"Finding the Right Dog," which accompanied the Health section's July 25 Cover Story, "Heal, Doggie, Heal," contained incorrect information on two key points: Canine Companions for Independence should be contacted through the organization's Northeast Regional Center in Farmingdale, N.Y., which serves the region from Maine to Virginia. The center's toll-free number is 800-572-BARK. The center can also be reached by mail addressed to Canine Companions for Independence (CCI), Northeast Regional Training Center, P.O. Box 205, Farmingdale, NY 11735-0205; and at www.caninecompanions.org. Virginia Canines for Independence can be contacted at 5408 Dickens Rd., Richmond, VA 23230, or by phone at 804-288-3647. (Published 08/15/2000)
Around noon each day, Jay Liesener gets hungry. But he can't get his own lunch. Paralyzed from the waist down and having limited use of his upper body and forearms, Liesener doesn't have the strength to pull open the refrigerator door without flopping forward from the waist. So he calls on Teddy.
"Ted, heel," Liesener says in a gently firm tone. He has moved his chair near the fridge. Teddy, a big, square-headed black Labrador, crosses the linoleum and sits next to Liesener's chair. "Ted, pull strap."
The dog pulls on the rope-and-rubber strap attached to the refrigerator's handle, opens the door, sticks his big head inside and, with his teeth, gently extracts a bag that holds Liesener's previously prepared lunch. Teddy carefully sets the bag in Liesener's lap.
As Teddy illustrates, a new breed of dogs has arrived in the world of health care. Once limited only to guiding the blind, trained canines are finding places in a variety of assistive settings. Hospitals and nursing homes are using animals called "therapy dogs" to comfort, entertain and de-stress -- and thereby help heal -- patients battling a variety of conditions. For the mobility-impaired, highly trained canines called "service dogs" can pick up dropped keys, open and close drawers, retrieve prepared meals, help a person in and out of a bathtub, dial 911 (really!), push and pull wheelchairs, help operate a car or van, and pull off gloves, shoes, socks and jackets. Other dogs provide specific assistance to those who suffer seizures and require special medication. And of course the helping dogs provide companionship, play and unconditional love for the people they assist.
This year marks the 25th anniversary of the placement of the first assistance dog (seeing-eye dogs have been around longer than that). But only in recent years, with the rising independence movement among disabled people, has the idea begun to spread widely. Two of the Washington area's three service dog programs have been in operation only six years; the other was launched in 1987. While most service dogs are trained to work with people who rely on wheelchairs, other categories of helping dogs include hearing dogs (they alert their owners to sounds: doorbells, phones, cooking timers, alarm clocks smoke alarms) and seizure dogs (they carry medications in their packs and are trained to dial 911 on large-keyed phones).
For Liesener, 28, who has been paralyzed since he snapped his neck while playing on a friend's backyard trampoline 11 years ago, Teddy was a step up from his human predecessors.
Teddy gives him around-the-clock assistance. "The big thing for me is having someone around at all times," says Liesener. "I used to feel like I was bugging people like [his fiancee] Melanie or my attendant, asking for help, picking things up for me. Having Ted there, I feel better about myself. He minimizes my disability."
It was not always this simple. Two years after his accident, equipped with an automated wheelchair, Liesener enrolled as a freshman at the University of Maryland, got an apartment in College Park and hired a live-in attendant to provide bathing, dressing and medical assistance during certain hours at his apartment. The set-up looks good in theory, but with human helpers, there are problems. Like the fact that they can't always be there to anticipate every problem.
One day in a parking lot in the middle of a downpour, Liesener dropped the remote control to his van. He couldn't bend down to pick it up. He had to wait in the rain until someone walked by and picked it up for him. "It was probably five minutes, but it felt like thirty," he says. Another time he was working on a paper in his apartment. He dropped his only pencil. He had to wait three hours for the attendant to arrive to resume work.
Despite all the high-tech gadgets now available, the most minor mishap can ruin a day for a disabled person who lacks 24-hour assistance.
The benefits of service dogs, who are always available uncomplainingly, are simple but profound. "Having confidence," says Liesener. "Not having to worry about what's going to happen to me this day." He pauses, then smiles. "Ted gets excited when I drop things. It makes him happy to help."
Teddy has been Liesener's full time companion for two years, going to the grocery store with him, sleeping on his bed at night, attending classes with Liesener while he finished his bachelor's and master's and now works toward a Ph.D. in counselor education. A human attendant now comes to the house only in the morning and evening to help with bedtime and morning routines.
