TW: self-harm mention
This photo was taken while I was just finishing up doing Deep Pressure Therapy for my girl. I moved to her legs because her body had already started responding to the pressure I’d been putting on her chest earlier, so she just needed some final grounding before this episode passed. You can see from my face how seriously I take my job!
A Medical Alert Service Dog performs a trained behaviour to indicate that their handler is about to have or is currently having a medical episode,* and a Medical Response Service Dog helps a handler who has a medical disability. Both types of Service Dogs can assist with a range of medical conditions, from epilepsy to type 1 diabetes, and from postural orthostatic tachycardia syndrome to narcolepsy, and everything in between. It’s not uncommon for a dog who is a Medical Response Service Dog to also be a Medical Alert Service Dog, because we dogs are perceptive creatures with strong noses and will often pick up on our handler’s changes in body chemistry. Remember, though, that a Service Dog under the ADA must be “individually trained” in the task(s) that they perform for their disabled handler. This means that a dog who performs a natural medical alert does not qualify as a Service Dog in the US unless that alert is reinforced by the handler (or a trainer) since the Service Dog must be “trained to take a specific action” under the ADA. As a Service Dog for my girl, I am both a Medical Alert and Medical Response Service Dog because I perform tasks both that alert her to a medical episode and that are in response to medical episodes.
Because my girl has such a broad range of symptoms, I also have a variety of alert behaviours so that I can tell her exactly what’s going on with her body.
As I explained in my post about my Psychiatric Service Dog tasks, I alert my girl to rising anxiety and incoming panic attacks through a variety of her body’s signals. One of the very first tasks I learned to help my girl was pawing with increasing intensity in order to interrupt her when she starts nervous-scratching or picking at herself. Her anxiety causes her to do this unknowingly, often to the point where she bleeds, and since the scabs that form become itchy, the cycle can continue quite easily — so the trick is interrupting the cycle so that she can catch herself before she starts bleeding, which is exactly what I do! This pawing also acts as an anxiety alert because the scratching indicates that her anxiety is rising close to the point of “no return.” I can also alert to increasing heart rate or elevated cortisol as signs that her anxiety is rising, as well as to her anxious “hand flapping” that she does as a physical anxiety tic, and I use a paw for these as well so that all anxiety alerts are clumped together into one behaviour.
A couple years ago, my girl added a hypoglycemia alert to my repertoire of tasks. Her GI issues are understandably the (most likely) culprit of her drops in blood sugar, which itself causes an assortment of un-fun symptoms, but the situation is even more nuanced than that: thanks to my girl’s chronic nausea, she often doesn’t want to eat, but she has to be careful because blood sugar dipping too low can be a trigger for her migraines, which can last multiple days. As you can imagine, my girl is grateful for any kind of preventative action! My hypoglycemia alert can tell her when she absolutely needs to push past her nausea, even if eating causes its own form of discomfort, because that discomfort is the lesser of the two potential evils. I currently alert with a nose “boop” when her meter reads 80 mg/dL or lower. Sometimes I do a “chin rest” with a serious look on my face, and although this is my default “there’s something wrong with you but I’m not formally trained to alert to it” behaviour, my girl has learned that sometimes I do this instead of a nose boop . My girl hasn’t yet figured out if this is because her low blood sugar stems from two different causes, and since I’m a dog, I can’t really communicate my reasoning to her. For the time being, we’re treating it as a training glitch, and she keeps reinforcing the “boop” whenever I offer the “chin rest” instead. When I learned my hypoglycemia alert, I also learned the Breath Check command, where my girl leans down so I can sniff her breath better. This behaviour helps reassure my girl that my alert was a true alert and not just an accidental nose boop, because if I still give the nose boop after a Breath Check, then my girl knows to definitely check her blood sugar.
If you’ve read this far, you’ve already learned that my girl has migraines, and they most likely have a genetic component to them because they run in her family. Although my girl knows some triggers for her migraines — pressure changes due to thunderstorms, low blood sugar — these migraines are tricksters and don’t always let her know what causes them. That’s where I can help! I have a migraine alert where I gently “mouth” my girl on the hand in order to let her that a migraine is coming on. This behaviour lets her know to take her migraine medication, which can help lessen the impact and also duration of the migraine (however, it’s not perfect and sometimes her migraines ignore medication completely). We haven’t figured out a way for me to tell my girl how long her migraine is going to last, since it would be helpful to know if one is going to last 9 days or only a few hours, but hey, at least I can sometimes give her a bit of warning and that’s better than nothing!
My newest medical alert (that I’m still perfecting, by the way) is to my girl’s fatigue crashes. For a period of time after my girl exerts herself either physically or mentally, even to an extent that most normal people would consider “minor,” she experiences a major energy crash, often accompanied by a “flare up” of other symptoms like chronic pain, anxiety, overstimulation (aka lots and lots of tears), or headaches and even her migraines. With these crashes, she can often barley think coherently, let alone function like a normal person, and even walking can sometimes feel like an insurmountable feat. When I give her an alert to an impending fatigue crash, I’m letting her know that she’s going down fast so she needs to get herself ready for that, whether it’s getting water to put beside her bed, finding the nearest dark and quiet space, or emailing someone to cancel plans while she still has the brain power to do so. Anyone who knows my girl knows that her face has it’s own “alert” — her cheeks turn lobster-red immediately before a fatigue crash. However, my alerts help for two main reasons: first, fatigue crash-to-lobster face isn’t a 1:1 ratio and my girl can crash without lobster-ing, and second, fatigue crashes can happen in a time frame ranging from immediately after an exertion to a day or so after doing the exertion. My absence of an alert reassures my girl that she has at least a little more time to live her life normally, so my alerts offer her some predictability, which is nice to have when your chronic illness is largely unpredictable.
