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Animal Therapy

Animal-assisted therapy is a huge topic: almost 1500 hits using those terms alone. There is no way I am going to cover all of them and do them justice. Instead I am going to cherry pick, er, I mean, select references of interest to illustrate issues surrounding animals in the hospital. Sometimes I get the impression that readers of the blog expect encyclopedic knowledge and understanding of a topic whenever we put pixel to screen. That is only true of the other contributors to the blog, not me.

I would like to mention that I do, in fact, like animals, even dogs. I loathe most dog owners, as confirmation bias suggests there is no such thing as a considerate dog owner. But I never have contact with the dogs that don’t bark, that don’t crap on my yard, that don’t run up to me to nip at my legs. I only see the dogs that their owners allow to behave in ways I would never allow a human to behave.

It is no surprise that my kids have grown up mostly animal free. My eldest did wear me down and I bought him a hamster. It promptly bit me, drawing blood. Great, I thought, LCM. Just what I need. Then in the dead of winter it escaped, fell down a heating duct (we were putting in new floor) and electrocuted itself on the heating coils so every time the heat turned on we smelled rotting, roasting hamster. It cost $500 to take the furnace apart and clean it. Good thing it wasn’t a beagle. That was enough pets in the house for me.

Animals have multiple uses in the medicine, from testing new drugs (how I learned rabbits can scream) to various and sundry, well just various, forms of therapy. As was alluded to recently in the comments, take a noun, add the word therapy, and voila, you have a treatment for patients.

Not that animals are useless in patient care but over the years I have noticed that I have noticed more and more animals being brought into the hospital.  There is a time and a place for everything and hospitals are not the place for animals.

I first became aware of animal therapy in my hospital years ago when I was seeing a late consult in the ICU and I noted a cat. In the ICU. Sitting on the chest of a fresh open-heart patient. Let’s say I did not react mildly.  I discovered we had no policies and procedures for animals in the hospital. That has since changed, although we have more animals in the hospital than I would like, human and otherwise.

A perusal of the literature suggests that for relieving pain petting a dog may be as efficacious as acupuncture and the proponents trot out the same mechanism of action:

Animal-assisted therapy is a complementary medicine intervention, typically utilizing dogs trained to be obedient, calm, and comforting. Several studies have reported significant pain relief after participating in therapy dog visits. Objective reports of reduced pain and pain-related symptoms are supported by studies measuring decreased catecholamines and increased endorphins in humans receiving friendly dog visits.

I am not going to deny that petting a dog is of benefit. Humans are social animals that like to touch and be touched. I have long thought that the placebo effect of SCAM therapies, such as it is, is a gussied up version of apes grooming each other. Ritual attention is good.  Except “in deference to a million years of evolution, [the SCAM provider] will not attempt to pick fleas off patients; Earthmen are not proud of their ancestors and never invite them ’round to dinner“.  At least I hope so. Nit picking should be reserved for the comments that follow the blog entry.

I have am intrigued by using animals’ sense of smell to help make diagnosis. Most of the time, like using a dog to smell for cancer, I do not see the point outside of proof of concept. It does not seem practical.

However in resource-poor areas, if an animal can be trained to diagnose an infection that could be very helpful.  Some poor dog was trained to smell C. difficile diarrhea (there is an animal I feel very sorry for) and they have trained the African pouch rat to smell MTB. That would be a good use for animals as a reusable and reliable diagnostic tool in those parts of the world that cannot afford modern diagnostic technology.

Other diseases? I recently had a patient who had a companion dog for emotional support and as a seizure-dog who warned him when he was going to seize so he could take preventative valium.

There have been dogs trained to watch for the prodrome of seizures, although my patient’s dog received no such training. What little literature I could find suggests that animals who are not trained are not reliable and may be used to reinforce illness that is not there. Like the cat who could predict death, seizure dogs are most likely an excellent example of confirmation bias.

As is usually the case when someone has a service animal for emotional support, they become quite belligerent when it is suggested that the hospital may not be the best place for a dog or other animal. Words like ‘sue’ and ‘Americans with disability’ get thrown around and the animal stays. Yet another reason I am not a fan of dog owners. Just because you can do something doesn’t mean you should, but consideration for others is not often high on the list of pet owners.*  They do not seem to consider there may be people in the hospital with allergies who cannot simply leave.

Besides dogs and cats, people want to bring all sorts in vermin, er, I mean animals, into the hospital. One of the IC practitioners mentioned that at a prior job they wanted to bring a reptile zoo into a pediatric cancer ward. Good idea, lets bring a Salmonella vector to the most immunoincompetent patients in the hospital.

In Portland they are bringin llamas into hospitals (not mine) and horses (not mine). As some are aware, I am in charge of infection control in my hospitals and I see everything, and I do mean everything, as a potential infection risk. It makes me fun at parties as I can often come up with an infection risk from any human behavior or exposure.

We are all biased by our experience and I am continually impressed with all the weird and unexpected ways people can acquire infections. Murphy was more than an optimist. If something can cause an infection, it will.

