Dogs Paired With Providers at Hospitals Help Ease Staff and Patient Stress
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DENVER — Outside HCA HealthONE Rose medical center, the snow is flying. Inside, on the third floor, there’s a flurry of activity within the labor and delivery unit.
“There’s a lot of action up here. It can be very stressful at times,” said Kristina Fraser, an OB-GYN in blue scrubs.
Nurses wheel a very pregnant mom past.
“We’re going to bring a baby into this world safely,” Fraser said, “and off we go.”
She said she feels ready in part due to a calming moment she had just a few minutes earlier with some canine colleagues.
A pair of dogs, tails wagging, had come by a nearby nursing station, causing about a dozen medical professionals to melt into a collective puddle of affection. A yellow Lab named Peppi showered Fraser in nuzzles and kisses. “I don’t know if a human baby smells as good as that puppy breath!” Fraser had said as her colleagues laughed.
The dogs aren’t visitors. They work here, too, specifically for the benefit of the staff. “I feel like that dog just walks on and everybody takes a big deep breath and gets down on the ground and has a few moments of just decompressing,” Fraser said. “It’s great. It’s amazing.”
Hospital staffers who work with the dogs say there is virtually no bite risk with the carefully trained Labradors, the preferred breed for this work.
The dogs are kept away from allergic patients and washed regularly to prevent germs from spreading, and people must wash their hands before and after petting them.
Doctors and nurses are facing a growing mental health crisis driven by their experiences at work. They and other health care colleagues face high rates of depression, anxiety, stress, suicidal ideation, and burnout. Nearly half of health workers reported often feeling burned out in 2022, an increase from 2018, according to the Centers for Disease Control and Prevention. And the percentage of health care workers who reported harassment at work more than doubled over that four-year period. Advocates for the presence of dogs in hospitals see the animals as one thing that can help.
That includes Peppi’s handler, Susan Ryan, an emergency medicine physician at Rose.
Ryan said years working as an emergency room doctor left her with symptoms of PTSD. “I just was messed up and I knew it,” said Ryan, who isolated more at home and didn’t want to engage with friends. “I shoved it all in. I think we all do.”
She said doctors and other providers can be good at hiding their struggles, because they have to compartmentalize. “How else can I go from a patient who had a cardiac arrest, deal with the family members telling them that, and go to a room where another person is mad that they’ve had to wait 45 minutes for their ear pain? And I have to flip that switch.”
To cope with her symptoms of post-traumatic stress disorder, Ryan started doing therapy with horses. But she couldn’t have a horse in her backyard, so she got a Labrador.
Ryan received training from a national service dog group called Canine Companions, becoming the first doctor trained by the group to have a facility dog in an emergency room. Canine Companions has graduated more than 8,000 service dogs.
The Rose medical center gave Ryan approval to bring a dog to work during her ER shifts. Ryan’s colleagues said they are delighted that a dog is part of their work life.
“When I have a bad day at work and I come to Rose and Peppi is here, my day’s going to be made better,” EMT Jasmine Richardson said. “And if I have a patient who’s having a tough day, Peppi just knows how to light up the room.”
Nursing supervisor Eric Vaillancourt agreed, calling Peppi “joyful.”
Ryan had another dog, Wynn, working with her during the height of the pandemic. She said she thinks Wynn made a huge difference. “It saved people,” she said. “We had new nurses that had never seen death before, and now they’re seeing a covid death. And we were worried sick we were dying.”
She said her hospital system has lost a couple of physicians to suicide in the past two years, which HCA confirmed to KFF Health News and NPR. Ryan hopes the canine connection can help with trauma. “Anything that brings you back to the present time helps ground you again. A dog can be that calming influence,” she said. “You can get down on the ground, pet them, and you just get calm.”
Ryan said research has shown the advantages. For example, one review of dozens of original studies on human-animal interactions found benefits for a variety of conditions including behavioral and mood issues and physical symptoms of stress.
Rose’s president and CEO, Casey Guber, became such a believer in the canine connection he got his own trained dog to bring to the hospital, a black Lab-retriever mix named Ralphie.
She wears a badge: Chief Dog Officer.
Guber said she’s a big morale booster. “Phenomenal,” he said. “It is not uncommon to see a surgeon coming down to our administration office and rolling on the ground with Ralphie, or one of our nurses taking Ralphie out for a walk in the park.”
