Tagged Love

Turning Your Pet Into a Therapy Dog

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Credit Paul Rogers

It did not take long for me to recognize the therapeutic potential of Max, the hypoallergenic 5-month-old Havanese puppy I adopted in March 2014. He neither barked nor growled and seemed to like everyone, especially the many children that come up and down our block.

When I asked if a crying child passing by would like to pet a puppy, the tears nearly always stopped as fluffy little Max approached, ready to be caressed.

So I signed us up for therapy dog training with the Good Dog Foundation, which met conveniently in my neighborhood. If we passed the six-week course, we would be certified to visit patients in hospitals and nursing homes, children in schools, and people in other venues that recognize the therapeutic potential of well-behaved animals.

Training involves a joint effort of dog and owner, usually in groups of four to eight pairs. The dog can be any size, any breed, but must be housebroken; nonaggressive; not fearful of strangers, loud or strange noises, wheelchairs or elevators, and able to learn basic commands like sit, lie down and leave it. Good temperament is critical; a dog that barks incessantly, nips or jumps on people uninvited would hardly be therapeutic.

During our first visit to patients at my local hospital, a woman who said she’d had a “terrible morning” invited Max onto her bed, showered him with affection and, crying with pleasure, thanked me profusely for bringing him around to cheer her up.

Moments later, on the pediatrics ward, a preverbal toddler hospitalized with croup spotted Max and came charging down the hall squealing with delight. The two met eye-to-eye; Max even appeared to smile, and she giggled as she patted his head.

I don’t know about Max, but I was hooked. I agreed to bring him for monthly patient visits, with a promise to do more if my schedule permitted, and I was able to do the required pre-visit bath.

A therapy dog need not be small and fluffy. A neighbor with a “mush” of a 90-pound American pit bull named Pootie has had similar experiences at the Veterans Affairs New York Harbor Healthcare System’s Brooklyn campus. During the first visit, one patient told him repeatedly, “You made my day.”

But while a hospital’s voluntary pet therapy program is designed to aid patients, in my experience the chronically-stressed hospital staff benefits as much if not more from pet visits. “Can I pick him up?” is the typical request from hospital personnel I encounter, and some don’t even wait for me to say yes.

Therapy pets differ from service animals like those that guide the blind, detect impending health crises for people with epilepsy or diabetes, or stimulate learning for children with autism or cerebral palsy.

Pet therapy most often involves privately owned animals – usually dogs, but also cats, rabbits, even kangaroos, birds, fish and reptiles – that their owners take to facilities to enhance the well-being of temporary or permanent residents. Thus, in addition to relieving the monotony of a hospital stay or entertaining residents in a nursing home, Max might visit a school where young children wary of reading aloud will happily read to a dog that does not care about mistakes.

At my local hospital, therapy dogs often attend group sessions for psychiatry patients. Cynthia Chandler, a counseling professor at the University of North Texas and author of “Animal Assisted Therapy in Counseling,” reports that visits by her dog Bailey increased patient participation in group therapy and improved hygiene and self-care among those with severe mental illness.

At Veterans Affairs hospitals, not only therapy dogs but also parrots have reduced anxiety and other symptoms among patients being treated for post-traumatic stress disorder.

Valerie Abel, a psychologist who coordinates the pet therapy program at the Brooklyn Veterans Affairs hospital, said, “The presence of therapy dogs makes such a difference. Many ask when they’ll next be back. A big dog can put its head on patients’ beds and you can actually see them relax.”

Studies have shown that after just 20 minutes with a therapy dog, patients’ levels of stress hormones drop and levels of pain-reducing endorphins rise. Endorphins are the brain’s natural narcotic, the substance responsible for the runner’s high that helps injured athletes ignore pain.

In elderly patients with dementia, depression declines after they interact with a therapy animal. And researchers at the University of Southern Maine showed that therapy dog visits can calm agitation in patients with severe dementia.

In a controlled study of therapy dog visits among patients with heart disease, researchers at the University of California, Los Angeles, found a significant reduction in anxiety levels and blood pressure in the heart and lungs in those who spent 12 minutes with a visiting animal, but no such effect occurred among comparable patients not visited by a dog.