There are two infection control issues with animals in the hospital.

First: entertain yourself by watching what people do with their hands. Hands go everywhere and are not always cleaned afterwards. People pet animals but do not clean their hands before, then the next person touches the animal, acquiring whatever organism was on the fur. While I have to foam my hands between each patient, no one ever foams the animal between patients.

While no animal has yet been identified in a hospital outbreak, dogs have been an intermediary for the spread of E. coli urinary tract infections and can be a source for MRSA and fungal infections as well.

Therapy animals have been cultured and they can carry have MRSA and C. difficile. And more:

Visitation of hospitalized people by dogs is becoming commonplace, but little is known about the potential health risks of introducing dogs to healthcare settings. This cross-sectional study evaluated the prevalence of zoonotic agents in a group of 102 visitation dogs from a variety of sources across Ontario. Between May and July 2004, owners were interviewed by a standardized questionnaire while dogs underwent a standardized physical examination. One specimen of faeces, hair-coat brushings and one rectal, aural, nasal, oral and pharyngeal swab were collected from each dog and tested for 18 specific pathogens. All dogs were judged to be in good health. Zoonotic agents were isolated from 80 out of 102 (80%) dogs. The primary pathogen was Clostridium difficile, which was isolated from 58 (58%) faecal specimens. Seventy-one percent (41/58) of these isolates were toxigenic. Extended-spectrum beta-lactamase Escherichia coli was isolated from one (1%) dog, extended-spectrum cephalosporinase E. coli was isolated from three (3%) dogs, and organisms of the genus Salmonella were isolated from three (3%) dogs. Pasteurella multocida or Pasteurella canis was isolated from 29 (29%) oral swabs, and Malassezia pachydermatis was isolated from eight (8%) aural swabs. Giardia antigen was present in the faeces of seven (7%) dogs, while Toxocara canis and Ancylostoma caninum were detected in two (2%) dogs and one (1%) dog, respectively. Methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Campylobacter spp., Microsporum canis, group A streptococci, Pseudomonas aeruginosa and Cryptosporidium spp. were not detected. Further information is needed before the full implications of these findings for infection control can be assessed properly.

There has yet to be a reported infection transmission or outbreak with a therapy but probably it is because people are not looking.  But given the results of the above, do you really want a dog wandering from room to room in your hospital?

With genetic techniques it is becoming increasingly easy to follow the chain of transmission. Anesthesiologists, as an example, can directly be the source for potential pathogens on the hub of central venous catheters.  It is only a matter of time before these techniques are applied to animals in the hospital.

Not only can animals be the intermediary for human pathogens, they have their own set of pathogens that can spread to humans: Pasteurella and Capnocytophaga being two. I always bear in mind that animals lick their butt and then they lick you. Ick. If I were to scratch my backside and then offer to shake your hand you would likely refuse but probably think nothing of having a dog lick you.

People do not consider animals as a source of infection, in part because the infections are relatively rare, in part because we do not look for them, and in part because who wants to blame the animal?  My favorite healthcare-associated infection, although not hospital acquired, was a patient who let her cat sleep in her dialysis bag warmer and she developed CAPD peritonitis with Pasteurella. And I can go on and on. And on. And on. About all the curious ways in which humans acquire infections from animals

To compound the problem, with the widespread use of veterinary antibiotics, it is of no surprise that pets and animals are a source for antibiotic-resistant bacteria.  I have enough trouble controlling infections from humans, much less adding dogs to the mix.

All of medicine is about the risk vs. the benefit of an intervention. I am particularly paranoid about infections in the hospital given how easily they can be spread.  But simple interventions can stop the spread of infection. It is why I am pushing for autoclaving any animal before we let it in the hospital.

*At some point someone is going to mention the poor behavior of children as a rationalization for lousy pet behavior. Don’t. It is no different than mentioning that since medicine is flawed SCAM is legit. You should know better.

P.S. The world needs more Mark Crislip: I was interviewed for the Skeptiles podcast. I have not heard the final edit, but I mostly rambled about infectious diseases and vaccines.

Posted in: Epidemiology, Science and Medicine, Veterinary medicine

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69 thoughts on “Animal Therapy

  1. windriven says:

    “In Portland they are bring llamas into hospitals.”

    Keep Portland weird. (A common bumper sticker in the PNW)

    It ticks me off, actually. I was going to do a riff on how one wouldn’t bring a cow into a hospital so why would one think a dog or cat would be a good idea. A llama is much worse than a cow. Really. Have you ever smelled a llama? They stink worse than the GI ward of a hospital in Guatamala. And they spit.

    I have a dog, a yellow lab, of which I am inordinately fond. She is a well trained beast, she never jumps on people, she sits, stays, and doesn’t eat until she is told (this serves a dual purpose; it helped her develop impulse control when she was a pup and it reduces the likelihood that she will eat something dangerous when we are hiking or walking).

    Despite all of these salutary characteristics, she does not belong in or on my bed or my furniture and she certainly doesn’t belong in any hospital other than an animal hospital. As the Byrds noted, there is a time for everything. And a time not for it.