This article is from a partnership that includes CPR News, NPR, and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Horse Sedative Use Among Humans Spreads in Deadly Mixture of ‘Tranq’ and Fentanyl
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TREASURE ISLAND, Fla. — Andrew McClave Jr. loved to lift weights. The 6-foot-4-inch bartender resembled a bodybuilder and once posed for a photo flexing his muscles with former pro wrestler Hulk Hogan.
“He was extremely dedicated to it,” said his father, Andrew McClave Sr., “to the point where it was almost like he missed his medication if he didn’t go.”
But the hobby took its toll. According to a police report, a friend told the Treasure Island Police Department that McClave, 36, suffered from back problems and took unprescribed pills to reduce the pain.
In late 2022, the friend discovered McClave in bed. He had no pulse. A medical examiner determined he had a fatal amount of fentanyl, cocaine, and xylazine, a veterinary tranquilizer used to sedate horses, in his system, an autopsy report said. Heart disease was listed as a contributing factor.
McClave is among more than 260 people across Florida who died in one year from accidental overdoses involving xylazine, according to a Tampa Bay Times analysis of medical examiner data from 2022, the first year state officials began tracking the substance. Numbers for 2023 haven’t been published.
The death toll reflects xylazine’s spread into the nation’s illicit drug supply. Federal regulators approved the tranquilizer for animals in the early 1970s and it’s used to sedate horses for procedures like oral exams and colic treatment, said Todd Holbrook, an equine medicine specialist at the University of Florida. Reports of people using xylazine emerged in Philadelphia, then the drug spread south and west.
What’s not clear is exactly what role the sedative plays in overdose deaths, because the Florida data shows no one fatally overdosed on xylazine alone. The painkiller fentanyl was partly to blame in all but two cases in which the veterinary drug was included as a cause of death, according to the Times analysis. Cocaine or alcohol played roles in the cases in which fentanyl was not involved.
Fentanyl is generally the “800-pound gorilla,” according to Lewis Nelson, chair of the emergency medicine department at Rutgers New Jersey Medical School, and xylazine may increase the risk of overdose, though not substantially.
But xylazine appears to complicate the response to opioid overdoses when they do happen and makes it harder to save people. Xylazine can slow breathing to dangerous levels, according to federal health officials, and it doesn’t respond to the overdose reversal drug naloxone, often known by the brand name Narcan. Part of the problem is that many people may not know they are taking the horse tranquilizer when they use other drugs, so they aren’t aware of the additional risks.
Lawmakers in Tallahassee made xylazine a Schedule 1 drug like heroin or ecstasy in 2016, and several other states including Pennsylvania, Ohio, and West Virginia have taken action to classify it as a scheduled substance, too. But it’s not prohibited at the federal level. Legislation pending in Congress would criminalize illicit xylazine use nationwide.
The White House in April designated the combination of fentanyl and xylazine, often called “tranq dope,” as an emerging drug threat. A study of 20 states and Washington, D.C., found that overdose deaths attributed to both illicit fentanyl and xylazine exploded from January 2019 to June 2022, jumping from 12 a month to 188.
“We really need to continue to be proactive,” said Amanda Bonham-Lovett, program director of a syringe exchange in St. Petersburg, “and not wait until this is a bigger issue.”
‘A Good Business Model’
There are few definitive answers about why xylazine use has spread — and its impact on people who consume it.
The U.S. Drug Enforcement Administration in September said the tranquilizer is entering the country in several ways, including from China and in fentanyl brought across the southwestern border. The Florida attorney general’s office is prosecuting an Orange County drug trafficking case that involves xylazine from a New Jersey supplier.
Bonham-Lovett, who runs IDEA Exchange Pinellas, the county’s anonymous needle exchange, said some local residents who use drugs are not seeking out xylazine — and don’t know they’re consuming it.
One theory is that dealers are mixing xylazine into fentanyl because it’s cheap and also affects the brain, Nelson said.
“It’s conceivable that if you add a psychoactive agent to the fentanyl, you can put less fentanyl in and still get the same kick,” he said. “It’s a good business model.”
In Florida, men accounted for three-quarters of fatal overdoses involving xylazine, according to the Times analysis. Almost 80% of those who died were white. The median age was 42.
Counties on Florida’s eastern coast saw the highest death tolls. Duval County topped the list with 46 overdoses. Tampa Bay recorded 19 fatalities.
Cocaine was also a cause in more than 80 cases, including McClave’s, the Times found. The DEA in 2018 warned of cocaine laced with fentanyl in Florida.
In McClave’s case, Treasure Island police found what appeared to be marijuana and a small plastic bag with white residue in his room, according to a police report. His family still questions how he took the powerful drugs and is grappling with his death.
