Wednesday, March 30, 2022

DOG INTERACTIVITY: A HORMONE STIMULANT FOR OUR MENTAL HEALTH

INTRODUCTION
The IPHA Health News is proud to launch our spring edition with this scientific review on how expressing love for 'man's best friend' actually works as a measurable therapeutic activity.  Brought to you by our clinical and mental health researcher, Dr. Bobbi Kline, this unique feature explains the physiological response between our touching or connecting with a dog and a biometric reaction to our endocrine system.



THE HEALING POWER OF PAW-SITIVITY 
Written by: Dr. Bobbi Kline

The relationship between dogs and humans began since the beginning of time when dogs looked to humans as a means of survival. Numerous studies have reported the significant benefits of pet ownership and interactive coexistence -  from stress reduction to social fulfilment to a healthier lifestyle.  Science is now providing insights into how this works, and the two hormones that are responsible: OXYTOCIN and CORTISOL.  A landmark study in 2015 revealed how dogs and their owners emotionally bond, and it’s related to the production of oxytocin – also known as the bonding hormone. When released, oxytocin creates a powerful social attachment between one person and another and creates that “feel good” sense of nurturing and closeness. [1]


THE SCIENCE OF THE MAGNETIC GAZE
It is known that a lengthy eye contact (or mutual gaze) forges a unqiue engagement between two individuals that somehow activates the release of our oxytocin, which also mediates a powerful emotional bond. One of the best-known examples of this is in the bond created between mother and infant. The oxytocin response is a feedback loop- a nurturing gaze from mom releases oxytocin in the infant, which stimulates production of oxytocin in the mother, then further stimulating nurturing behavior into a self-sustaining positive feedback loop. 

This study demonstrated that the same process happens when a dog and owner engage in the same behavior. For the first time, this oxytocin-mediated bonding has been shown to occur outside of intraspecies relationships.  A prolonged eye contact between dog-to-owner has shown to produce an oxytocin response in both the dog and the human owner. Unlike wolves, or even primates who are genetically closer to humans, dogs alone are able to elicit this oxytocin response loop. This may explain the extraordinary bonds formed between dogs and our human owners, and why puppies often exhibit similar behavior patterns as young children in response to visual cues. It may also explain why many dogs grieve when separated from their owners.

Oxytocin also has been shown to reduce stress and increase social reward behavior. But when people have SNPs or small errors in their genes involved in this pathway – including the receptor for the hormone oxytocin – they don’t always get the same level of benefit. [insert link to genetics vs genomics article]  Often they need more oxytocin than they get from a short interaction – something that can be challenging in today’s busy world. Perhaps this is one of the mechanisms behind the success of service dogs for people with disorders involving impaired social pathways, such as autism, PTSD, and other neurodevelopmental conditions where oxytocin is being used as an experimental treatment.

PHYSICAL TOUCH
But it may not only be about oxytocin. More recent studies have added a second hormone into the equation: CORTISOL. [2] Known as the stress hormone, cortisol is released as part of the normal stress response. It is part of the “fight or flight” reaction that helps us flee from danger or hold our ground to confront it.  The challenge is that so often in our modern world, that stress response doesn’t go away when the threat does. Our brains and nervous system stay on high alert far longer than needed, resulting in chronic stress which wreaks havoc with our biology. 

While oxytocin is produced through the gaze, physical touch is the secret behind the stress-reducing power of dogs. When we hold or pet a dog, especially our own but this is not as critical an element as with the oxytocin, science has shown that cortisol levels go down. This, in turn, reduces the “fight or flight” stress response and gives us a chance to reset those alarm bells – and our biologic response. 

As with oxytocin, there are genes involved in the cortisol response that when they have these small errors, or SNPs,  can predispose a person to a heightened or prolonged stress response. This can be a significant reason to why the same experience that one person brushes off can lead to serious consequences in another – including anxiety, depression, PTSD, and even many chronic health issues thought to be purely physical – heart disease, obesity, autoimmune disease, and cancer just to name a few.

So when dog owner says they feel better around their dog, we now know why.  One can venture that a key reason behind the healing power of dogs is the combination of increasing the oxytocin response and reducing the cortisol-driven stress response. It’s science, it’s biology, and it’s their unconditional love that makes this partnership between dogs and humans so enduring.


