Sniffing Danger

First published in the NASGP Newsletter 1st November 2021

Many medical traditions use body odours as a diagnostic tool, but by the time I was a medical student diabetic ketoacidosis and renal failure were the only conditions I recall being associated with a characteristic smell. Now the odours caused by specific biochemical changes generated by many more diseases are being recognised, at least by dogs.

In 2016 I wrote about dogs’ ability to accurately detect various cancers. In 2021 biodetection dogs can identify Parkinson’s, malaria, bacterial infections and Covid-19. The challenge is to develop a clinically feasible way of using these skills. Employing dogs in outpatients or biochemistry labs isn’t a practical idea, but surely putting them to work at airports would be a feasible and effective way of screening incoming passengers for covid?

Service dogs are trained to screen large areas rapidly for chemicals. They have been detecting mines for many years. But warfare has changed. Dogs are now being trained to identify the household items used in booby traps and IEDs. Dogs also investigate fires because they can detect chemicals used by arsonists. And dogs can assist individual members of the armed forces and emergency services who develop PTSD.

PTSD, panic attacks, emotional support – it seems there is no limit to the psychological conditions which a dog can alleviate. The internet has a wealth of moving stories by people for whom such dogs have been a blessing, maybe even a lifesaver.

There are only 5,000 visually impaired people with guide dogs in the UK, but as dogs take on more therapeutic roles, sooner or later one is likely to trot into a consulting room near you. It is worthwhile to understand what your patient’s dog can do and what rights it has. Unfortunately, the titles aren’t used consistently.

Biodetection dogs can identify Parkinson’s, malaria, bacterial infections and Covid-19.

Service dogs are employed by organisations to protect the public, for instance from fires or drugs. Yet, confusingly, the organisation providing dogs to support service personnel with PTSD is called Service Dogs UK.

Assistance dogs – ‘auxiliary aids’ are trained to help individuals with disabilities carry out their day-to-day activities. Assistance dogs are covered by the 2010 Equality Act which gives them the right of access to public places and obliges organisations to make adjustments to accommodate them. But that’s as far the law goes. Most dogs are provided by charities, so their governance is by the Charities Act of 2011. But the law sets no training standards – legally you can train your own dog – and though most dogs wear a harness when they are working and most owners carry an ID booklet, these are not a requirement.

Guide dogs for people who are visually impaired are the best-known assistance dogs. Hearing dogs for deaf people may also be called guide dogs, though they rarely ‘guide’ their owners around their environment. Assistance dogs can be trained to mitigate all sorts of vulnerabilities – warning owners of a diabetic hypo or a seizure, calming an autistic youngster, performing an impressive range of tasks for people with severe physical disabilities. They restore a degree of independence.

Therapy dogs seems to be a general term for dogs that provide some sort of therapeutic role such as visiting care homes or hospitals. They can enter only with prior agreement of the organisation – which may be denied on hygiene grounds, though research shows that dogs’ paws are cleaner than the soles of humans’ shoes.

In our increasingly fragmented society, dogs also provide many people with emotional support. During lockdowns, dogs and their owners have spent weeks together in valued companionship. Returning to the office may be difficult for both, and some employers are encouraging staff back by allowing them to bring their dogs with them.

Emotional support dogs are not legally recognised as assistance dogs in the UK, though their status may change if a current campaign is successful. But I suspect it would be a minefield. Assistance dogs perform tasks for people with measurable disabilities. Emotional support dogs provide comfort. They may be crucial to their owners’ wellbeing, but if an independent report is required, who is going to judge? I trust it wouldn’t be GPs.

Despite the UN law, assistance dogs can be unwelcome, indeed forbidden entry, to public places for hygiene or religious reasons. Amit Patel, whose sudden blindness forced him to give up his career as an A&E doctor, took the Neasden Temple to task for refusing entry to his guide dog Kika. The temple management’s response was impressive. They consulted the RNIB. They invited Amit to tour the temple – a huge and complex structure – to explain what help a blind person would need. They ran an exercise, blindfolding temple staff to give them first-hand experience of the problems. When Amit next visited the temple they had installed handrails and ‘tactiles’ – braille information and floor bumps – all in marble. They are educating visitors about assistance dogs, and other temples are learning from their experience.

Carol, a deaf friend, finds her dog Comet’s help invaluable, and forgives him for waking her at 2am when drunken revellers ring her doorbell. In her late 70’s, she finds his exercise routine challenging. But his value as a companion is priceless. For people isolated by disability, that is a crucial benefit. It’s not just emotional support dogs that provide emotional support.

I recommend reading Amit Patel’s book Kika & Me: How One Extraordinary Guide Dog Changed My World. It’s a compelling and inspiring story, and as a GP and a member of the public I now appreciate much better the difficulties blind people face and how to respond. A&E’s loss is a gain for the dignity and rights of disabled people.

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