  2. windriven says:

    “One of the IC practitioners mentioned that at a prior job they wanted to bring a reptile zoo into a pediatric cancer ward.”

    Hmmmm… a reptile dysfunction.

  3. DevoutCatalyst says:

    Dogs can detect a loaded diaper and wolf down the contents with glee. No training necessary. The purpose driven life of man’s best friend.

  4. Angora Rabbit says:

    Mark, I would suggest that you get a pet to mellow out a bit, but I would be worried for the pet’s well-being. For those who share their lives with non-humans, they can be an unparalleled source of comfort. If I were stuck in a hospital for a long period, I would have a far more positive outlook and lower cortisol if I could be visited by a non-human. Rabbits of course would be best but I admit to being biased.

    Of course one should test therapy animals for infectious agents including MRSAs before approving them for hospital visits. I have adopted several companion rabbits to people with immunosuppression (transplants in both instances), and we *always* test for E. cuniculi prior and only will adopt negative-titer rabbits.

    I am far more worried about being infected by the humans in the hospital, whether physicians, nurses, other patients, or children. Especially children.

    Regarding behavior, it is invariably the fault of the human. Watching a dog’s behavior tells you far more about the human than the dog. Don’t blame the dog, blame the human.

  5. norrisL says:

    An animal story from Australia:

    The husband was in Afghanistan, shooting Taliban types. The dog stayed home in good old Oz.
    The wife suffered from epilepsy. The dog saw the wife getting ready to leave the house and became very insistent that she should not leave. So much so, that she decided that she must be about to have a large seizure. So she lay on her bed and phoned the ambulance. When they arrived, the wife had passed out on the bed (please bear in mind that this is a newspaper story), so the ambos loaded her on a gurney and started to put her into the back of the ambulance. Then, out came the dog, carrying a small woman’s bag (that is a small bag for a woman. not a small woman with a bag). The ambos (may I remind you that this was a newspaper story) decided that this must be her bag that she kept ready in case she had to suddenly go to hospital, so they took the small woman’s bag and headed off for the hospital. When the nurses at the hospital opened the bag, what did they find? The dog’s toys!

    Now for a slightly more pertinent story.

    My friend Gary Wilson is THE veterinary dentist in Australia. There is a terrible TV show here with a young vet, let’s call him Joe, as the main presenter and who “pretends” to deliver the calf etc, and sometimes, maybe he does. But not on this occasion.

    In Melbourne there is the Children’s craniofacial unit. Then there is also the horse! The horse is the smallest horse in Australia. But who went and measured every small horse to be sure this was the case, I do not know. This horse is the mascot of the children’s craniofacial unit and it goes into the hospital to visit the children. It has, supposedly, never passed that which should not be passed on a hospital floor. The thing with the horse is that the children look at the horse and see something of themselves in the horse and this makes them feel better. Maybe.

    So the terrible TV show went along to “assist” with the surgery that the horse required. Gary and a human surgeon (yes, I know that all surgeons are human, some maybe less so than others), but the point is that one surgeon, the human one, operates on humans and Gary operates on animals. So together they removed several teeth from this tiny horse. The teeth were the size of a normal sized horse’s teeth and were actually almost meeting in the nose. At some point in the surgery, Joe stepped in to “operate”, which of course he could not do. Then again, why is a human surgeon allowed to occasionally operate on an animal, when Gary or myself, as veterinarians, would go to jail if we operated on a human being? Would a lawyer be allowed to perform surgery on a person? I’m just sayin’s all.

  6. elburto says:

    Yep, I’m with Windriven. Had a black lab once (I hope I will again some day) and she was impeccably behaved^, if only because it’s as cruel/neglectful/stupid to not teach and guide a dog how to behave at home and in society, as it is to do likewise to a child. I’ve encountered some truly atrociously behaved kids, but that’s down to bad parenting, just like poorly behaved pets are down to bad ownership.

    And, like Windriven’s dog, ours was a dog. She didn’t sleep in our beds, use our furniture, or share our mealtimes. Again, as with children, boundaries and rules are a kindness, a form of love, because dogs and children alike become upset and confused by inconsistency and chaos.

    Oh, and an odd anecdote, she had to be taught to bark. She was terrified to make a sound. She stood out at the shelter because she was the only still, silent dog. The staff believed she’d been punished, kicked and hit with a broom by her original owner, for barking. For the entire 14 years she lived with us she was terrified of mops and sweeping brushes.

    All of that said, she did not belong in a hospital any more than she belonged behind the wheel of a car. You can no more sterilise a dog than you can teach it to sing Nessun Dorma.*

    Cats in an ICU because there was no official rule against doing so? Erm… that shouldn’t even have to be a rule. Is there a rule about taking a hedge trimmer into the labour and delivery suite, or one about driving a motorcycle up and down the corridors?