On a typical day, Liesener gets up and feeds Ted by moving his chair next to a waist-high food bin, filling the special plastic scoop with food, moving to the specialized food bowl raised about a foot off the ground, and dumping in the food. Next, he lets Ted out to relieve himself, which he does twice a day--morning and night.
"At home, Ted is half pet, half service dog," explains Liesener. "He gets up on the couch with us and plays, and I brush him, but if I drop something, he gets it."
Ted is fully specialized, meaning he performs tasks to fulfill Liesener's specific needs. But training is a continuing process. Most recently, Liesener has been trying to teach Ted to bark on command. "I sometimes have bad muscle spasms that knock me forward into my lap, and I can't get back up," he says. The plan is that Ted could bark when this happens to get attention and help.
"But they've been trained their whole lives to not bark," adds Liesener. "I've been barking at him to show him how."
Twenty five years ago, while traveling and teaching in Turkey, Nepal and Iran, Bonnie Bergin noticed self-sufficient handicapped people going about their unremarkable daily business, often using burros and donkeys to hold pots, pans and other wares to be sold. She later returned to the United States to begin work on a master's degree in special education.
"I thought hard about what can be done to get people out of institutions and onto the streets, getting jobs, and it came to me: dogs," says Bergin, who today has a doctorate in education and is founder of the Assistance Dog Institute and originator of the service dog concept.
She ran into fierce resistance from academics and professionals at first: Dogs spread disease. Dogs are stupid. The disabled can't take care of dogs, how could dogs take care of them? But the long list of negative reactions didn't stop her. Her first trainee was Abdul, a golden retriever puppy someone had given to her.
"I knew absolutely nothing and had no preconceived notions," she says from her office in Rohnert Park, Calif.
Her first dog-assistance client was Kerry Knaus, a soft-spoken 19-year-old woman who had a neuromuscular disorder that had left her unable to move her legs and much of her arms. If Knaus accidentally fell forward in her wheelchair, she could not get up. She clearly lacked the physical force to train and maintain a dog. But Bergin was undeterred.
Bergin and Knaus concentrated not on physical gestures but on verbal cues such as "sit" or "stay," using variations in tone of voice and facial expressions to get Abdul to help Knaus. By the end of training, the dog could push Knaus up from her in-chair falls, open doors, turn on lights, retrieve food and push levers to help her operate the chair lift to her van. Most important, Knaus had to develop a trusting emotional bond with Abdul simply by spending time with him, much in the way humans get to know one another and develop subtle, complex relationships based on mutual understanding.
Today, more than 150 programs provide similar services, and an estimated 3,500 service dogs are in place worldwide. Waiting lists for the dogs, who are worth around $10,000 by the end of training, can be long--sometimes five years--because of the extensive breeding, training and bonding required.
People in this mostly nonprofit business foresee significant growth to meet the needs of aging baby boomers, who will likely live longer than the elderly in previous generations and therefore have higher risk of disabilities--and more need for assistance.
"No one wants to be institutionalized," says Debbie Gavelek of Fidos for Freedom, a Washington area nonprofit group that offer seeing, service and therapy dogs. "But at some point, there are going to be a lot of us disabled."
Lydia Wade of Manassas graduated from Bergin's eight-week program for trainers in 1994. Wade operates her program, Blue Ridge Assistance Dogs Inc., in a remodeled barn in Manassas.
Like many people in the business, Wade compares her dogs to children. Emotionally and intellectually they are very similar to human toddlers, she says. They can't make language, but they have emotions on which they act without understanding them completely. They follow directions when kept on track. They want to please. They need and return loads of affection.
Repetition, patience, display of respect for the animal, verbal and sometimes culinary rewards--methods that mirror today's toddler toilet training--help Wade teach a dog about 20 commands in six weeks. Commands, printed on enormous posters on the sides of the barn, include "settle" (calm down), "lap" (stand on hind legs and place paws on person's lap), "fix it" (step around the leash to untangle it) and "wait" (to prevent collisions between dog and chair). The dogs also get six to 12 months of training in specialized tasks, such as opening a refrigerator door equipped with special grab ropes and pushing shopping carts.
Wade carefully matches a trained animal with a client, and the three work together for two weeks, often spending eight-hour days in the barn. "The dog should be looking to the client, not to me, for what he or she needs," says Wade. She often hides behind the client's wheelchair on the first day and gives commands in her own voice until the dog makes a visual connection between the command and the client.
"The client really has to want the dog," Wade says, "because training is frustrating."