Therapy dogs are often described as better than any medicine. They know instinctively when someone needs loving attention. Last winter, when I was felled by the flu (despite my annual shot), 1-year-old Max lay at the foot of my bed for hours on end, making none of his usual demands for attention and play.

In an intriguing pet therapy program, sometimes called pets behind bars, benefits accrue to both the animals and the humans with whom they interact. Shelter dogs considered unadoptable and living on “death row” are assigned to be cared for and trained by selected prison inmates, including convicted killers and rapists, many of whom have serious anger issues.

The inmates work to socialize the dogs, teaching them to trust people, behave appropriately and obey simple commands. In turn, violence and depression among the inmates is lessened; they learn compassionate behavior, gain a sense of purpose, and experience unconditional love from the dogs in their care.

At the completion of training, rehabilitated dogs are offered to people who want to give a shelter animal a permanent home. Through the Safe Harbor Prison Dog Program at Lansing Correctional Facility in Lansing, Kansas, for example, some 1,200 dogs have been adopted as pets.

In a related program, veterans back from service in Iraq and Afghanistan are giving basic obedience training to shelter dogs, a project that helps the vets readjust to being home and offers the dogs a chance to gain a home of their own.

Before signing up for therapy dog training, you’d be wise to find out first what the program involves and its cost and what will be required of you by the facilities you hope to visit. I’ve had to provide annual documentation of Max’s vaccinations and freedom from intestinal parasites, which typically requires a visit to the vet. I too had to show I was immune to multiple infectious diseases and free of H.I.V., and the hospital had to test me for drug abuse.

Still, the rewards Max and I have accrued as hospital volunteers more than compensate for these requirements.

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Getting Pregnant After a Miscarriage

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Credit Alice Proujansky for The New York Times

A woman who miscarries early in pregnancy is often told to wait at least three months before trying to get pregnant again. But a new study suggests it can be fine to try again as soon as possible.

Researchers studied 998 pregnancies lost at 20 weeks gestation or less. (They included spontaneous losses only and excluded ectopic or molar pregnancies, which are known to require extended care.)

They followed the women for six menstrual cycles after the loss, or until pregnancy outcome for those who became pregnant, recording the time from pregnancy loss to the time of attempting a new conception. The study controlled for the prior number of pregnancy losses, age, B.M.I., smoking, alcohol use and other factors.

Among those who began to try in less than three months, 53.2 percent gave birth successfully, compared with 36.1 percent of those who waited longer. The study, in the February issue of Obstetrics & Gynecology, found no increased risk for pregnancy complications among women who began trying less than three months after a loss.

“Anyone who wants to become pregnant has to be emotionally ready,” said the senior author, Enrique F. Schisterman, an epidemiologist with the National Institutes of Health. “But if you’re emotionally ready, and there are no other complications, there is no physiological reason to wait.”

Support for Breast-Feeding, in a Multitude of Ways

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Credit Paul Rogers

In 2001, when Dr. Alison Stuebe was pregnant with her first child, breast-feeding was a personal challenge that soon morphed into a professional research interest. Her son Noah was 3 months old when she began her residency in maternal-fetal medicine at Brigham and Women’s Hospital in Boston. Determined to nurse him for a year, she arrived at the hospital carrying a breast pump and, through sheer determination, more than met her goal. Noah was 2½ before he was weaned.

In the years since, with two more breast-fed sons, Dr. Stuebe has become a leading expert in the health value of breast-feeding for both mother and baby and a tireless advocate for new mothers trying to navigate its all-too-frequent challenges.

As the leading author of new guidelines from the American College of Obstetricians and Gynecologists, Dr. Stuebe insists that, given timely information, professional and workplace support, and hands-on help when needed, many more women would breast-feed their babies, and do so exclusively for the first half year of life, as recommended by the college, the American Academy of Pediatrics and the World Health Organization.

“Moms deserve better support, and obstetric providers can and must help, both by assisting their patients and by advocating for policies and practices that enable women to achieve their goals,” she said. And, the guidelines maintain, that support should begin as early as the first trimester of pregnancy.

To be sure, much has changed for the better since 1972, when breast-feeding by American women reached its nadir of 24 percent. Just three years prior, when my twin sons were born and a serious postpartum infection kept me in the hospital for 13 days, isolated from them, I had to beg for a breast pump every four hours. My desire to breast-feed was belittled by the nurse in charge: “You can always feed them formula,” she said dismissively as I dissolved in tears.