    It’s a bloody hospital. The sheer number of unthinking clods that had to have been in on/aware of the decision to bring a cat into a CICU is staggering. It terrifies me to think that nobody realised that was a very. bad. thing. That lack of a specific “no pets in ICU” rule apparently made all involved just shrug, and go “Must be ok then, if it wasn’t then there’d be like… rules or something!”.

    Really? REALLY? I just… Wow. The NHS may have some issues at the moment, but CICU staff apparently not grasping that their ward is not a petting zoo is not one of them.

    As for the “cat in the dialysis bag warmer” patient, that goes beyond idiocy and into “Are you HIGH, lady?”

    I despair, I really do, and I’ve only touched on two of the anecdotes you relayed. Llamas, and other assorted (and apparently hospital approved!) non-human animal visitors, are seriously making me question the sanity of all involved.

    ^Her biggest fault, if you can call it that, was the frequent tail-breaking and tail dislocations. Spinal injuries can be costly to treat, and trying to give NSAIDs to a stubborn lab can be a Herculean task. There’s a reason that ‘dogged’ is a synonym for ‘determined’.

    It’s also embarrassing to explain that your dog’s gait is temporarily wonky due to injuries sustained during overenthusiastic wagging.

    *Dogs can be taught to drive, no really, they can, but mine would have been awful at it. Her only route would have been to the dog spa and back, or maybe round trips to the local Tandoori house.

    Enjoy:

    http://www.bbc.co.uk/news/world-asia-20614593

  7. elburto says:

    Yep, I’m with Windriven. Had a black lab once (I hope I will again some day) and she was impeccably behaved^, if only because it’s as cruel/neglectful/stupid to not teach and guide a dog how to behave at home and in society, as it is to do likewise to a child. I’ve encountered some truly atrociously behaved kids, but that’s down to bad parenting, just like poorly behaved pets are down to bad ownership.

    And, like Windriven’s dog, ours was a dog. She didn’t sleep in our beds, use our furniture, or share our mealtimes. Again, as with children, boundaries and rules are a kindness, a form of love, because dogs and children alike become upset and confused by inconsistency and chaos.

    Oh, and an odd anecdote, she had to be taught to bark. She was terrified to make a sound. She stood out at the shelter because she was the only still, silent dog. The staff believed she’d been punished, kicked and hit with a broom by her original owner, for barking. For the entire 14 years she lived with us she was terrified of mops and sweeping brushes.

    All of that said, she did not belong in a hospital any more than she belonged behind the wheel of a car. You can no more sterilise a dog than you can teach it to sing Nessun Dorma.*

    Cats in an ICU because there was no official rule against doing so? Erm… that shouldn’t even have to be a rule. Is there a rule about taking a hedge trimmer into the labour and delivery suite, or one about driving a motorcycle up and down the corridors?

    It’s a bloody hospital. The sheer number of unthinking clods that had to have been in on/aware of the decision to bring a cat into a CICU is staggering. It terrifies me to think that nobody realised that was a very. bad. thing. That lack of a specific “no pets in ICU” rule apparently made all involved just shrug, and go “Must be ok then, if it wasn’t then there’d be like… rules or something!”.

    Really? REALLY? I just… Wow. The NHS may have some issues at the moment, but CICU staff apparently not grasping that their ward is not a petting zoo is not one of them.

    As for the “cat in the dialysis bag warmer” patient, that goes beyond idiocy and into “Are you HIGH, lady?”

    I despair, I really do, and I’ve only touched on two of the anecdotes you relayed. Llamas, and other assorted (and apparently hospital approved!) non-human animal visitors, are seriously making me question the sanity of all involved.

    ^Her biggest fault, if you can call it that, was the frequent tail-breaking and tail dislocations. Spinal injuries can be costly to treat, and trying to give NSAIDs to a stubborn lab can be a Herculean task. There’s a reason that ‘dogged’ is a synonym for ‘determined’.

    It’s also embarrassing to explain that your dog’s gait is temporarily wonky due to injuries sustained during overenthusiastic wagging.

    *Dogs can be taught to drive, no really, they can, but mine would have been awful at it. Her only route would have been to the dog spa and back, or maybe round trips to the local Tandoori house.

    Enjoy:

    http://www.bbc.co.uk/news/world-asia-20614593

  8. elburto says:

    Sorry, posting glitch with my phone.

    I will say that specially trained PAT dogs can be valuable in some healthcare settings, but only in non-ward areas (dayrooms etc) or in nursing homes /mental health units/physical rehab facilities, and only for patients/residents without immune dysfunction.

    As for rabbits, I love them (recently lost my two) but obviously it depends very much on the individual bunny.

    Mine were fully litter-trained indoor-only beasties who didn’t sleep in a pen/cage near any of their waste, so they weren’t exposed to any outside pathogens or dirt. However, they were fairly large (10lbs), very fast, and way too fond of nibbling wires. Lots of wiring in a hospital.

    The smaller of the two could scale shelving, like some sort of freakish cat, in order to access cabling. She was very useful if we needed to drill into a wall though, like a furry multimeter!

  9. Jann Bellamy says:

    “Animal-assisted therapy is a complementary medicine intervention . . .”