REFERENCES

(1) Nagasawa, M et al Oxytocin-gaze positive loop and the coevolution of human-dog bonds. Science 17 April 2015: Vol. 348 no. 6232

(2) Petersson M et al.  Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns: An Exploratory Study


Thursday, March 3, 2022

THE FUTURE IN PERSONALIZED MEDICINE (Part 1)

"Personalized medicine is an emerging practice of medicine that uses an individual's genetic profile to guide decisions made in regard to the prevention, diagnosis, and treatment of disease. Knowledge of a patient's genetic profile can help doctors select the proper medication or therapy and administer it using the proper dose or regimen. Personalized medicine is being advanced through data from the Human Genome Project." -NIH



NEW HOPE FOR GENETIC DISEASES
Written by: Dr. Bobbi Kline
One of the biggest controversies in screening for inherited diseases with genetic testing is the lack of effective tools to help people feel empowered. People found to carry one of these genetic mutations that cause disease often felt like it was a death sentence. Even armed with the latest medications or surgeries, often they felt helpless, just waiting for the day when they got the bad news. 

Thankfully that conversation is changing with genomics and Personalized Medicine. When you understand the biology and biochemistry of our bodies – and the genes that run them, it is very clear that there is much more that can be done to alter the perceived fated outcome. But the scientific studies have lagged behind – until now.

A recent study published in Nature (1) is providing support for the polygenic model of genomics. This model is an advanced application of Personalized Medicine utilizing genomics - the newer branch of genetics. Rather than the conventional single gene- single outcome model, this newer approach takes into account multiple genes involved in multiple biochemical pathways, and how small changes in these genes called single nucleotide polymorphisms (SNPs for short) each contribute to disease over time. [see: genetics vs genomics] It’s much more complicated, and as a result much harder to study. It’s also much harder to address with a single medication or the limited approach of conventional medicine.

But now that is changing. In this research study, they looked at 3 diseases with a strong genetic link: hereditary breast and ovarian cancer, familial hypercholesterolemia, and Lynch syndrome.  They evaluated more than 80,000 individuals of primarily European ancestry to examine the interaction between SNPs in multiple genes in other systems (polygenic) and single gene (monogenic) mutations for these specific inherited diseases. 

The study showed that there was a wide range of risk as to whether someone who carried one of these mutations actually developed the disease. The probability of disease by the age of 75 ranged from 17% to 78% for coronary artery disease; 13% to 76% for breast cancer; and 11% to 80% for colon cancer (Lynch syndrome). And the explanation was the influence of this polygenic model on the effect of the genetic mutation.

KNOWING YOUR BLUEPRINT & STRATEGIC INTERVENTION
We can potentially modify the outcome of inherited diseases by understanding the multiple biochemical pathways and mechanisms involved, along with the genes that impact them. The key is in going beyond the conventional fated model of one gene-one disease, and integrating the more advanced polygenic model. 

This may make a difference as to what surveillance and intervention strategies are chosen for an individual. Perhaps equally or even more importantly, it opens up the opportunity to use a person’s genomic blueprint to be able to lower a person’s risk. By leveraging the function of these genes and their biological systems through targeted diet, lifestyle, supplement and even perhaps medication strategies, we can potentially alter the course of what was once thought to be an inevitable outcome.

Now we have the start of what promised to completely change how we approach genetic diseases, and what those of us practicing Personalized Medicine have been seeing for years in our practices - certain genetic mutations may not leave us as helpless as we thought. While there is still much scientific study that needs to be done, we have the tools and the power right now to make a difference.

References: Fahed, A.C., Wang, M., Homburger, J.R. et al. Polygenic background modifies penetrance of monogenic variants for tier 1 genomic conditions. Nat Commun 11, 3635 (2020). https://doi.org/10.1038/s41467-020-17374-3




There's no one-size-fits-all solution and a lot of what we're trying to do is individualize our treatments to the patient.  One of the most important things I try to assess when I'm meeting a patient is to ask “what are your goals?  What are your expectations?  How can we meet those?”  A lot of it is education to let them know what's realistic and what's not.  A lot of my treatment strategies involve therapeutic exercise, engaging in physical therapy and there are different modalities even within that.  There's manual therapy, there are different electrical therapies, there are ultrasound therapies to name a few.  Other tools include complementary and alternative medicine and mind-body treatment which I'm a big proponent of because when you have physical issues, they can exacerbate the psychological side and vice-versa.  Tools like acupuncture can be helpful for some people, but again, there isn't as I one-size-fits-all.  We try to follow evidence based medicine protocols and an integrative approach.  

