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Paging Badger

By Greg Rienzi
How medical practitioners are working with dogs and other animals to bring you new healing therapies.

Let’s be clear, Badger versus the beauty pageant winner is not a fair contest. On any other day, Rachel Distefano, decked out in a silver crown, white dress, and sash that reads “Miss Anne Arundel County 2017,” may have won the full attention of 12-year-old Karabeth Chanler. But who can resist friendly eyes and floppy ears?

Badger is a 9-year-old brown mutt, jokingly referred to by his owner, Amy Dickman, as a cocker-chow-beaglesetter. For the last four years, Amy and Badger have volunteered at Johns Hopkins Hospital where they visit patients of all ages. Today, they are in the library of the Johns Hopkins Children’s Center to bring some cheer to Karabeth, who traveled from her home in Kilgore, Texas, to undergo a colon resection. Owing to complications post-surgery, she and her mother, Koren, had to extend their stay in Baltimore. It’s been 27 days. Karabeth misses her house and her friends. She misses good Mexican food, and her golden retriever, Lady.

“Animals keep us in the present. That alone can reduce stress, as we’re not worrying or dwelling in the past.”

Now, here’s Badger, wearing his hospital uniform—a dark brown vest with a patch on one side that reads, “Therapy Dog. Please Pet Me.”

Karabeth is happy to oblige. She sits on the edge of the couch and gently strokes his fur.

“Feel his ears. They are so soft,” Dickman says. She rescued Badger from a Baltimore shelter when he was 5 months old.

“Oh, yeah,” Karabeth responds, before letting out a soft giggle. The 20-minute visit ends with a big doggy snuggle.

“This is our third stay in the hospital in the past six weeks,” says Koren, who has been in and out of hospitals and doctor’s offices with Karabeth since she was 15 months old. “She’s generally pretty happy and talkative, but she does love the dog therapy. A dog can sense things. What you need. It’s comforting to her.”

This meet-and-greet with Badger has a name. It’s called an animal-assisted activity (AAA), which is a short, informal, and relaxing visit with a patient. Animals, as many of us know, make us happy. More than that, they are beneficial to our health. Several studies have shown that just looking into a dog’s eyes can raise levels of oxytocin, the so-called love hormone that plays a vital role in parent-infant bonding. Other studies have found that animals reduce stress and anxiety, lower blood pressure, and lessen depression, which is why dogs—and also birds, fish, and even horses—are being used as calming tools in assisted living facilities, funeral homes, courts, airports, and schools.

There is a biological reason for our bond with animals, says Alan Beck, an animal ecologist who directs the Center for the Human-Animal Bond at Purdue University’s College of Veterinary Medicine. “We get social support from them, which is so necessary for human beings,” Beck says. “We feel less lonely in their presence. They provide humor. Animals keep us in the present. That alone can reduce stress, as we’re not worrying or dwelling in the past.”

Increasingly, hospitals are encouraging visits with animals. There are now more than 45,000 therapy dogs working in clinical settings. A 2016 report by the Society for Healthcare Epidemiology of America found that 83 percent of U.S. hospitals surveyed permitted animal-assisted activities, and most major hospitals have formal animal therapy programs.

Now, animals are doing more than just offering short cuddle breaks. New studies have shown that animals used in a clinical setting can improve pain levels, mood, and other measures of distress, and serve as a prime motivator in physical rehabilitation. This has led to a new kind of treatment—animalassisted therapy (AAT)—which uses dogs and other animals to help people recover from, or better cope with, health issues such as heart disease, brain trauma, cancer, and mental health disorders. At Johns Hopkins, and at hospitals around the country, animals are becoming a part of patient treatment.

The Kennedy Krieger Institute, a partner institution that collaborates with Johns Hopkins Medicine, has had an AAA program for more than 20 years. The institute focuses on the care of children and young adults with developmental disabilities, and disorders of the brain, spinal cord, and musculoskeletal system. Sherry Fisher, special activities program coordinator for Kennedy Krieger’s Child Life/Therapeutic Recreation Department, is the one who alerts families arriving at Kennedy Krieger to the animal program. Even before traditional therapy begins, Fisher will often schedule an in-room visit with a dog to break the ice. Fisher recalls one recently admitted teenage girl who was struggling to adjust. “With the dog in the room she’s smiling like she hadn’t been since she arrived,” Fisher says. “Often, after these visits patients have a new feeling that everything is going to be OK. Even for just that moment, they might forget they’re lying in a hospital room.”

Not just any dog can pop into a sterile hospital setting. Johns Hopkins Hospital currently has 18 volunteer dog and owner teams that regularly visit with patients and their families. These therapy dogs have to be at least 1 year old, and certified by a recognized registering organization. Within 24 hours prior to a hospital visit, a therapy dog is bathed, brushed, and has its teeth and ears cleaned. They are inspected prior to each day’s visit. Therapy teams like Badger and Dickman generally work two-hour shifts, visiting as many as 10 rooms in oncology, adult brain trauma, psychiatry, neurology, pediatrics, and other departments.

In recent years, both Johns Hopkins Hospital and Kennedy Krieger have expanded to include an AAT program. At Kennedy Krieger, the animals interact with patients during traditional therapy—behavioral, occupational, recreational, speech, and physical—to help them achieve their goals. A child with a brain injury may have difficulty moving an arm, but given the opportunity to pet or throw a ball to a therapy dog, she finds mobility. A boy relearning to walk will be asked to go across a room or hall to where a therapy dog sits. His reward, animal play time.