    Oh,great. I suppose the National Health Interview Survey will add sick people petting dogs as a “CAM” therapy and further inflate the “CAM” use figures. Then we can all hear about how the percentage of people using “CAM” is rising. That will lead to the state legislatures citing these figures in support of giving dogs and cats a license to practice “animal assisted therapy.” After that, the animals can argue they must be covered by insurance under the Affordable Care Act’s non-discrimination provision. Just like the naturopaths are doing now.

  10. mousethatroared says:

    My uncle had glaucoma and a little sheltie. He still loves to talk about how, when his eyesight got really bad before his surgery, his little sheltie would lead him around the neighborhood, stopping him at streets and turning him around corners.

    I don’t know. I love my pets. Sure, I go on vacation without them, I could go to the hospital or be without them for a few months, but if I had to go to a nursing home and have no animals around for a long period of time, I don’t think life would be worth living. To me, being without an animal is like not being able to go outdoors.

    Maybe we’d all be safer in a bubble, though.

    Of course I still appreciate the information on risks (and Mark Crislips humorous, as usual, delivery). While I might think something is worth a risk (for myself) it’s good to have accurate information on what the real risks are.

  11. DugganSC says:

    Complicating matters is that there’s “service animals” and there’s “therapy animals” and the laws of various states and areas do a poor job of discriminating between the two. Theoretically, the distinction is in certification, which leads to that bit familiar to almost anyone reading a sign on a front door of a business that service animals are permitted even if no other animals are. In actuality, it’s kind of blurry, especially since, if someone claims it’s a service animal, the laws of most states don’t allow you to either bar them (unless you have a reason to also forbid service animals such as a sterile environment) or ask what the animal is for.

  12. DevoutCatalyst says:

    Our local nursing home has bird feeders outside the windows, will that do, MTR? To me being without a household pet is life at its fullest, to own a companion animal would be shackles and chains. I do feed crows, though. Anywhere around town I walk they alight above and make a racket demanding food. They sometimes follow after my car and persuade a drive-by tossing of cashews. No litter box, no trips to the vet, I scarcely know their names.

  13. WilliamLawrenceUtridge says:

    Hmmmm… a reptile dysfunction

    Oh, that’s terrible. You should be ashamed.

  14. Myrddin says:

    AAT is not a complemetary medicine. It is a psychological reaching out to another through a shared affection for an animal. If you have not been around people with performance dogs, you do not realize that a well trained dog is probably a better companion for you than most rude, inconsiderate people. Also, a well trained dog is safer in a hospital or nursing home than an uncontrolled small child.

    Seeing eye dogs, hearing dogs, service dogs all serve a beneficent purpose for the handicapped. I breed and train performance dogs (and I am a physician and my wife a veterinarian) and have also trained dogs for “therapy” work. We donate puppies to service dog organizations and have had pups who became service animals for people with macular degeneration, deaf, and Parkinson’s disease. They provide a service not necessarily what a complementary practitioner would call therapy. Their service is no less a benefit than that provided by rescue dogs, cadaver dogs, military dogs, or police dogs.

    There are also well establised benefits with hippotherapy (Horses not Hippos) for patients with balance disorders and traumatic brain injury. More recently there has been evidence that dogs can be trained to recognize bladder cancer by the smell of the urine. A well trained seizure dog can improve the independence of a patient with poorly controlled seizure disorder. Some psychiatrists have found that traumatically withdrawn and autistic children will interact with a trained dog where they would not with the human therapist. This allows the therapist to observe and gain insight on how to work with the child.

    I don’t consider AAT as a complememtary medical practice, but it can be used as a medical tool and therapeutic tool. Your issue should not be with the dog nor the practice of AAT, but rather with the unregulated and poor training of some “practitioners”. The Delta Society does try to make training of an assistance animal more uniform (much like the training of a seeing eye dog) but it is voluntary and there are no state or federal guidelines or regulations. The practice is not unlike the pre-regulated drug and patent medicine days where the drug may or may not work or may or may not kill you…Problem not pharmacy but lack of regulation and proper guidelines for use.

    I would rather deal with a dog that is trained than a physician that is either poorly trained or too arrogant to be aware of his/her limitations. Take a look at the Oath and Prayer of Maimonides and you will see that there many are resources on earth which can serve to heal and show compassion for the ill or injured. Animals are one of those resources and should be used wisely and in the right place.

  15. windriven says:

    @elburto

    “overenthusiastic wagging”

    One of the unbreakable behaviors of Labs. If there exists a friendlier breed I don’t know what it is. Sorry for the loss of yours, I hope you get another. Good dogs deserve good trainers.

    @WLU

    I am ashamed. Deeply. I had tried to walk viagra into it somehow but came up limp.

  16. goodnightirene says:

    “They do not seem to consider there may be people in the hospital with allergies who cannot simply leave.”

