prostate cancer are coming closer to consensus regarding their recommendations regarding PSA screening. Remember that these recommendations apply to men who are at low risk and who do not exhibit signs or symptoms of prostate cancer. Older men, African American men, and men who have a family history of prostate cancer have an increased risk of developing prostate cancer. While not just specific for prostate cancer, symptoms suggestive of prostate cancer include trouble urinating, blood in the semen or urine and discomfort in the pelvic area.

PSA Screening Recommendations:

1. The US Preventive Services Task Force recommends against PSA-based screening for prostate cancer regardless of age. They have found with moderate to high certainty that PSA testing has no net benefit and that the potential harms from screening outweigh benefits. Again, this recommendation does not include the use of PSA testing for surveillance after diagnosis or treatment of prostate cancer.
   
   
2. The latest recommendations from the American Urologic Association are as follows:
   • PSA screening in men under age 40 years is not recommended.
     
   • Routine screening in men between ages 40 to 54 years at average risk is not recommended.
     
   • For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients' values and preferences.
     
   • To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
     
   • Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.
     
3. The American Cancer Society recommends men learn as much as they can about prostate cancer screening risks and benefits and discuss the information with their doctor before deciding whether to be tested at all. Men at average risk of prostate cancer should have this discussion starting at age 50. Men at higher than average risk (African Americans and those with first-degree relatives who had prostate cancer at an early age, in particular) should have the discussion starting at age 40 or 45.
   

While the recommendation to avoid the use of routine PSA screening from various medical authorities is reaching consensus, these groups are also aware that better, more specific tests are needed to screen for this common form of cancer.

Sweet Dreams, tips for getting a good night's sleep

Chronic insomnia affects approximately 30% of the general population. It is a particularly common occurrence among women and the elderly. With rare exception, insomnia is a symptom of a problem, not the problem itself. Some of the situations associated with insomnia include:

• Medical conditions such as gastroesophageal reflux, restless leg syndrome, sleep apnea, and chronic pain.
• Psychiatric disorders, especially depression, which may be present in up to 40% of people with insomnia.
• Working nights or rotating shifts.

Insomnia is not an innocuous issue. People with persistent sleep disturbance are more prone to accidents, have higher rates of work absenteeism, report a decreased quality of life, and utilize the health care system more often.

For many people, the underlying cause for disturbed sleep has to do with poor sleep habits, such as staying up too late, drinking too much alcohol or caffeine, or napping during the daytime. "Sleep hygiene" is the term applied to measures to improve the quality or quantity of sleep. The following are tips to help enhance your sleep hygiene:

• Avoid prolonged napping during the day. For those people who experience an afternoon "slump", a short nap during this time is reasonable. Napping too long, however, may make getting to sleep or staying asleep in the evening more difficult.
• Stimulants, such as caffeine, nicotine, and alcohol should be avoided too close to bedtime. Coffee, tea, cola, cocoa, chocolate and even some non-prescription drugs contain caffeine. Like caffeine, nicotine is a central nervous system stimulant that tends to increase heart rate and blood pressure as well as stimulate brain activity in ways that are incompatible with sleep. While alcohol has an initial sleep-inducing effect, once the alcohol is metabolized, the mind can become aroused resulting in awakening or a poor quality of sleep.
• Exercise regularly. Engaging in vigorous exercise within two hours of bedtime can be counter-productive, however, because it tends to activate the nervous system. For some people a relaxing exercise, such as yoga done before bedtime helps to initiate a restful night's sleep.
• Avoid eating large meals close to bedtime. Although a light snack before sleeping can be beneficial, consuming large meals too close to bedtime can increase the risk of heartburn during the night. In order to reduce awakening from the need to urinate, avoid drinking fluids a couple of hours before retiring to bed.
• Avoid watching TV, eating, or discussing emotional issues in bed. Associate going to bed with going to sleep.
• Make sure that the sleep environment is relaxing. A comfortable mattress is one of the keys to a good night's sleep. Find a comfortable temperature setting for sleeping. A cool bedroom is often the most conducive to sleeping.
• Block out distracting sounds and light. Use of earplugs or machines that generate "white noise" can help with distracting sounds. Excessive light can be diminished with the use of "blackout" shades on the windows or by wearing eyeshades.
• Receive natural daylight regularly. Daylight helps regulates our circadian rhythm and tell us when it's time to be awake or asleep. Being in natural sunlight for at least 30 minutes each day will help keep our biological clocks properly adjusted.

Sound sleep is important to health and well-being. If your sleep is continually disrupted and you lack initiative and energy during the day, you should seek professional help. Feel free to contact us at eDoc to help sort out the general nature and severity of a sleep problem.