Today, more than three-fourths of women start to breast-feed, although more than half end up weaning their babies sooner than they would have liked, often short of six months. The target set byHealthy People 2020, a federal initiative to promote good health, would have nearly 82 percent of babies breast-fed initially, 60.6 percent at six months and 34 percent at one year.

Faced with financial and logistical stresses, many new mothers find it challenging to meet such a goal. Working women rarely get more than six weeks of paid maternity leave, and once back at work, the obstacles to expressing and storing breast milk can be daunting.

Accordingly, the new guidelines urge policy changes that “protect the right of a woman and her child to breast-feed,” including “paid maternity leave, on-site child care, break times for expressing milk,” and a place “other than a bathroom” to do so. Two decades ago, a former colleague of mine gave up her dream job after two frustrating months pumping milk in the office lavatory.

“Breast-feeding is optimal and appropriate for most women,” the new guidelines state. However, they add, while advice and encouragement by obstetric professionals are recommended, no woman should be coerced, pressured or unduly influenced to breast-feed.

Among the few medical contraindications to breast-feeding are infections in the mother – H.I.V., untreated tuberculosis, chickenpox or a herpes lesion on the nipple – and mothers being treated with cell-killing cancer drugs. Although clear-cut data are lacking on the effects of marijuana on breast-fed infants, the drug can get into breast milk and the guidelines discourage marijuana use by nursing mothers. Babies with the genetic disorder galactosemia, which impairs digestion of a sugar in milk, should not breast-feed.

During pregnancy, women trying to decide whether to breast-feed deserve to be informed about both its benefits and barriers and be given an opportunity and assistance to find ways around any obstacles, the guidelines state.

Both mother and baby benefit from breast-feeding. Women who breast-feed have a lower than average risk of developing breast cancer, ovarian cancer, diabetes, hypertension and heart disease later in life. Breast-fed infants enjoy greater protection from infections, sudden infant death syndrome and metabolic disease. Babies born prematurely especially benefit from breast milk, which lowers their risk of infections, especially necrotizing enterocolitis, a serious intestinal disease.

Assessing the health of a woman’s breasts and her prior experience with breast-feeding should be part of prenatal care, the guidelines urge. Past or anticipated difficulties and concerns should be discussed, ideally in conjunction with the woman’s partner, and strategies devised to make the desired feeding plan compatible with the needs and values of the woman and her family.

Ultimately, the obstetric guidelines conclude, a well-informed woman is best qualified to decide whether to breast-feed exclusively, combine breast with formula-feeding or feed only formula.

“Physicians should not be dogmatic,” Dr. Stuebe said. “Formula is not poison. Like antibiotics, if it’s needed, it should be used judiciously.”

I created my own plan when I could produce only a quarter of the milk my twins were consuming and faced conflicting advice from the obstetrician and pediatrician. I chose to combine the advice, first offering each baby the breast, then topping it off with formula. When I finally began producing enough milk, they all but gave up the bottle.

As in the past, the new guidelines disparage an all-too-common practice of outfitting new mothers at discharge with a “gift bag” that contains samples of formula, which can suggest that the hospital endorses formula feeding. Direct-to-consumer marketing of infant formula is also disparaged.

But even the most determined breast-feeder can sometimes have difficulty at first establishing successful nursing. Such women face an increased risk of developing postpartum depression “and should be screened, treated and referred appropriately,” the guidelines note.

Accordingly, there is now a growing legion of professional lactation specialists who can help. Some hospitals have them on staff. More good news: The services of a certified lactation consultant or counselor are now covered as preventive care under the Affordable Care Act.

A lactation specialist may also be helpful to women who stop nursing before they want to because of problems with pain, low milk supply or difficulty getting the infant to latch on to the breast.

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Post-Cesarean Bacteria Transfer Could Change Health for Life, Study Shows

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Credit iStock

The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section.

The small proof-of-principle study suggests a new way to inoculate babies, said Dr. Maria Gloria Dominguez-Bello, an associate professor of medicine at New York University and lead author of the report, published on Monday in Nature Medicine.

“The study is extremely important,” said Dr. Jack Gilbert, a microbial ecologist at Argonne National Laboratory who did not take part in the work. “Just understanding that it’s possible is exciting.”

