How dogs can be of help - by Dr. Dana Hardin

Dr. Dana Hardin, Pediatric Endocrinologist, is one of today's leading expert when it comes to service dogs assisting with medical disabilities. Combining her research background, her medical experience along with her work with service dogs, she talks about how dogs can make a difference in the life of people affected with disabilities. From autism to PTSD, epileptic seizures or diabetes, dogs offer help, emotional support, and companionship to their person.

When it comes to service dogs, does breed matter?

Can a Chihuahua, a Great Pyrenees or a Pit bull be a service dog? Do service dogs have to be Labradors, Golden Retrievers or German shepherds? Are there certain breed requirements for service work or is it up to each one of us to decide what breed we would like to have as a service dog? To answer these questions, we need to take a closer look into the work these dogs perform for their humans.

We can divide the training of service dogs into two main categories: 1/ the special skills for the work they will be trained for, such as opening and closing doors, pulling clothes off, picking up objects from the floor, getting help or alerting to changes in blood glucose levels; 2/ the public access skills, such as lying quietly under a restaurant table, walking through a crowd in a heel position while paying attention to the handler and generally staying as well behaved and inconspicuous as possible.

Most service dogs are taught between 30-60 different behaviors and are required to perform under any circumstances and levels of distractions. With such requirements, it only makes sense that whatever dogs are used, they need to have certain training qualities. Food-drive, above average attention span and desire to interact with people are a must. Very independent dogs, with little interest in food and interaction would be difficult to train to the required level. So as long as a Maltese, a Rottweiler or a Chow have the required training qualities, teaching them the different behaviors would be possible. However, depending on the task, certain breeds would definitely be more suitable than others. Labradors or shepherds or mixes of these breeds are better suited for mobility assistance for instance than a dachshund or a Brittany. Although these breeds could learn just as well, for those tasks, size does matter. For diabetes alert where scent is in questions, small or medium dogs can perform just as well as larger breeds as long as they have a regular nose (as opposed to brachycephalic dogs like pugs, Boston terriers, Pekinese, etc.). Hearing dogs can also be smaller size dogs and Papillons are often trained for that particular task.

 

Trainability and physical aptitude for the task however aren’t the only criteria when choosing a dog for service work. As mentioned above, a large part of the training, although much less spectacular than the first category of skills, has to do with public access skills. In fact, socializing dogs to enough situations, places, sounds, surfaces and people, and teaching them to be well-behaved and responsive, requires as much or more training hours exposure and practice than the specialized skills. In addition to the trainability qualities mentioned earlier, dogs that work in public settings need to have the right temperament. Skittish, barking and generally reactive dogs would not do well. If the dogs are under-confident either for lack of socialization or genetics, they’ll be mostly concerned about their safety and may be unresponsive to their handler’s needs. Being disruptive in public would also put anyone in difficult situations. If a dog barks in a restaurant or movie theater, handler and dog will be asked to leave. Not to mention any aggression issues that can become a real liability to the handler.

So we’ve identified that service dogs need to have certain trainability, physical aptitudes and temperament qualities. Does that mean that as long as these requirements are met, any breed can do the job? This is where good judgement comes into play. On one level, yes, absolutely, there is no reason that any dog with those qualities couldn’t make a great service dog, regardless of breed. On the other hand however, we also need to consider the public’s reaction to the dogs. It’s impossible to walk through a mall or any public place with a dog, without drawing attention. Some people will love to see the dogs, others will be indifferent or mildly annoyed and some will be outright scared. Everybody has his/her own history with dogs. Most business owners will be very accepting of dogs and if they’re dog lovers, they may even be very welcoming. Others on the other hand, will have concerns for their business and other customers and will be uncomfortable having the dog in their facility.

According to ADA laws, service dogs have the right to be in public places and anyone with a disability should be able to bring their dog with them. That being said, just because we have the right to a service dog doesn’t mean we also have the right to bully our way into situations where others can be uncomfortable. The physical appearance of the dog can make a big difference in the reaction the dog will elicit in others. When walking through a mall with a Labrador or a Golden Retriever, or even a German shepherd, because of a long history of those breeds as service animals, most people will automatically assume the dog is very friendly and questions about the dog’s right to be in a public place will be very rare. Other breeds however may raise more concern and reactions can be very different. A Rottweiler or Pit Bull for instance, although totally suited for most service work, would be more likely to trigger fear and concern in others. There has been an increase in news reports lately of disabled veterans being questioned and sometimes asked to leave a restaurant with their service dog. In most case, these dogs were of bully breeds. Although it makes sense to want a dog with guarding features, especially if we’re dealing with PTSD, we also need to understand that such dogs will trigger agitation in others. Fear is often irrational and difficult to control. Why chose dogs of breeds that will increase the chances of concern and sometimes distress in others, and therefore more problems for the handler? Any time we interact with the public, we become an ambassador for other service dog owners. These breeds could make great service dogs and constant exposure will over time desensitize the public to their presence in public places, but we have to be aware that until then, many may have negative reactions to them. We can either make it easier for others to get used to having more dogs in public, or we can develop concerns from the public with potential consequences for all of us down the road. When I choose a dog to work with, I look for friendly looks. The friendlier the dog looks, the easier it is for both the handler and the public.