Luis "Gus" Estrella, who has cerebral palsy, moved from Arizona to Silver Spring in 1995 and struggled while living alone. He eventually called Wade, and Estrella now has been living independently with his dog, Boz, a chocolate lab, since 1997. A policy analyst at the United Cerebral Palsy Association (UCP) in Northwest Washington, Estrella, 37, has extremely limited use of his arms and legs. He, perhaps more than many disabled persons, demonstrates the importance of the psychological/emotional bond between dog and human. Estrella can't talk, and it is difficult for him to signal to an untrained dog because his arms move in spastic ways that might well be confusing.
Fishing his keys out of a pack on the side of his power chair, Estrella purposely drops them on the carpet. Boz, who is sleeping under his desk, immediately looks up, first at the keys, then at Estrella. Using a series of grunts and hand motions Estrella coaxes him to stand up, retrieve the keys with his mouth, and place them in Estrella's unstable hand.
Five days a week, Estrella and Boz take the Metro to Farragut North, Estrella in his power chair and Boz on a leash. He finds vast rewards that come from having a dog rather than an attendant. Obviously attendants are a costly expense. Also, they have an average turnover rate of six months. And it's humiliating to ask for help all the time; the dog is always eager to please.
"Attendants are on the clock," Estrella says, typing and speaking through a specially designed laptop computer unit that produces a computerized voice. "They want to leave as soon as they can. With Boz, I can take my time and talk to him whenever I want, and he doesn't give me any lip."
But the dogs have needs, too. When it thunders, Boz moves closer to Estrella. "And he knows when I'm feeling sad or mad and comes to me," says Estrella. "He knows what I like and dislike."
Service dogs, recognizable by their official backpacks--usually leather with a tag, or blue or purple fabric with a round insignia on each side--work hard and should not be petted before asking. But they are not mere robots, and the lines between physical and emotional aid often blur--arguably the greatest advantage of all. They're trained to not sniff at a discarded hot dog on the sidewalk. And when the harness/backpack goes on, they know it's time for work.
Some dogs begin to anticipate tasks, such as turning on lights when coming home in the evening. "It's symbiotic teamwork that in terms of the dog's intelligence far surpasses what most people believe is possible," says Bergin. "The dog truly becomes an extension of the person."
That sort of relationship is evident between Estrella's co-worker, Muffi Lavigne, and her standard schnauzer, Rudy. "Boz and my dog have very different personalities," she says, wearing a University of Connecticut jacket and holding Rudy on a leash. "Rudy won't let people near me, and they practically have to sign an affidavit to get close. I feel naked without him."
In addition to physical help and friendship, service dogs provide security in the sometimes vulnerable world of the disabled. Lavigne, 29, an information specialist at UCP, left her home in Connecticut in 1994 and has been living independently in Rockville with a power chair and Rudy ever since, taking the Metro to work. "Should anyone break into my apartment at night, I'm in bed. I. Can't. Move," she says, with emphasis, all the while stroking Rudy's gray, spiked head with her left hand. "But Rudy could protect me. If my chair breaks down on the Metro, at least Rudy is there to keep me company.
"It's not just a matter of 'you're the person who feeds me.' It's unconditional love 24 hours a day, and that kind of love and loyalty is the best gift Rudy has ever given me."
Therapy dogs, which deliver some of the emotional benefits of canine contact but not the lasting relationships, visit people in hospitals, nursing homes and other locations. There, people with physical or mental illnesses can share, at least briefly, the joy, comfort and liberating moments the animals can provide.
Medical studies have shown that petting an animal can lower blood pressure, heart rate and skin temperature, and that pet owners tend to live longer than non-pet owners. Although much of the literature devoted to the benefits of human-animal bonding is anecdotal, a number of local health care providers--including two high-profile research centers--offer such visits for some patients.
Anyone can volunteer themselves and their dogs to participate in a therapy program. The dogs must pass a test that demonstrates obedience and a docile nature.
The Delta Society, a national organization that oversees animal assisted therapy and provides certification protocols for animals and their handlers, estimates that more than 2,000 animals nationwide participate in assisted therapy programs, visiting more than 350,000 people each year.
National Capital Therapy Dogs Inc. (NCTD), a Washington area nonprofit group, organizes regular visits to several local hospitals, including the National Institutes of Health in Bethesda and the Children's House at Johns Hopkins in Baltimore, which provides housing and emotional support for families of Hopkins's pediatric patients. In all the years of pet assisted therapy throughout the country, not one case of infection has been shown to be caused by the animal, the group reports.
One recent Tuesday night at the Children's House, volunteers Linda Solano and her whippet, Jessie, Marlene Truesdell and her chocolate Lab, Claire, and Michelle and Mark Cohen and their beagles Daisy and Annie, gathered in the downstairs rec center. Solano and the volunteers, members of NCTD, covered the newly upholstered couches with pink sheets.
