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Anxiety

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Sweet Pea

Welcome to the 34th edition of Paw Prints, a monthly column for animal lovers dedicated to helping shelter pets find their furever home.

Sweet Pea

Meet Sweet Pea

This adorable four-month-old calico kitten at Kent Animal Shelter in Calverton is looking for her forever home. Rescued and ready to share her love, she’s playful and full of personality. If you’re ready to add a furry friend to your family, consider adopting Sweet Pea! Drop by the shelter to meet her today! 631-727-5731

Romeo

Meet Romeo

This star-crossed lover is Romeo, a ten year old Poodle mix up for adoption at Little Shelter in Huntington. Ready to pledge his loyalty and devotion, he’s outspoken about his feelings, declaring he’s ready to find his soulmate. Full of life, he enjoys walks, harmless kennel gossip, and, of course, treats! With a decade of experience under his collar, he knows the value of friendships and promises to always be a true blue companion. Warm and cuddly, he’s the perfect one to have next to your side on classic movie night or while trying to make sense of Shakespeare. Romeo, Romeo, wherefore art thou Romeo? You’ll find this handsome fellow at Little Shelter Animal Rescue and Adoption Center! 631-368-8770

Cinnamon and Cider

Meet Cinnamon and Cider!

These two 10-month-old purebred Olde English Bulldogs are as sweet as pumpkin pie! They were living outside and were absolutely filthy when they arrived at Save-A-Pet in Port Jefferson Station and immediately were bathed. They were just spayed and completely vetted and are now available for adoption. Super gentle, big girls, Cider (on the left) is black and white while Cinnamon brindle and white. Come meet these precious sisters today! 631-473-6333

Dobby

Meet Dobby

Say hello to Dobby, a lovable Great Dane mix at Brookhaven Animal Shelter who’s around 5 years old and ready to find his forever home. With his impressive size and those delightfully floppy ears, Dobby is the ultimate goofball who’s sure to bring a smile to your face! Dobby came to the shelter as a stray, and now he’s eager to settle into a home where he can be the center of attention. This sweet boy is looking for a place where he can be the only pet—no other animals or kids—so he can soak up all the love and affection you have to offer. He loves playing with tennis balls and stuffed toys and adores belly rubs and he’s always eager for some affection from his people. He’s up to date on all his vaccines, heartworm testing, and has been neutered, so he’s all set to start his new life with you. 631-451-6955

Anxiety and Ennui

Meet Ennui and Anxiety

These adorable kittens having been waiting to be adopted at the Smithtown Animal Shelter since June. Big fans of the movie Inside/Out, the shelter staff has named them Ennui and Anxiety. At 7 months old, this playful brother and sister pair just need time to trust people. They are bonded and the shelter staff would like to see them adopted together if possible. If you are interested in meeting these two cuties, please call ahead to schedule an hour to properly interact with them in the Meet and Greet Room. 631-360-7575

BARKTOBERFEST CELEBRATION

From Oct. 27 to 31, the Town of Brookhaven Animal Shelter, 300 Horseblock Road, Brookhaven offers free adoptions for all dogs and cats from Oct. 27 to 31 which includes neuter or spay, vaccinations, microchip, and license. 

Rescue is a lifestyle. Adopt, don’t shop.

Check out the next Paw Prints in the issue of November 14.

Paw Prints is generously sponsored by Mark T. Freeley, Esq.

 

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METRO photo

By Leah S. Dunaief

Leah Dunaief

We seem to be living at a higher level of anxiety. Maybe not all of us. Somewhere there might be one or two souls who are still calmly oblivious to the world around us. Those are the ones who have turned off their televisions and radios, who don’t read newspapers and have put away their cellphones. But from conversations I have had, that’s not the rest of us. The rest of us are quietly, or not so quietly concerned.

What’s wrong? Let’s make a list. Better yet, let’s not. Instead, let’s think about how to cope.

One way to start is to divide what troubles us into two lists: those we can do something about and those we cannot. Then concentrate on the former. When confronted with hate, we can respond with kindness. We can listen rather than scream. We can do our tiny bit to help make our neighborhood a better place.

A psychotherapist I was interviewing recently told me she instructs her anxious clients to concentrate on their breathing, taking deep breaths for ten minutes to calm the body. The usual trio of eating, sleeping and exercising properly are critically important to maintain. Meditation, and even aromatherapy may also help. 

Specifically:

Exercise regularly. It’s good for both body and mind. One recent study revealed that “people with physically active lifestyles had about 60 percent lower risk of developing anxiety disorders,” according to healthline. This study was done over 21 years and followed 400,000 participants.