When working with service dogs or owning a service dog to help us deal with our disability, we want to chose the dog that will best fit our needs. As we’ve seen, many breeds or even mixed breeds can do the job. It all depends on the dogs’ ability to learn, perform and go into public places safely and discreetly.

Jennifer Cattet Ph.D.

www.medicalmutts.com

Why are service dogs so expensive?

Over the years, service dogs and working dogs in general, have shown the many ways they can assist those in need by offering autonomy along with a sense of security and comfort. Although I think highly of guide dogs for the blind and all working dogs, for this article, I will be focusing more specifically on service dogs which assist with a variety of disabilities from mobility challenges, autism or epileptic seizures, to more recently PTSD and diabetes. There are so many accounts of how these dogs have contributed to a person’s life, that their value is unquestionable. But once we’ve decided that we could benefit from a service dog, the journey towards acquiring such a unique animal can often be long and expensive. When costs are not covered by a foundation or not for profit organization, service dogs typically cost $20,000 or more. But why are they so expensive? Does the cost really reflect the true value of such dogs?

Service dogs are usually required to accompany their human everywhere they go: to the mall, the supermarket, the movie theaters, the doctor’s office, to work or to school, to concerts and sporting events. Whether in a crowd, exposed to loud and sudden noises or when food is all over the floor, when people are clapping or when quiet and calm is required, no matter where they are and what is going on, service dogs have to be able to perform and respond to the person they’re assisting.

Training a dog to the point where he’ll stay silent and discreet under a restaurant table, even with waiters coming and going, food all over the floor and children trying to pet him, requires hours of controlled repetition and exposure. For that seemingly simple task alone, the trainer will be spending months of work. The dog needs to be reliable enough to work with an untrained handler; especially when that person has physical limitations. Service dogs typically know between 20 and 60 different behaviors, depending on their particular specialty. Those behaviors can be classified into two main groups: 1/ the behaviors required for public access, like leash walking, sit, down and other basic skills and 2/ the specialized skills, like retrieving objects from the floor, turning on and off light switches, opening doors, helping a person get up from the ground, assisting in the transition of the person from a wheelchair to a bed, alerting to a change of blood glucose levels, or getting help. Each one of the behaviors, whether necessary to ensure appropriate behavior out in public or to specialize the dog to specific tasks, will require hours of methodic repetition with the trainer. To make things even more difficult, in order to reach the level of reliability required, each one of the behaviors also has to be practiced in a wide variety of settings and with different levels of distractions.

What we sometimes fail to recognize, is that many dogs simply don’t have the temperament to stay calm and responsive under such a wide variety of settings, so just selecting the right dogs to perform the job requires expertise. Even with careful breeding or selection from shelters or independent breeders, almost 40% of dogs recruited, don’t make it as service animals and will be put up for adoption as well as behaved pets. As dogs go through adolescence, many develop fears and reactivity that would disqualify them from working out in public. In the process, organizations still have invested training time and resources to feed and care for those animals and these costs have to be covered in the ones that they do sell as service dogs. When all goes well, and the dogs complete the program, a large part of the price is due to the cost of keeping them during the many months to a couple of years it takes to get them ready for placement. During that time, the dogs require housing, food, veterinary care, and professional training that add up over time.

All in all, between the intense training required and the different expenses related to caring for the dog, having a dog in training is expensive for any organization. In addition to the dog alone, the companies also have overheads that can quickly bring expenses up. Some may have employees and building structures, marketing budgets and other operating expenses that will also influence the overall price of the dog.

When we’re in need of a service dog, there are a few ways to overcome the cost factor, so money alone shouldn’t stop us from getting the needed assistance:

1/ Working with a not for profit organization. Many reliable and accredited service dog organizations operate under a 501c format and will place dogs at little to no cost to the recipient. How do they do that? Although the dogs still cost the same to produce, a large part of their activity is to do the fundraising themselves, so the cost of the dog is already covered by grants and donations. The downside to those organizations is that their waiting lists are typically saturated and getting a dog may take as long as 3-5 years.