Gradually the kids, who suffer from serious illnesses--cancer and neurological and spinal disorders--were wheeled in. One blond, paper pale wisp of a boy in a wheelchair with his legs propped straight out and a pillow clutched protectively across his stomach was so weak he could barely speak. Solano gently picked up Jessie and carried her over to the boy.
Encouraged by his mother, the boy attempted to raise his hand to pet the animal. Solano got closer. The boy smiled. By the end of the hour-long session, he was giggling at the circus-like performance of Daisy and Annie, especially Annie as she flew from the couch and landed on the Cohens' backs. The boy's legs were then bent and swaying contentedly. The pillow was tossed aside. "Do that again," he said to the Cohens, and laughed.
At the evening's peak, the place was packed with more than 23 highly animated, smiling people and four dogs. Claire visited with a girl with severe palsied movements. Claire never flinched. The dogs, wearing official therapy dog packs and tags, maintained their composure through it all.
On another night at the Clinical Center at the National Institutes of Health, a similar but more subtle scene unfolded. Solano lifted Jessie onto the bed of Lou Ellen Wentworth in the cardiology unit, careful not to disturb the wires and tubes that monitor Wentworth's heart, which has gone through many surgeries dating to 1961. Wentworth, 76, a soft-spoken woman from Monroe County, Tenn., gracefully received her guests despite her surroundings--the beeping of machinery, the "Friends" episode blaring on the television. Perched on the edge of the bed in a blue robe and Chinese-style slippers, she told stories that involve rattlesnakes, her 12 siblings and carrots stuffed into pressure cookers, all the while stroking Jessie's ears. She and Solano talked and talked and looked at Wentworth's embroidery. Jessie fell into a deep sleep, her head cradled by Wentworth's aged hand.
Holly Parker, coordinator of pet-assisted therapy at NIH, first looked into the idea in 1988 after a patient suggested it. Today, the Clinical Center's full-time staff veterinarian, Mark Haines, checks the dogs for parasites, infection and signs of disease. He also verifies that their fur has been shampooed and their teeth brushed. These steps are necessary, he says, because "30 to 40 percent of our patients are immuno compromised" and would have trouble fighting off any germs they encountered.
Rewards are immediate and visible. Not long after patient Carolyn Hoover had pancreatic and kidney transplants at NIH, she received medications that left her feeling nauseated.
"I was so sick I couldn't possibly eat," she says. Then Solano entered her room with her other dog, Willow.
"It was amazing," says Hoover. "The dog changes your whole perspective. It takes your mind off what you're going through. I asked for food right after their visit."
Pamela Gerhardt last wrote for the Health section about post-partum depression.
Finding the Right Dog
Service and therapy dog programs vary widely in cost and operations. Applicants seeking a hearing or service dog from Fidos for Freedom in Laurel pay $160 and must complete at least 120 hours of training with the dog. At the Assistance Dog Institute in California, applicants pay $2,500 but train for only two weeks.
Also, organizations vary dramatically in their relationships with the disabled person after the dog has been placed. Clients frequently need ongoing assistance.
So applicants might want to weigh the benefits of a local versus a national company. Fidos for Freedom has get-togethers every Wednesday night and Saturday morning that offer a big-family atmosphere for anyone who has chosen one of their dogs.
Lydia Wade of Blue Ridge Assistance Dogs Inc., frequently visits with clients and dogs she has matched. National organizations, such as Canine Companions for Independence, don't always have local contacts. Canine Companions lists a person in Richmond as the Washington area contact.
Among the groups offering assistance dogs are:
* Assistance Dog Institute, P.O. Box 2334, Rohnert Park, CA 94927; phone, 707-585-0300; e-mail, AssistDog@aol.com; Web, www.assistancedog.org.
* Blue Ridge Assistance Dogs Inc., 11215 Dumfries Road, Manassas, VA 20112; phone, 703-369-5878; e-mail, BLRDGHOPE@aol.com.
* Fidos for Freedom, Inc., P.O. Box 5508, Laurel, MD 20726; phone, 410-880-4178; TTY, 301-570-7570; e-mail, firstname.lastname@example.org; Web, www.fidosforfreedom.org.
* Dog Ears & Paws Inc., P.O. Box 688, Owings Mills, MD 21117; phone, 410-655-2858, TDD, 410-655-2858; e-mail, Debbie@YOURCOMPANIONS.COM.
* Canines Companions for Independence, 5408 Dickens Rd., Richmond, VA 23230; phone, 804-288-3647.
HEALTH ON THE WEB
For a photo gallery by Carol Guzy and original video clips of the helping dogs featured here, go to www.washingtonpost.com and choose HEALTH from the menu on the left.