But it will take further studies following C-section babies for many years to know to what degree, if any, the method protects them from immune and metabolic problems, he said.

Some epidemiological studies have suggested that C-section babies may have an elevated risk for developing immune and metabolic disorders, including Type 1 diabetes, allergies, asthma and obesity.

Scientists have theorized that these children may be missing key bacteria known to play a large role in shaping the immune system from the moment of birth onward. To replace these microbes, some parents have turned to a novel procedure called vaginal microbial transfer.

A mother’s vaginal fluids — loaded with one such essential bacterium, lactobacillus, that helps digest human milk — are collected before surgery and swabbed all over the infant a minute or two after birth.

An infant’s first exposure to microbes may educate the early immune system to recognize friend from foe, Dr. Dominguez-Bello said.

Friendly bacteria, like lactobacilli, are tolerated as being like oneself. Those from hospital ventilation vents or the like may be perceived as enemies and be attacked.

These early microbial interactions may help set up an immune system that recognizes “self” from “non-self” for the rest of a person’s life, Dr. Dominguez-Bello said.

In the United States, about one in three babies are delivered by C-section, a rate that has risen dramatically in recent decades. Some hospitals perform the surgery on nearly seven in ten women delivering babies.

An ideal C-section rate for low-risk births should be no more than 15 percent, according to the World Health Organization.

Dr. Dominguez-Bello’s study involved 18 babies born at the University of Puerto Rico hospital in San Juan, where she recently worked. Seven were born vaginally and 11 by elective C-section. Of the latter, four were swabbed with the mother’s vaginal microbes and seven were not.

Microbes were collected on a folded sterile piece of gauze that was dipped in a saline solution and inserted into each mother’s vagina for one hour before surgery. As the operations began, the gauze was pulled out and placed in a sterile collector.

One to two minutes after the babies were delivered and put under a neonatal lamp, researchers swabbed each infant’s lips, face, chest, arms, legs, back, genitals and anal region with the damp gauze. The procedure took 15 seconds.

Dr. Dominguez-Bello and her colleagues then tracked the composition of microbes by taking more than 1,500 oral, skin and anal samples from the newborns, as well as vaginal samples from the mothers, over the first month after birth.

For the first few days, ambient skin bacteria from the delivery room predominated in the mouths and on the skin of C-section babies who were not swabbed, Dr. Dominguez-Bello said.

But in terms of their bacterial colonies, the infants swabbed with the microbes closely resembled vaginally delivered babies, she found, especially in the first week of life. They were all covered with lactobacilli.

Gut bacteria in both C-section groups, however, were less abundant than that found in the vaginally delivered babies.

Anal samples from the swabbed group, oddly, contained the highest abundance of bacteria usually found in the mouth.

The results show the complexity of labor, said Dr. Alexander Khoruts, a microbial expert and associate professor of medicine at the University of Minnesota. “It cannot be simplified to a neat, effortless passage of the infant through the birth canal,” he said.

As the month progressed, the oral and skin microbes of all infants began to resemble normal adult patterns, Dr. Dominguez-Bello said. But fecal bacteria did not, probably because of breast or formula feeding and the absence of solid foods.

The transfer fell short of full vaginal birth-like colonization for two reasons, Dr. Dominguez-Bello said. Compared to infants who spent time squeezed inside the birth canal, those who were swabbed got less exposure to their mother’s microbes.

And all infants delivered by C-section were exposed to antibiotics, which also may have reduced the number and variety of bacteria colonizing them.

A larger study of vaginal microbial transfer is underway at N.Y.U., Dr. Dominguez-Bello said. Eighty-four mothers have participated so far.

Infants delivered both by C-section and vaginally will be followed for one year to look for differences in the treated and untreated groups and to look for complications. Thus far the swabbing has proved entirely safe.

The procedure is not yet recommended by professional medical societies, said Dr. Sara Brubaker, a specialist in maternal and fetal medicine at N.Y.U. Until more is known, physicians are hesitant to participate.

“But it has hit the lay press,” she said. “Patients come in and ask for it. They are doing it themselves.”

Dr. Brubaker is one of them. When her daughter was born three-and-half months ago, she arranged to have her baby swabbed.

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