Dogs can alert to many different medical conditions including POTS, seizures, diabetes, panic, anxiety, repetitive behaviors, allergic reactions, and more. It is NEVER limited to these conditions, and, in fact, we try to add new conditions whenever we can.

Little Angels Service Dogs has led the way through these discoveries. We were one of the first organizations to actively train dogs to alert to seizures, and we enjoy sharing our methods with other organizations who want to add medical alert to their task lists.

Dogs need the opportunity to recognize the condition, be trained in a behavior, understand the association, and be motivated to perform the trained behavior.

For each individual recipient, we need to ask these questions to determine the likelihood of a successful alert:

1) How often does the medical episode occur? It needs to be more than once a month.

2) Are you or a resident aware EVERY time the episode occurs, either during the episode, or within 5 minutes of it occurring? This needs to happen in order for the behavior to be reinforced in a timely manner, enabling the dog to understand the association between the game and the episode. If the episode occurs without anyone noticing, the dog may never learn to alert. An example would be absence seizures, which are practically invisible. Another is seizure activity that does not produce any physical effects in the patient; it is totally invisible, and only the EEG and the dog can tell.

3) Can you play the alert game with the dog within 5 minutes of the episode occurring, EVERY TIME?  This often can’t happen with panic attacks because the recipient is so overwhelmed that they cannot communicate with anyone at all for a longer period of time. The dog needs the timing to be clear in order to understand what is being communicated.

4) Is this something a dog can recognize? This is the big ‘what if’. If it is something the dog can smell, hear, or see – then yes. Many times a dog can hone in with one these senses, when it is beyond human ability. An example of this is the scent of seizures. We cannot smell changes before a seizure occurs, but a dog, who has a sense of smell up to millions of times stronger than ours, can certainly do so. Dogs and humans are designed very differently, and we can take advantage of that once we learn to communicate with them. A dog’s wet nose, with its length and extraordinary bony crevices, possesses around 300 million olfactory sensors, compared to our 6 million, and a dog’s olfactory center in the brain is 40 times larger than ours! Now, all we have to do is determine how to ask them to tell us when they smell something, when we cannot.

So what if it is a medical condition that Little Angels have not worked with before? How do we know if the dog will sense the condition?

This is often something we discover after handler training, and sometimes even weeks or months after the dog has been living with their recipient. It can take some time to ‘explain’ to the dog what we need them to detect.

If you can answer ‘yes’ to the above questions, then we can certainly try. However, if you answered ‘no’ to any of the above, then it is unlikely to communicate the information to the dog.

Even if all of the above factors line up, a trainer should never guarantee the outcome of a dog’s training. This is not only limited to medical alert, but to training in general. A dog is a living, breathing creature who makes real-time decisions. A trainer can guarantee that they will remain available to assist or retrain a dog, or even to exchange a dog – but we should never make promises of what someone else will do.

Surprisingly, training a dog to perform medical alert, is very similar to training a dog to perform most obedience commands, only that the cue will end up being the symptom, such as the scent of rising or dropping blood sugar. Teaching the dog to recognize the symptom is the most difficult aspect.

First, we train the dog to perform a very simple behavior: pawing at the leg. The dog gets a tasty treat for doing so, which leads them to enjoy the interaction. Initially, the dog is asked to perform this behavior with a hand signal from their trainer. We call this the ‘alert game’.

Next, we pair the behavior with the medical condition. In certain cases, we can get some of this training out of the way before the recipient meets their dog. In the cases of diabetes, hearing, and seizures this is possible, because we do have a way of presenting the cue.

For hearing dogs, we are teaching them to paw at our leg to the sound of buzzers, alarms, and even the recipient’s name. Once the dog has learned to paw at our leg with our hand signal, we simply set a tone off, such as an alarm, and tell the dog to paw at our leg. Pretty soon, we no longer need to give the hand signal, because the dog has learned to associate the alarm as the cue. Now when the dog hears the alarm, they paw at the trainer’s leg to get a treat. Simple right?

Well, it’s not that much different when training a dog to alert to seizures. Here, we know the cue will be scent, so we ask the recipient to send us a scent sample of their seizure. This is simply taken with clean gauze, by swabbing the inside of the patient’s cheeks, and palms of their hands directly after a seizure. The recipient seals up the scent and mails it to our kennel. We are careful to put the gauze into an airtight container which opens quietly, and we store it in the refrigerator between training sessions so the scent will last longer. Can you guess why the container needs to open quietly? It is because we don’t want the dog associating the alert behavior with any stimulus other than the scent of the seizure. If they could see the scent container, or hear it open before we played the alert game, then that becomes part of the puzzle for the dog.

Our trainers are careful to keep the scent container hidden and will hold it in their treat pouch, or behind a barrier in our classroom when it is opened. As soon as the dog is exposed to the scent – either by walking into a room with the open container, or walking alongside their trainer when the container is opened – the trainer will give the hand signal to play the alert game. The dog is ecstatic about this, of course, because they love playing this game.

Before very long the dog walks into the room with an open scent container and will immediately start pawing at the trainer’s leg. We can also have another trainer walk behind the dog in the middle of a lesson, waiving the scent container inconspicuously in the air, and the dog will paw at their trainer’s leg. This is when we know the dog understands. The scent has become the cue!

In some cases where scent is involved, the dog needs to work with their recipient for a while before they truly understand which scent was the important one. Imagine this from a dog’s perspective (which is really what all trainer’s need to do when working with a dog). The dog’s sense of smell is so strong, the olfactory center of their brain so large, that they can easily recognize and memorize scents. It would be like if I asked a two-year-old child to clap their hands every time they saw me hold up a red card. Do you think they would do that for a lollipop? You bet! A scent for a dog is recognized in a similar way. It’s hard for us to imagine this because our sense of smell just barely gets us by – but a dog’s world is navigated through the use of this incredible feature. A dog can separate scent in their mind, taking a whiff of marinara sauce and recognizing individual ingredients such as thyme, garlic, and tomato. If we look back at the scent sample, we can guess that there are many other scents locked up into that gauze. There will be the scent of the recipient for sure, as well as anything they ate that day, and the scents of all the people who handled it since. The opportunity for the dog to experience live seizures with their recipient, followed by an alert game, communicates to the dog that they need to ignore all the other scents – they determine it was only the scent of the seizure which was important.

We often view service dogs as ‘the magical unicorn’, having mystical abilities and powers. But really, it comes down to our ability to view life from a dog’s perspective, being aware of their incredible senses, repeating training enough times that communication is clear, and motivating them thoroughly enough that they are excited to ‘play the game’. When all is said and done, we’ve opened the pathways and have established a connection with one of the most incredible animals on earth, and through that connection, they forever alter our lives.

By Katie Gonzalez, Director of Little Angels Service Dogs

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