(See Dr. Kirschner's complete feature article on the 2022 LIFE EXTENSION REVIEW at Health & healing 101)



How to Choose the RIGHT DOCTOR


Today, we exercise our freedom of choice to seek complete confidence in our decisions. Seeking what's right for you is just that! I support all patients to be well-informed with research and asking a lot of questions that pertain to their health and issues.  Do not be swayed by pressure just because this doctor takes your insurance or the popularity of that procedure. The almighty Google is still on your side to answer any question about anything and anyone, where making an intelligent choice must be strategic and thought through.

THE SECOND OPINION
From the moment your physician calls you about a debilitating illness,  that inner voice may express curiosity about what other treatment options another doctor would prescribe?  You may want to get another perspective on your current diagnosis or get another set of professional eyes to review your reports.  All these concerns are quite natural and common - especially when it comes to pursuing such a major commitment as cancer care.  We all want to gather all the information we can from trusted sources to build an intelligent direction that gives us complete confidence and peace of mind.  

To seek a SECOND OPINION is a patient's right as a cautious and educated consumer. This measure is also a smart financial coverage encouraged by insurance companies geared to prevent much higher claims from costly or 'wrongful' procedures.  Whether you're searching for a primary care physician or a specialist, shopping for any doctor can be quite a challenge. Ingredients for finding a professional that you can trust with your life rely heaviest on their reputation, expertise and qualifications found under smart research methods.  

REFERRALS: Though medical professionals are now participating in the commercial world of marketing (such as broadcast and podcast commercials, youtube videos, social media promotion and public relations campaigns), the largest and most popular method of deciding on a doctor is still word of mouth. At least starting with a recommendation from a friend, colleague or family member, getting positive feedback about a practitioner through others' experience is a great place to begin.

(See complete article)


MEDTECH REVIEW: SUPPLEMENTAL IMAGING FOR BREAST CANCER SCREENING

The current standard in screening for breast cancer is mammography. However, this imaging tool  may miss some breast tumors, especially in women with dense breasts. Published data suggests that sonography can play an important role in detecting tumors that mammography misses. In fact, over 94% of cancers seen only on ultrasound were invasive tumors with average size of 10 mm, and in the studies where staging was detailed, 91% were node negative, meaning it had not spread and complete cure was possible due to early detection. 

Power Doppler Sonography adds increased accuracy to breast imaging evaluation over ordinary ultrasound because it shows higher blood flow speeds, often a sign of cancerous activity in the breast. Studies have shown that suspicious blood flow identified by pre-surgery Power Doppler scans corresponds very well with the size, location and aggression of actual tumors that are then surgically removed. Thus, Power Doppler brings an important clinical dimension to breast cancer detection. 3D sonography clearly shows tumor margins and 3D Doppler affords an index of cancer aggression and metastatic potential.  

Breast Sonograms and Ultrasound offers the following advantages:

• Highest accuracy in dense (lumpy, cystic) breasts

• Non-invasive-no radiation exposure

• Cost effective

• Can distinguish cysts (fluid-filled masses) from cancerous tumors without needle sampling

• Ease of image guidance for breast biopsy

Women who should consider ultrasound scanning of the breast include those at risk of breast cancer because of personal or family history and the presence of fibrocystic (dense) breast tissue which increases cancer risk by as much as 400%. (See complete program- LINK)



WHY CANCER COMES BACK  (Source: NIH- National Cancer Institute)
 When cancer comes back after treatment, doctors call it a recurrence-  or recurrent cancer. Finding out that cancer has come back can cause feelings of shock, anger, sadness, and fear. But you have something now that you didn’t have before—experience. You’ve lived through cancer already and you know what to expect. Also, remember that treatments may have improved since you were first diagnosed. New drugs or methods may help with your treatment or in managing side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can manage for many years.

Recurrent cancer starts with cancer cells that the first treatment didn’t fully remove or destroy. This doesn’t mean that the treatment you received was wrong. It just means that a small number of cancer cells survived the treatment and were too small to show up in follow-up tests. Over time, these cells grew into tumors or cancer that your doctor can now detect.





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