He was an avid fisherman, catching snook and grouper in the Gulf of Mexico, said his sister, Ashley McClave. He dreamed of being a charter boat captain.
“I feel like I’ve lost everything,” his sister said. “My son won’t be able to learn how to fish from his uncle.”
Mysterious Wounds
Another vexing challenge for health officials is the link between chronic xylazine use and open wounds.
The wounds are showing up across Tampa Bay, needle exchange leaders said. The telltale sign is blackened, crusty tissue, Bonham-Lovett said. Though the injuries may start small — the size of a dime — they can grow and “take over someone’s whole limb,” she said.
Even those who snort fentanyl, instead of injecting it, can develop them. The phenomenon is unexplained, Nelson said, and is not seen in animals.
IDEA Exchange Pinellas has recorded at least 10 cases since opening last February, Bonham-Lovett said, and has a successful treatment plan. Staffers wash the wounds with soap and water, then dress them.
One person required hospitalization partly due to xylazine’s effects, Bonham-Lovett said. A 31-year-old St. Petersburg woman, who asked not to be named due to concerns over her safety and the stigma of drug use, said she was admitted to St. Anthony’s Hospital in 2023. The woman, who said she uses fentanyl daily, had a years-long staph infection resistant to some antibiotics, and a wound recently spread across half her thigh.
The woman hadn’t heard of xylazine until IDEA Exchange Pinellas told her about the drug. She’s thankful she found out in time to get care.
“I probably would have lost my leg,” she said.
This article was produced in partnership with the Tampa Bay Times.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Undoing Creatine’s Puffiness Side Effect
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Creatine is known to increase “puffiness”, especially in my face. Are there any supplements that do the opposite?!❞
So first, let’s examine why this happens: creatine is most often taken to boost muscle size and performance. Your muscles are, of course, mostly water by mass, and so building your muscles requires extra water, which triggers systemic water retention.
In other words: you take creatine, exercise, and as the muscles start growing, the body goes “oh heck, we are running out of water, better save as much as possible in order to keep hydrating the muscles without running out” and starts putting it anywhere it can that’s not your bladder, so this will largely be the soft tissues of your body.
So, this results in classic water retentions symptoms including bloating and, yes, facial puffiness.
How much this happens, and how long the effects last, depend on three main things:
- What daily dose of creatine you are taking
- What kind of exercise you are doing
- What your hydration is like
The dose is relevant as it’s most common to get this puffiness during the “loading” phase, i.e. if you’re taking an increased dose to start with.
The exercise is relevant as it affects how much your body is actually using the water to build muscles.
The hydration is relevant because the less water you are taking, the more the body will try to retain whatever you do have.
This means, of course, that the supplement you are looking for to undo the facial puffiness is, in fact, water (even, nay, especially, if you feel bloated too):
Water For Everything? Water’s Counterintuitive Properties
Additionally, you could scale back the dose of creatine you’re taking, if you’re not currently doing heavy muscle-building exercise.
That said, the recommended dose for cognitive benefits is 5g/day, which is a very standard main-phase (i.e., post-loading) bodybuilding dose, so do with that information what you will.
See also: Creatine’s Brain Benefits Increase With Age
On which note: whether or not you want to take creatine for brain benefits, however, may depend on your age:
Creatine: Very Different For Young & Old People
Most research on creatine’s effects on humans has usually been either collegiate athletes or seniors, which leaves quite a research gap in the middle—so it’s unclear at what age the muscle-building effects begin to taper off, and at what age the cognitive benefits begin to take off.
Want a quicker fix?
If you want to reduce your facial puffiness acutely (e.g., you have a date in an hour and would like to not have a puffy face), then there are two things you can do that will help immediately, and/but only have short-term effects, meaning you’d have to do them daily to enjoy the results every day:
The first is an ice bath; simply fill a large bowl with water and ice cubes, give it a couple of minutes to get down to temperature, hold your breath and plunge your face in for as long as you can comfortably hold your breath. Repeat a few times, and towel off.
This helps by waking up the vasculature in your face, helping it to reduce puffiness naturally.
The second is facial yoga or guā shā, which is the practice of physically manipulating the soft tissues of your face to put them where you want them, rather than where you don’t want them. This will work against water retention puffiness, as well as cortisol puffiness, lymphatic puffiness, and more:
7-Minute Face Fitness For Lymphatic Drainage & Youthful Jawline
Enjoy!
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Sugar, Hazelnuts, Books & Brains
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It’s Q&A Day!
Each Thursday, we respond to subscriber questions and requests! If it’s something small, we’ll answer it directly; if it’s something bigger, we’ll do a main feature in a follow-up day instead!