How does exercise work? For one, it provides a distraction from whatever is worrying. Also, getting the heart rate up changes brain chemistry, encouraging the secretion of anti-anxiety brain messengers like serotonin and gamma-aminobutyric acid (GABA). According to the American Psychological Association, “regular exercise leads to an enhancement of concentration and willpower, which can help certain anxiety symptoms.” 

Plus you feel good, especially when you stop. Walking is the simplest and perhaps most enjoyable way to exercise, particularly at this time of year, when it is not too hot nor too cold, and the changing colors of the foliage are a delight.

Eating a balanced diet, and eating it calmly, is important. Low blood sugar levels, dehydration and chemicals in processed foods, such as artificial flavorings, artificial coloring and preservatives can cause mood changes. A high-sugar diet can also have a negative reaction. So what should we eat? Fruits and vegetables, especially those leafy dark green ones rather than those high in starch, are ideal. After that, complex carbohydrates and beans, are a good source of nutrition. I happen to like fish, the white fleshy kind like sea bass, rather than lean meat, for animal protein. But remember, there is plenty of protein in veggies and beans.

Sleep is so important. A good night’s sleep leaves me feeling as if, the next day, I could “leap tall buildings at a single bound,” to borrow from the Superman tagline. Ah, but how to get a good night’s sleep? I am a good sleeper, and I will tell you what I do—most of the time.

I don’t watch television or use my computer or cellphone before going to bed. Something about that blue light wakes me up. I don’t even have those in my bedroom. I will sometimes read a bit, but not a page turner. My room is the coolest in the house, and I will frequently have the window open, even a tiny bit, in winter. I know that going to bed the same time each night is recommended, though I don’t always follow that advice. Also no alcohol before bedtime is also advised. It helps put me to sleep but I will be wide awake when the alcohol wears off in the middle of the night. And, I invested in a comfy down comforter years ago that, with its plushness, invites me into bed.

Better not to nap during the day, and that leaves me sufficiently tired by bedtime, especially if I have exercised. At least, it should. If it doesn’t, I will empty my thoughts onto a list, put the pad on the bedside table, then doze off.

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Left, Dr. Daniel Jamorabo, gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. Right, Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. Left by Stony Brook Medicine/Jeanne Neville; right from Northwell Health

No one rushes to make a reservation at a pre-colonoscopy restaurant with a cleansing and well-reviewed special of the day. 

In fact, for most people, the preparation for a potentially lifesaving diagnostic procedure is somewhere between unpleasant and unpalatable.

That, however, may have changed as the U.S. Food and Drug Administration recently approved another incremental improvement in the colonoscopy preparation that could make the preparation and the procedure — which can detect early signs of cancer — less bothersome.

Manufactured by Sebela Pharmaceuticals, Suflave is a low-volume preparation that tastes like a lemon-lime sports drink. It should be available in August.

“Patients really like” Suflave, with about 80 percent finding it palatable, said Dr. Daniel Jamorabo, a gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. 

Jamorabo called it a “wonderful addition to the bowel preparations that are out there.”

Jamorabo said the ingredients in most preparations are the same: the difference in the Suflave preparation seems connected to the flavor.

The thinking in the gastrointestinal community is that “we need to find a preparation” that is more pleasant, said Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. “That will capture more people who are somewhat reluctant to have a colonoscopy.”

Colonoscopies are a “necessary screening procedure,” Purow added, and health care professionals in the field don’t want the discomfort during preparation to discourage people from getting the procedure.

Indeed, doctors have a much higher success rate with patients when they detect evidence of colon cancer early.

Getting it right

Doctors suggested that the success of preparing for a colonoscopy varies.

Jamorabo estimated that around 10% of patients may not take all the steps necessary to have the screening.

In those circumstances, these patients have to reschedule the procedure and go through drinking fluids that clear out their systems more effectively.

Gastroenterologists urged people to ask questions if they don’t understand any of the steps they need to take to prepare.

For some patients, the COVID-19 pandemic delayed their routine colonoscopy visits, as people stayed away from hospitals and medical care facilities during periods of highest viral infection.

Jamorabo added that colon cancers have started to show up in younger people.

In 2018, the American Cancer Society recommended lowering the age for screenings from 50 to 45.

“It’s showing up more” in people under 50, said Jamorabo. “It may even go lower.”

Doctors discovered stage three colon cancer in late actor Chadwick Boseman before he was 40.

“We don’t know yet” why it’s causing cancer in younger people, Jamorabo added, but “it’s not rare. It’s been going on for a couple of years. We can’t write it off as some statistical anomaly.”