    This is my answer to all above who argue for pets in public places or places where the public goes to try to get well. I have severe allergies (and this is not exactly a rare condition) to many animals–especially cats–and yet when I went to a hospital in Port Townsend, Washington for lab tests, the waiting room had not one, not two, but three people there with “therapy” (not “service”) animals (at least one told me it was to assuage his anxiety!). No amount of complaint to staff, management that was called in, or letter writing following the visit would change the policy, which apparently was based on the ADA and fear of lawsuits (with only a shrug in response to my rights as someone with serious allergies). The room was small and crowded and it was very difficult to try to avoid inhaling dander.

    I’m not saying I was going to die or even suffer any serious harm, but in the case of cats, if I don’t have an inhaler with me (usually I do, but not always) I can run into some pretty serious asthma attacks and breathing difficulty. I guess the hospital is the place to be. I have had to leave many a small business, where an animal is present and sometimes I only know this when the asthma attack starts, as the pet may not be visible. But a hospital waiting room really seems a bit much. Rights need to be balanced, no? What was really aggravating is how smug these people were about having the “right” to have these (supposed) therapy animals anywhere they want to take them.

    It is amazing how quickly these comments devolve into anecdotes when the subject is pets, but I’ve been wondering about the validity of the claims of “therapy animal companions” ever since this incident in the PNW a few years ago in the broader sense of everything SCAM, not just my own experience.

  17. Harriet Hall says:

    If petting and contact with animals is beneficial for things like relieving pain, it seems to me we could find an infection-free substitute that could remain with the patient instead of just visiting. Perhaps a stuffed animal, a robot pet like AIBO, a fur blanket to stroke, watching animal videos, a virtual reality setup, etc. In fact, might a gentle massage provide just as much benefit without the infection risk? These options could be tested. Sham acupuncture works as well as the “real thing.” Maybe sham pet therapy would too.

  18. mousethatroared says:

    DevoutCatalyst “I do feed crows, though. Anywhere around town I walk they alight above and make a racket demanding food. They sometimes follow after my car and persuade a drive-by tossing of cashews. No litter box, no trips to the vet, I scarcely know their names.”

    I am a big fan of crows. You may scarcely know their names, but they probably recognized your face.

    http://www.nytimes.com/2008/08/26/science/26crow.html?_r=0

    A set of well stocked bird feeders, large windows and hopefully a view of other wildlife habitat may do (I’m also a big fan of bats, groundhogs, squirrels, fox, raccoons, mice, etc…not big on possum, but I don’t hate them)….Maybe they would let me feed the crows, deer or somesuch. But then the infectious disease experts would probably start complaining about the risk bird flu, rabies or TB. :P

    I can completely respect that someone might not want to be tied down to pets. Who knows, maybe I’ll be like that sometime in the future. But right now it’s hard to imagine.

  19. mousethatroared says:

    @Harriet Hall – “it seems to me we could find an infection-free substitute that could remain with the patient instead of just visiting”

    http://icanhas.cheezburger.com

  20. BrewandFerment says:

    I like to tease (they probably consider torment a better choice of words) my indoor only cats by tossing a handful of peanuts out onto the deck for the blue jays and squirrels to duke it out. I have been fascinated by watching the blue jays, depending upon the individual bird’s ranking within the flock, sample and consider which peanut to take away. Some will sample and reject 3 or 4 nuts before departing with the first one they chose; others will quickly swoop in and snatch before fleeing. Blue jays, of course, are in the corvid family like crows.

    Even funnier than feeders are the bouncy toys for squirrels: basically an armored bungee cord with an eye-bolt on the end of a wire cable. You screw the eyebolt into a dried corn cob and hang from a tree etc about 2 feet off the ground. Squirrel has to take a flying leap from the ground and they bounce up and down (not hitting the ground till they jump off) while hanging on for dear life as they wrestle the corn kernels off the cob.

    But cats purr in your lap and do not require daily walks. I like dogs but they are like having a permanent toddler…

  21. Myrddin says:

    Harriet–Bah–

    Stuffed animals and robots is just bunk. The point is contact with a livng creature that can or at least that you can perceive as having some sort of compassion for you. Whether the dog (or whatevr) actually does is as arcane as whether your attending physician actually does. The dog at least will not be charging you for their care!

    We all know physicians that are pretty robot like anyway (or stuffed shirts for that matter). They are not the most compassionate of “caregivers”. There are some of us who think that much of the explosion of alternative medicine is, in fact, due to the stuffed shirt, robotic, business model of medical care in the modern world. While many alternative treatments can cause harm, it is not likely that a properly trained and handled Dr Dog would do so. If they provide comfort for a person in need, good for them.

    You might try reading Leo Bustad’s book on Compassion: Our Last Great Hope. He was a veterinarian and one of the founders of the Delta Society. His essays demonstrate a particular skill that is lacking in far too many of our physician and nurse colleagues. That, perhap is why so many seek out alternative practitioners and non-human companion animals.

  22. ConspicuousCarl says:

    “WilliamLawrenceUtridge on 03 May 2013 at 10:19 am
    “Hmmmm… a reptile dysfunction”
    Oh, that’s terrible. You should be ashamed.”