2/ Getting your own dog trained by a professional. If your dog has the right characteristics of breed, age, temperament, and trainability, you may find a trainer who specializes in service dogs and can help you train your own dog. Because of the time it takes for each behavior, the trainer might need to take the dog to his or her facility, but as the dog will only be working on the behaviors that you need, the overall training time can be cut down when compared to a dog trained for all sorts of potential placements. Depending on your particular disability, you may not need a dog to go out in public and the training can then be reduced even more. You should, however, consider your dog’s age before choosing this option as you may not want to put thousands of dollars into training a dog that can only work for a few years.

3/ Working with a for-profit company. Such companies can often provide you with a fully trained dog in hand in a much shorter time than not for profits that are generally limited in how many dogs they can place, by how much money they can raise. Not all for-profits are equivalent in price and quality, however. Just like in any other profession, there are companies that will overcharge for their services. There are some breeders who will, for instance, place young puppies as service dogs and charge up to $25,000 even though you will have to do most of the training and may have a dog that can develop behavior problems as you go. On the other hand, many organizations are very trustworthy and offer fully trained quality dogs. Some organizations, like my own, specializing in training very specific skills, like diabetes alert or autism, assist dogs, thus reducing training time and therefore overall cost. Taking the dogs from shelters at an older age can also reduce the time of keeping such dogs, reducing the cost even further for the benefit of both the dogs and the recipients.

If you still cannot afford the price of a service dog but don’t want to wait for one at a reduced cost, just like when buying a car, one obvious option is to borrow the money. There are different lenders that, as long as you qualify, will provide the money up front for a monthly payment. A more popular, yet more time intensive solution, however, is to fundraise. Many people work with specialized organizations that will help with setting up fundraising options so that ultimately, there is no need to either break your piggy bank or take out a loan.

Getting a dog ready to assist a person to overcome difficult health of physical challenges requires time, effort and money. Ultimately, the service these dogs can provide during many years is well worth it. Keep in mind though, that just like with any other purchase, looking for information, learning about your different options and watching out for those who may try to take advantage of you is recommended. With the many organizations providing assistance dogs and the different options available to fund such animals, cost alone should not limit those who need their help.

Jennifer Cattet Ph.D.

MedicalMutts.com

Jennifer Cattet Ph.D. talks about diabetes alert dogs on Talk2theAnimals, a radio show by Janet Roper. #diabetesalertdogs

 Click on the following link to listen to the show: Talk2theAnimals

Thinking of getting a #Diabetes Alert Dog? What to look for before signing a contract

Diabetes – Science has proven that dogs can really help - #diabetesalertdogs

Over the past few years, a number of service dog organizations have started to train dogs for diabetes alert. Type 1 diabetes patients are at risk of medical complications when their blood glucose levels drop as they often cannot feel the change until it’s too late. These often restrict their lifestyle and activities to avoid the risk of hypoglycemic episodes, reducing at the same time their quality of life and wellbeing. Specifically trained dogs can put their nose to work and provide the much needed help.

I worked with a young man in his thirties, with Type 1 diabetes, who had lost the vision in one eye as well as his ability to walk without crutches after a dramatic drop in his glucose level, sent him to the hospital. Concerned about his recurring life threatening episodes, his family convinced him to get a diabetes alert dog. With the help of the dog, alerting to most of the changes in his glucose levels, he was able to monitor his sugar levels before they reached extreme levels. Over time, his hypo and hyperglycemia episodes were less frequent and less severe and his overall health was greatly improved.

Like him, many have benefited from the assistance of a dog. But what dog trainers and diabetes alert dog (DAD) owners have know for years, has finally been demonstrated scientifically. Dogs can smell a drop in blood glucose levels, significantly helping patients, increasing wellbeing and quality of life.

One study presented 4 dogs with samples collected from diabetes patients while they were experiencing a hypoglycemic episode (Harding& al., 2013). When placed amongst 6 other samples (3 from the patients while in normal range, 3 blanks), the dogs were capable of identifying the Low sample, proving their ability to detect a particular smell associated with the change in blood glucose levels.

A second study investigated whether such trained dogs truly provided health and psychological benefits to diabetes patients (Rooney &al., 2013). Dogs can be trained to nudge, paw, lick, jump or vocalize to alert the person when their glucose levels are lower than normal. Seventeen diabetes patients were surveyed about the reliability and efficiency of their diabetes alert dogs. The researchers recorded the incidences of nocturnal hypoglycemic episodes before and after receiving a dog.

All clients reported a reduction in either the number of hypoglycemic events, the number of unconscious episodes, or the number of emergency calls after receiving a dog. Eight people stated that they had not called the emergencies or been unconscious at all since receiving a dog (when they had previously). Most patients reported more independence and increased quality of life once they had a diabetes alert dog.

When measuring the impact of diabetes alert dogs on the patient’s health, the researchers found a significant change after dog placement. These measures confirmed what the patients had stated; most clients experienced improvement in their glycaemic control.