I want to take a moment to note that my medical alerts vary in how good I am at performing them. Medical alerting has probably been my biggest training struggle, so my girl and I still practice with scent samples quite frequently (and if you want to learn how I was taught to alert to medical episodes, click here).
If I alert my girl to her rising anxiety or an impending panic attack, one of the ways she can respond to that alert is by asking me to perform Deep Pressure Therapy (DPT), which is a form of firm sensory input that results in a calming effect for the body. I do DPT for my girl by lying on her chest preferably, especially because it forces her to take deep breaths instead of hyperventilating, but I can also lie across her legs if we’re not in a situation where she can lie down fully. My body weight acts to quiet her sympathetic nervous system, which is responsible for her “fight or flight” response, and instead activates her parasypathetic nervous system, which is responsible for her “rest and digest” response and therefore is associated with decreased anxiety. As a result, her panic symptoms decrease, and she can eventually continue her life as normal. DPT may look like “just cuddling,” but – scientifically – it’s so much more! I can also do deep pressure therapy for her chronic pain, most often my girl’s hips. My body heat acts like a hot water bottle to soothe her joints.
When my girl has one of her migraines, I can respond by doing forward momentum pulling, where I act like a dog-sized tugboat by pulling into my harness. Many people think of migraines as “just a headache,” but migraines are actually a neurological problem. My girl’s migraines “scramble” her brain and make it short-circuit on her, even if she has taken medication to get rid of the pain. Navigation can be a little tricky with a brain that’s not cooperating, especially in a crowded area. Add in light sensitivity due to the migraine and navigation can be just downright difficult. But that’s where I can help! Because my forward momentum pulling as a guiding aspect to it, I make sure that my girl gets safely where she needs to go. She can just close her eyes against the light if need be, and I’ll weave around people and other moving obstacles as needed. The pulling aspect of this task also helps with my girl’s balance, which is often thrown off by her brain’s migraine “scrambling.” I know how to find a few locations, lead her to a handful of important people in her life, and follow an indicated person. Sometimes words are tricky when my girl has a migraine and she’ll trip over her words while trying to tell me where to go or what to do, but luckily I know her well enough after four years of being her pup that I can interpret her vague gesturing pretty accurately.
Of course, I can also perform forward momentum pulling when my girl’s fatigue is flaring, even if I often do it to save her energy. When I pull her along, she doesn’t use quite as much energy while walking and therefore doesn’t get tired as quickly as she would walking on her own. Of course, the energy saved isn’t vast, but every little erg of energy is necessary when you start your day short on spoons. When I do forward momentum pulling for my girl when she’s experiencing fatigue, it can make a huge difference in whether or not she can accomplish a task.
Moving to a home with more space has meant that I’ve been able to expand my tasks in migraine response. Over the course of the past year, I’ve learned how to open doors using a special tug, as well as closing them with my nose. I have slowly begun learning how to turn light switches on and off all by myself. Being able to close doors and turn off the lights is helpful for my girl’s migraines because she can get very light and sound sensitive. However, the pounding in her head gets worse with any small movement, so if I can save her getting out of bed, I prevent her from having to endure that pain. Similarly, I can do both of these tasks when my girl is having a high pain or fatigue day and appreciates whenever I can save her from doing even small actions, like when I help her undress at night.
Opening and closing doors has led to another task that I’m currently working on: retrieving a bottle of ginger ale from a specific spot in the fridge. In order to complete this task, I need to know how to open the fridge with a tug, grab the drink in its special holder (since its glass and therefore slippery), deliver the bottle to my girl in another room, and then return to close the fridge. Assuming I’m in my girl’s bedroom with her, I would also have to open and close her bedroom door as well. That’s a lot for a pup to remember to do! It’s taking a lot of practice (and many treats!), but I’m starting to learn what I need to do. Once I’ve perfected this task, I’ll be able to respond to my girl’s bouts of bad nausea by bringing her a bottle of ginger ale.
You may have noticed that there’s a lot of overlap between my psychiatric tasks, my mobility tasks, and my medical alert/response tasks. One symptom can be helped by many tasks, and one task can simultaneously help many symptoms. My girl’s health issues are often interconnected and have similar symptoms, so it makes sense that my tasks can overlap to help multiple aspects of her health. I have a lot of aspects of my job, it’s true, but I’m a pup that needs a job and needs to be mentally stimulated — my foster mom knew this when she was trying to find me a fur-ever home, and so far, thanks to my girl’s ever-fluctuating symptoms, there’s been no shortage of work for me to do in this fur-ever home. And as a bonus, I get paid with fetch, and that’s a pretty good trade-off in my opinion!
Tail wags and puppy kisses,
Service Dog team etiquette (particularly apropos after this post!)
Don’t distract Service Dogs
Spoon Theory
Confused? See my terms and abbreviations
* Some people classify Medical Alert Dogs as only those dogs who alert their handlers before a medical event occurs, but we’re including dogs who alert both before an episode and during episode (e.g. since dogs who assist diabetics are usually called Diabetic Alert Dogs, even though most of the time, they’re alerting to a handler’s already high or low blood sugar level – although some also alert to rapidly rising or rapidly lowering blood sugar levels).
If you missed Part 1 of this series about how I help my girl as a Psychiatric Service Dog, click here. And if you missed Part 2 of this series about how I help my girl as a Mobility Service Dog, click here.
Kelsie Iris: Service Dog 