    Shaming him will only make the problem worse. Well, for most people.

  23. mousethatroared says:

    I find the idea of robotic doctors and organic animals much more appealing than that of organic doctors and robotic animals.

  24. ConspicuousCarl says:

    Good idea, Dr. Hall. I’m thinking maybe a stainless endoskeleton covered with temporary living tissue which can be melted away in the autoclave and replaced with a fresh skin for each patient.

  25. Harriet Hall says:

    @ Myrddin,

    “The point is contact with a livng creature that can or at least that you can perceive as having some sort of compassion for you.”

    How do you know that? And how do you know it wouldn’t be effective to pretend that an inanimate object was real and had compassion for them?

    Actually, I find petting a dog soothing, but I don’t think of the dog as having compassion for me. I think more about about my reaction to the dog. I’ve seen animals visiting patients in nursing homes, and it doesn’t look to me as if the patients think the animal has compassion for them. They just enjoy seeing and touching the animal.

  26. @ Myrddin

    “We all know physicians that are pretty robot like anyway (or stuffed shirts for that matter). They are not the most compassionate of “caregivers”.”

    We don’t all know that, and please don’t presume to speak for the rest of us regarding what our physicians are like. That is most definitely not typical of my current or recent physicians or health care practitioners (nurses, dentists, et al)

    “I would rather deal with a dog that is trained than a physician that is either poorly trained or too arrogant to be aware of his/her limitations. ”

    I wasn’t aware that one’s options were limited to those 2 choices, which appear to have nothing to do with each other.

  27. mousethatroared says:

    HH “How do you know that? And how do you know it wouldn’t be effective to pretend that an inanimate object was real and had compassion for them?”

    Why would human’s have “compassion” and other social animals, such as a dog, not? Isn’t “compassion” just a fancy way of saying we have evolved to be emotionally motivated to care for those close to us? Why is the default the assumption that humans have some special trait that is non-existant in other social animals?

  28. mousethatroared says:

    I don’t know what’s up with my putting apostrophes in all sort of places they don’t belong. My right pinky has a mind of it’s own. Apologies to the puncuationally sensitive.

  29. mousethatroared

    “Why would human’s have “compassion” and other social animals, such as a dog, not? Isn’t “compassion” just a fancy way of saying we have evolved to be emotionally motivated to care for those close to us? Why is the default the assumption that humans have some special trait that is non-existant in other social animals?”

    I think compassion requires some understanding of the other’s situation and the ability to empathize. Non-human animals are inherently limited in these respects. (Please note that I did not say these were completely beyond animals’ abilities)

  30. mousethatroared says:

    @Karl – how do you know that non-human’s are inherently limited in their understanding of their pack (flock, etc) member’s situation or ability to empathize? How do they function as a social unit without some of these skills?

  31. mousethatroared says:

    Also the MW definition of compassion is “sympathetic consciousness of others’ distress together with a desire to alleviate it”. So the creature must be conscious of another’s distress and have a desire to alleviate it. There’s nothing in there about “understanding” another’s distress.

  32. mousethatroared says:

    I just wonder if we don’t create a bunch of romantic vocabulary and explanations for impulses that are basically herd and reproductive instincts, then pretend that OUR human version of herd and reproductive instincts is somehow special and unique. Sorry, I know that’s quite tangential.

  33. Angora Rabbit says:

    It is so interesting to read the posts – it becomes clear who shares their homes with non-humans. There are multiple studies showing that animals show empathy both within the species as well as other species. Anyone who has observed mourning behavior or the pet nudging your knee when you’re down has experienced this. Animals, perhaps because they are non-verbal, are masters at reading body language including that of other species. There are strong arguments that a major selector in domestication (especially for dogs) was precisely that ability. Read up on the studies of dogs watching and responding to human body language. I very much doubt an animal would reduce pain itself; that would be a CAM claim. But the interaction can confer strong *psychological* and emotional benefits that affect pain perception, stress levels, and quality of life. I would hope these are part of the goals in medical practice.

    Obviously there need to be controls and monitors on therapy or medical situations – a responsible organization should have accommodate allergies, infection risk, etc. This is no different from other situations that pose risk. But there are ways to do this, and a blanket “no” sets up a double-standard against other risks.

    @Mouse: thanks – I love icanhas too. And there it was – the lifeguard therapy animal. I’m so there. :)

  34. mr. grieves says:

    Let’s be honest here – whose more likely to be carrying a pathogen, the dog or the human patient in the next bed?

  35. mousethatroared,

    “@Karl – how do you know that non-human’s are inherently limited in their understanding of their pack (flock, etc) member’s situation or ability to empathize? ”

    I never said that. I wasn’t discussing animals’ pack behavior with pack members of the same species. I was writing specifically (though not explicitly) about non-human animals’ inherently limited ability to fully understand and empathize with a human’s situation. I really find it hard to believe anyone disputes this position. I can understand if you dispute the degree of limitation of that ability or whether that limit has any practical effect on animal’s ability to display sufficient compassion for a human, but I find it hard to believe you really need me to defend my basic premise.