The animals, Fisher says, often inspire the kids to work harder. “When you see a child who could barely wiggle his fingers the day before lift his hand up to feel a dog’s fur, your heart just grows two sizes,” Fisher says. “My role is to help our patients accomplish their therapy goals, and using dog teams has become an important part of that effort.”

therapy mini horse

More recently, Kennedy Krieger introduced new animals to its therapy team: miniature, sneaker-wearing horses named Colt and Marshall Dillon who visit the inpatient lobby once a month. In addition to the novelty of seeing a tiny horse, children looking to reclaim the use of a limb can have a therapeutic experience just by brushing the horses’ mane or placing a hand on its back to support his or her weight.

Animals can also help patients who are struggling to read. Both Kennedy Krieger and Johns Hopkins Hospital have incorporated a national initiative called Reading Education Assistance Dogs program—or READ—into their therapy offerings. Here, the dogs and their handlers visit with the explicit idea of supporting literacy. Kids who might be hesitant to read out loud feel more comfortable doing so in front of a dog. One student at Kennedy Krieger spoke for the first time during such a therapy session.

“That’s because dogs are not judgmental,” says Dave Williams, chief medical officer for Pet Partners, one of the largest animal therapy organizations in the country. The nonprofit has been training and vetting therapy animals for 40 years. “Dogs accept you as you are. Whether you’re in a wheelchair or have trouble talking. Especially for children with handicaps, this could be the first time they’re seen as an equal with another physical being, free from any human prejudice and fears.”

Just looking into a dog’s eyes can raise levels of oxytocin, the so-called love hormone that plays a vital role in parentinfant bonding.

This nonjudgmental companionship is especially important to children with autism, who are often at higher risk for stress and bullying by their peers. Some studies have found that children with autism interact more socially, smile more, and focus better around animals. One recent Purdue University study found that children with autism looked longer at faces of dogs than faces of humans, so animals are now used as a way to keep a child attentive to an intervention.

In physical therapy, animals can be a great motivator and distractor from discomfort. Eleven-year-old Natalie Bentos-Pereira had always been a motivated kid—she was a gymnast in her hometown of Rock Hill, South Carolina—but in the winter of 2017, Bentos-Pereira suffered a spinal stroke that left her paralyzed from the chest down. She arrived at Kennedy Krieger a few months later to begin intense, twice-a-day therapy sessions to relearn howto perform everyday functions, such as dressing herself. In her first few weeks of therapy, Bentos-Pereira took her first steps holding on to a walker, in part due to her work with therapy animals.

In one session, Bentos-Pereira was paired with the animal-therapy team of owner Bonita O’Callahan and Maxine, a 3-year-old black-and-white King Charles spaniel. At the start of the session, Bentos-Pereira lifted herself—with the assistance of two occupational therapists—out of a wheelchair, and onto a mat. On unsteady knees, she used her arms to support her weight on a 2-foothigh bench where Maxine sat with her owner. For the next 20 minutes, Natalie brushed the dog’s fur, played a shell game using cups and some Cheerios, and placed a T-shirt on the calm animal who raised no objections. Every activity was interspersed with a brief rest and playtime with the dog.

Lisa Rones, one of Bentos-Pereira’s occupational therapists, was pleased with the session. “That’s the longest Natalie has done that activity since she’s been here,” she says.

The therapeutic goal of the session was to help strengthen Natalie’s core. “We’re working on this so she can stand and walk. So when she leaves us Natalie is ready for more self-care like standing at the sink and brushing her teeth,” Rones says. “The dog provides distraction during the harder activities, and parts they might not like to do. With the dog present, they’re not thinking about the therapy as much.”

With the promising early interventions of AAT, several new long-term studies are evaluating these animal assisted therapy programs with the aim of bringing new treatments to patients. In fall 2016, the University of Tennessee College of Veterinary Medicine began a three-year study to measure the effect of pet therapy sessions on pediatric patients 20 minutes prior to surgery. The preliminary results found that the patients who interacted with a therapy dog needed less anesthesia and pain medication than a control group given an iPad.

At Duke University’s School of Medicine, a new research study will examine the influence of AAT on young children undergoing an echocardiogram. The theory is that children will have a more complete and higher quality echocardiogram in the presence of therapy dogs because the animals will put them at ease without sedation drugs. Johns Hopkins researchers have two studies that observe the impact of therapy dogs on adult oncology patients receiving chemotherapy, measuring both their anxiety and pain levels before and after intervention with animals.

The benefits aren’t one-sided. Like the patients he helps, Badger has his own medical issues. He has epilepsy and is on phenobarbital to control focal seizures. He has terrible allergies and gets a shot once a week. “We don’t talk about this with the kids and patients, as they tend to worry about this kind of stuff,” Dickman says. “But we do bring it up with the adults, as they see it as
a common bond and they can identify with the dog.”

When Badger gets his vest on, Dickman says, he knows he has a job to do. “He knows when visit days are. He wiggles his butt. He swaggers. He gets more confident. He’s perkier because he knows he’s on show,” she says. “If he didn’t enjoy it, we wouldn’t do this. He’s the star. I walk down the hall, nobody knows my name, but everyone goes, ‘There is Badger.’ That’s fine with me.”

Illustrations by Dan Craig
Dogs, birds, fish, and even horses are being used as calming tools in assisted living facilities, funeral homes, courts, airports, and schools.

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