So, no question/request to big or small; they’ll just get sorted accordingly
Remember, you can always hit reply to any of our emails, or use the handy feedback widget at the bottom. We always look forward to hearing from you!
Q: Interesting info, however, I drink hazelnut milk LOL so would have liked a review of that. But now I want to give hemp and pea milks a try. Thanks
Aww! Here then just for you, is a quick rundown…
- Pros: high in protein¹, vitamin B, and vitamin E
- Cons: high in fat², low in calcium
¹Compared head-to-head with almond milk for example, it has double the protein (but also double the calories)
²However, is also has been found to lower LDL (bad) cholesterol (and incidentally, also reduce inflammation), and in a later systematic review, it was found to not correlate to weight gain, despite its high calorie-content.
If you don’t already, and would like to try making your own…
Click here for step-by-step instructions to make your own hazelnut milk! (very simple)
Q: Wondering if you can evaluate CLA and using it to assist with weight loss. Thanks
Will do! (Watch this space)
Q: What’s the process behind the books you recommend? You seem to have a limitless stream of recommendations
We do our best!
The books we recommend are books that…
- are on Amazon—it makes things tidy, consistent, and accessible. And if you end up buying one of the books, we get a small affiliate commission*.
- we have read—we would say “obviously”, but you might be surprised how many people write about books without having read them.
- pertain in at least large part to health and/or productivity.
- are written by humans—bookish people (and especially Kindle Unlimited users) may have noticed lately that there are a lot of low quality AI-written books flooding the market, sometimes with paid 5-star reviews to bolster them. It’s frustrating, but we can tell the difference and screen those out.
- are of a certain level of quality. They don’t have to be “top 5 desert-island books”, because well, there’s one every day and the days keep coming. But they do have to genuinely deliver the value that we describe, and merit a sincere recommendation.
- are varied—we try to not give a run of “samey” books one after another. We will sometimes review a book that covers a topic another previously-reviewed book did, but it must have something about it that makes it different. It may be a different angle or a different writing style, but it needs something to set it apart.
*this is from Amazon and isn’t product-specific, so this is not affecting our choice of what books to review at all—just that they will be books that are available on Amazon.
Q: Great video on dopamine. Thumbs up on the book recommendation. Would you please consider doing a piece or two on inflammation? I live with Lupus and it is a constant struggle. Thanks for the awesome work you do. Have an excellent day.
Great suggestion! We will do that, and thank you for the kind words!
Q: Why is your newsletter called 10almonds? Maybe I missed it in the intro email, but my curiosity wants to know the significance. Thanks!”
It’s a reference to a viral Facebook hoax! There was a post going around that claimed:
❝HEADACHE REMEDY. Eat 10–12 almonds, the equivalent of two aspirins, next time you have a headache❞ ← not true!
It made us think about how much health-related disinformation there was online… So, calling ourselves 10almonds was a bit of a tongue-in-cheek reference to that story… but also a reminder to ourselves:
We must always publish information with good scientific evidence behind it!
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7 Healthy Gut Habits For Women Over 40 – by Lara West
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With regard to the titular 7 healthy gut habits for women over 40, a chapter is devoted to each one of those habits, and she goes into quite some detail in each category, more than you might expect.
As for the 7 things, we’ll not keep them a mystery; they are:
- Intermittent fasting
- Prebiotics & probiotics
- Mindful eating
- Understanding ingredients
- Movement
- Sleep
- Stress management
Of course, all of these things are good regardless of one’s age or gender, but West is writing with women over 40 in mind, and as such, she will focus on things that are especially relevant to those of us who are indeed women over 40.
You may be wondering: what if I’m a long way over 40, and menopause is a distant memory? In that case, 90% of this will still be relevant to you; the only parts that won’t be, are those that pertain specifically to the menopausal transitional phase itself, rather than the post-menopause state.
You may also be wondering: what if I’m a man, and menopause is just not in the cards for me? In that case, maybe about 70% of this will still be relevant to you, because of the broad applicability of most of the advice. That said, if it’s just for yourself, you’d probably do better with a book of which 100% is relevant to you, rather than this one.
The style is conversational pop-science, with personal anecdotes mixed in with references to science. It’s definitely on the light/easy-reading end of books that we’ve reviewed on the topic.
Bottom line: if you’re a woman over 40 who would like to improve your gut health, this book was written for you.
Click here to check out 7 Healthy Gut Habits For Women Over 40, and rediscover vitality!