Early symptoms

People can and should be on the lookout for symptoms that might indicate colon cancer.

Unintentional weight loss, such as losing 10 pounds or more in three to four months without changing diet or exercise regimen, could indicate a problem.

Blood in the stool, changes in bowel habits and ongoing constipation could also require medical attention.

More subtle signs, such as fatigue, shortness of breath or decreased appetite, could indicate that people are losing blood in their stool.

As for the overlap between COVID and colon cancer, Jamorabo believes that the ongoing inflammation from the SARS-CoV2 virus could predispose people to cancer.

“I don’t think enough time has elapsed” to know if there’s a link between the virus and colon cancer, he added.

With anxiety building over big-picture issues like global warming and an intensely divided population, people are likely increasingly worried about the state of the world.

“Most gastroenterologists are probably busier than they’ve ever been,” Purow said. “Some of that is probably due to the times in which we are living.”

Stress and anxiety can cause gastrointestinal symptoms that manifest in different ways.

Even with less concern about the pandemic, doctors are still seeing more people with alcoholic liver disease, as some turned to alcohol to relieve their ongoing anxiety.

“We’re trying to expand our network of dietitians and mental health professionals that we’re working with,” said Purow.

Information is power

An important tool in preventing colon cancer involves tracking the colon’s health through colonoscopies.

Having Suflave on the market could “lower the dread” of having a colonoscopy, Jamorabo noted. “We need to make the logistics of the preparation easier.”

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By David Dunaief

Now that spring has sprung, the pace of life tends become more hectic. Although some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.
It is very likely that there is a mind-body connection when it comes to stress. In other words, it may start in the mind, but it can lead to acute or chronic disease promotion. Stress can also play a role with your emotions, causing irritability and outbursts of anger, and possibly leading to depression and anxiety. Stress symptoms are hard to distinguish from other disorders but can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold and with cognitive decline and Alzheimer’s (1).
A stress steroid hormone called cortisol is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of cortisol’s functions include raising the glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as recent research suggests. Let’s look at the evidence.

Inflammation
Inflammation may be a significant contributor to more than 80 percent of chronic diseases, so it should be no surprise that inflammation is an important factor with stress. In a recent meta-analysis (a group of two observational studies), high levels of C-reactive protein, a biomarker for inflammation, were associated with increased psychological stress (3).
What is the importance of CRP? It may be related to heart disease and heart attacks. This study involved over 73,000 adults who had their CRP levels tested. The research went further to suggest that increased levels of CRP may result in more stress and also depression. With CRP higher than 3.0 there was a greater than twofold increase depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of different proinflammatory cytokines, inflammatory communicators among cells (4).
In one recent study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop of all forms of blood cells), resulting in specifically an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.

Infection
Stress may increase the risk of colds and infection. Cortisol over the short term is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin. In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).

Cortisol
When we measure cortisol levels, we tend to test the saliva or the blood. However, these laboratory findings only give one point in time. Thus, when trying to determine if raised cortisol may increase cardiovascular risk, the results are mixed. However, in a recent study, measuring cortisol levels from scalp hair was far more effective (7). The reason for this is that scalp hair grows slowly, and therefore it may contain three months’ worth of cortisol levels. The study showed that those in the highest quartile of cortisol levels were at a three-times increased risk of developing diabetes and/or heart disease compared to those in the lowest quartile. This study involved older patients between the ages of 65 and 85.

Lifestyle and the Cellular Level
Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives. In a recent study, those women who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (8).
This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group. The study followed women 50 to 65 years old over a one-year period.
In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (9). The high-stress group was caregivers, specifically those caring for a spouse or parent with dementia. Thus, it is especially important to eat a healthy diet when under stress.
Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort study shows that those who deal with stressful events directly are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors to address stress all resulted in insomnia after being followed for one year (10). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.
Psychologists and other health care providers sometimes suggest distraction from a stressful event, such as television watching or other activities, according to the researchers. However, this study suggests that this may not help avert chronic insomnia induced by a stressful event. The most important message from this study is that how a person reacts and deals with a stressors may determine whether they suffer from insomnia.

Constant stress is something that needs to be recognized. If not addressed, it can lead to suppressed immune response or increased levels of inflammation. CRP is an example of an inflammatory biomarker that may actually increase stress. In order to address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. A good lifestyle may be protective against cell aging when exposed to stressors.

References:
(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) J Clin Endocrinol Metab. 2013;98:2078-2083. (8) Mol Psychiatry Online. 2014 July 29. (9) Psychoneuroendocrinol Online. 2014 April 12. (10) Sleep. 2014;37:1199-1208.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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