Dogs have shown the ability to alert to both lows and highs, but it’s still unclear what chemical compound they’re responding to. We know they smell a change, but more research will be needed to find out what exactly they smell. Over time, as dogs identify patterns of behavior associated with the change in blood glucose levels, they may also pick up on behavior cues that can confirm the onset of a hypo or hyperglycemic event.

Overall, what these studies show, is that dogs can be effectively trained to help Type 1 diabetes patients better monitor their glucose levels. They contribute to not only improving their sense of wellbeing, but also to their overall health by helping to keep the blood glucose levels in more normal ranges.

Jennifer Cattet Ph.D.

MedicalMutts.com

New Study confirms the ability of dogs to smell changes in glucose levels in diabetes patients

According to the American Diabetes Association, 8.3% of the US population suffers from diabetes. Close to 20 million people have already been diagnosed and 79 million are pre-diabetic. Health complications from diabetes range from heart disease, stroke, high blood pressure, blindness, kidney disease, neuropathy and gangrene, leading to amputation. Those who developed the disease early in their life are at a higher risk for Type 1 Diabetes. Over the years, these patients may loose the ability to feel the impending drop in blood sugar, such as tremors, sweating, confusion or irritability and are at greater risk of dangerous health complications.

Until now, regular testing of blood glucose levels throughout the day is the only way to know whether changes are needed in diet or insulin. Changes, however, could occur in between tests and go unnoticed until symptoms of severe hypoglycemia develop (stupor, seizure, unconsciousness). Dogs could provide the much needed warning by detecting the change in glucose levels through smell. Until recently, this ability was only anecdotal. New research has now proven that dogs are indeed capable of smelling the occurrence of a hypoglycemic episode.

Dogs have up to 220 million olfactory cells while people only have approximately 5 million. From the detection of bombs, drugs, and cancer to search and rescue missions, dogs have been putting their noses to work to save many human lives year after year. Today, dogs have shown the ability to assist people in a new and innovative way: alerting them when their blood glucose level changes.

Lupine Lens Photography

Dana Hardin MD (endocrinologist), Wes Anderson, Zachary Skrivanek (statisticians) and myself (Jennifer Cattet, Ph.D., ethologist/dog behaviorist and trainer), aware of the potentially life threatening characteristics of Type 1 diabetes, decided to test the dog’s ability to smell a drop in glucose levels. Four dogs were trained to alert whenever presented with gauze containing breath and skin secretions from patients. They were then presented with a test, in which a hypoglycemic sample was loaded in one of the seven identical containers on a scent wheel. Three other containers were loaded with euglycemic (samples collected from the patient while in the normal blood sugar range) and the last three with blank gauze. None of the handlers knew the location of the hypoglycemic sample during the test so the dogs had to rely only on their nose to find it.

The results of this study demonstrated that the dogs were capable of finding the hypoglycemic sample amongst the seven samples presented, confirming the existence of a particular smell associated with the episode. It’s probable that what they’re detecting is an increased concentration of ketones. When there isn’t enough insulin to convert glucose into energy, the body starts burning fat instead. This process leads to the build-up of ketones in the bloodstream. The accumulation of ketones is what will cause most of the symptoms and complications described above. Although more research will be needed to fully understand the biochemical changes that occur with hypoglycemia, we now have more evidence that dogs may provide additional help to patients in avoiding the dangerously low glucose levels.

Dogs have the ability to alert a patient of a change in glucose levels when the body’s warning signals no longer kick in, and may therefore provide an additional tool to better monitor the constant ups and downs typical of Type 1 diabetes. They are not machines however and their reliability is not 100%. As living creatures, they can be distracted at times from their alerting duties. But even with a little variability, patients with such dogs have reported experiencing a significant improvement of their overall health through better monitoring of their glucose levels, coupled with reduced stress levels.

The training of Diabetes Alert Dogs (DAD) requires specific qualities of the dog and expertise in this particular field from the trainer. This type of training is very different than other scent detection tasks. The dog needs to be attentive to the person at all times, highly social and capable of working in a variety of public settings. When the presence or absence of the scent is imperceptible to the human trainer and doesn’t disappear from the patient after the episode, there are added challenges to training that can have life consequence for the patient. Training requirements are intensive and as they go through puberty, the dogs can develop behaviors that could limit their ability to work. With only a small fraction of dogs that make it as service dogs, even when carefully bred for that purpose, diabetes alert dogs are typically placed between 18 and 24 months old.

To date, dozens of dogs have been placed with diabetic patients and are helping them monitor their sugar level more effectively. More then a medical device, they also provide companionship and peace of mind.

Jennifer Cattet Ph.D.

For more information on Diabetes Alert Dogs and a PDF

copy of the study, visit www.MedicalMutts.com.