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The Mindful Body – by Dr. Ellen Langer
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Fear not, this is not a “think healing thoughts” New Age sort of book. In fact, it’s quite the contrary.
The most common negative reviews for this on Amazon are that it is too densely packed with scientific studies, and some readers found it hard to get through since they didn’t find it “light reading”.
Counterpoint: this reviewer found it very readable. A lot of it is as accessible as 10almonds content, and a lot is perhaps halfway between 10almonds content in readability, and the studies we cite. So if you’re at least somewhat comfortable reading academic literature, you should be fine.
The author, a professor of psychology (tenured at Harvard since 1981), examines a lot of psychosomatic effect. Psychosomatic effect is often dismissed as “it’s all in your head”, but it means: what’s in your head has an effect on your body, because your brain talks to the rest of the body and directs bodily responses and actions/reactions.
An obvious presentation of this in medicine is the placebo/nocebo effect, but Dr. Langer’s studies (indeed, many of the studies she cites are her own, from over the course of her 40-year career) take it further and deeper, including her famous “Counterclockwise” study in which many physiological markers of aging were changed (made younger) by changing the environment that people spent time in, to resemble their youth, and giving them instructions to act accordingly while there.
In the category of subjective criticism: the book is not exceptionally well-organized, but if you read for example a chapter a day, you’ll get all the ideas just fine.
Bottom line: if you want a straightforward hand-holding “how-to” guide, this isn’t it. But it is very much information-packed with a lot of ideas and high-quality science that’s easily applicable to any of us.
Click here to check out The Mindful Body, and indeed grow your chronic good health!
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Seasonal Affective Disorder (Beyond Sunlight!)
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For those of us in the Northern Hemisphere, the time of increasing darkness is upon us again. Depending on our latitude, the sun barely rises before it skitters off again. And depending on other factors of our geography, we might not get much sun during that time (writer’s example: the ancient bog from which I write has been surrounded by fog for two weeks now).
So, what to do about it?
Firstly, we can make the most of whatever sun we do get (especially in the morning, if possible), and we can of course make some use of artificial sunlight. To save doubling up, we’ll link to what we previously wrote about optimizing both of those things:
‘Tis To Season To Be SAD-Savvy
More ways to get serotonin
Sunlight, of course, triggers our bodies to make serotonin, and hence we often make less of it during winter. But, there are other ways to get serotonin too, and one of the best ways is spending time in nature. Yes, even if the weather is gloomy, provided there are still visible green things and you are seeing them, it will promote serotonin production.
Of course, it may not be the season for picnics, but a morning walk through a local park or other green space is ideal.
On which note, gardening remains a good activity. Not a lot of people do so much gardening after a certain point in the year, but in one way, it’s more important than ever to get some soil under your fingernails:
There are bacteria in soil (specifically: Mycobacterium vaccae) that work similarly to antidepressants.
When something is described as having an effect similar to antidepressants, it’s usually hyperbole. In this case, it’s medicine, and literally works directly on the serotonergic system (as do many, but not all, antidepressants).
See also: Antidepressants: Personalization Is Key!
While many antidepressants are selective serotonin uptake inhibitors (i.e., they slow the rate at which your brain loses serotonin), Mycobacterium vaccae increases the rate at which you produce serotonin. So, you feel happier, more relaxed, while also feeling more energized.
^this one’s a mouse study, but we’re including it because it covers exactly how it works in the brain, which is something that the ethics board wouldn’t let them do on humans, due to the need for slicing the brains up for examination.
As to how to benefit: touching soil will get you “infected” by the bacteria, yes, even if you wash your hands later. Growing food in the soil and eating the good (including if you wash and cook it) is even better.
Boost the other “happiness chemicals”
Serotonin is just one “happiness hormone”, other feel-good neurotransmitters that are just as important include dopamine and oxytocin.
Dopamine is most associated with being the “reward chemical”, so it pays to do things that you find rewarding. If you’re stuck for ideas, engaging in small acts of kindness is a sure-fire way to get dopamine flowing and lift your own mood as well as theirs.
See also: 10 Ways To Naturally Boost Dopamine
Oxytocin, meanwhile is the “cuddle chemical”, and can be triggered even if you have nobody to cuddle*. If you do, by the way, make it at least 20–30 seconds, as that’s generally how long it takes to get oxytocin flowing.
*Vividly imagining it has much the same effect, since the brain can’t tell the difference. Alternatively, looking at pictures/videos (your choice) of small cute animals tends to work for most people also.
For more on these things, check out: Neurotransmitter Cheatsheet
Take care!
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