    “How do they function as a social unit without some of these skills?”

    Which part of “(Please note that I did not say these were completely beyond animals’ abilities)” did you not understand?

  36. mr. grieves

    ‘Let’s be honest here – whose more likely to be carrying a pathogen, the dog or the human patient in the next bed?”

    I’m not sure what you think the obvious answer is, so I’ll go ahead and say, the dog rather than the person in the next bed with a kidney stone, broken hip, hernia, etc.

  37. Mark Crislip says:

    who is most likely to carry a pathogen? The dog. Half of dogs have Pasturella while at best 4% of humans have, say MRSA. Most human commensals are pathogenic under unusual circumstances while many animal commensals are intrinsically more often pathogenic for humans.

    Most humans don’t carry many pathogens, even hospitalized patients, while potential human pathogens are a normal part of the animal flora. They are just not common pathogens.

    With humans I can culture and use infection control to prevent the spread of infections in the hospital as I have written about http://www.sciencebasedmedicine.org/index.php/the-appication-of-science/ and over at medscape.

    So my hospitals, where I am in charge of infection control? The risk is absolutely higher with the strange animal entering the hospital. Your milage may vary with your local institution

  38. windriven says:

    @Myrddin

    They are not the most compassionate of “caregivers”.

    Hmmm…. mine is pretty compassionate, I think. But that isn’t why I chose her. I look first for competence and last for bedside manner. I have friends and relatives for compassion (and a wonderful dog, though I’m not convinced that she is capable of compassion in the human sense). I hire a physician for professional skills and straight truth. Compassion is lagniappe.

  39. ConspicuousCarl says:

    Also important, the patient in the next bed is IN THE NEXT BED, not in your bed and licking your face.

  40. mousethatroared says:

    @Karl – So, if I have a limited understanding of a mouse’s life or the experience of someone in Syria, then I don’t have compassion for them?

  41. mousethatroared says:

    Also Karl “I really find it hard to believe anyone disputes this position. I can understand if you dispute the degree of limitation of that ability or whether that limit has any practical effect on animal’s ability to display sufficient compassion for a human, but I find it hard to believe you really need me to defend my basic premise.”

    I’m wasn’t asking you to defend your premise. I’m asking you how you know it and if perhaps you would share. “Understanding” is a kinda nebulous word. I’m not really sure if you mean cognitive abilities, theory of the mind, some other criteria I’m not familiar with…just curious.

    I’m not trying to say that all species have the same cognitive abilities…or anything like that, though. But I’m not sure that cognitive abilities beyond a certain baseline are necessarily causally related to compassion, and I don’t know where many animals fall in terms of that baseline. Do you?

    *I completely understand if you don’t have time, though.

  42. mousethatroared,

    Do you honestly not understand what I am talking about, or or you just engaging in logical pedantry?

    Yes, depending on the degree of your limitation of understanding. If you don’t understand that the mouse is suffering (it may not be obvious), it is hard to have compassion for it. You may not be able to tell that the mouse is hungry, or that it doesn’t enjoy the food you are giving it.

    If you don’t understand why a person in Syria is upset, it may be hard to have sympathy for them either. Surely at least of some of the conflict (and lack of compassion) that goes on in the world is due to exactly this kind off lack of understanding of others.

    If you’re one of the non-human animals I was discussing, you’re far more limited in your ability to understand either that mouse or the person in Syria than you are if you’re a typical, non-psychopathic human.

  43. windriven says:

    @Dr. Crislip

    “Most humans don’t carry many pathogens, even hospitalized patients,”

    When I read this it put me back on my heels. Back in the day nosocomial infections were, as you well know, a serious threat to hospitalized patients. I had always presumed it was because so many patients were riddled with bacteria and fungi. Now I understand that it was more the paucity of meaningful infection control measures than disease ridden patients.

    Semmelweis can relax now ;-)

  44. mousethatroared says:

    @Karl – “Yes, depending on the degree of your limitation of understanding. If you don’t understand that the mouse is suffering (it may not be obvious), it is hard to have compassion for it. You may not be able to tell that the mouse is hungry, or that it doesn’t enjoy the food you are giving it.”

    Could you show me the definition of compassion you are using? You seem to be incorporating having the cognitive tools for most effectively identifying and alleviating suffering. I don’t think that is necessarily part of the definition. Merriem Webster – “sympathetic consciousness of others’ distress together with a desire to alleviate it”

    They do not talk about the ability to alleviate distress, only the desire.

    Maybe we are just using different definitions.

  45. mousethatroared

    “I’m wasn’t asking you to defend your premise. I’m asking you how you know it and if perhaps you would share. ”

    So, are you seriously asking me how I know that an animal, such as a dog, is limited in it’s ability to understand what (for instance) a person who is facing cancer surgery is experiencing and to have compassion for that person?

    I know this is the Science Based Medicine blog, and that skepticism, critical thinking, and well supported logical discourse are our bread and butter, but unless you seriously dispute my premise or consider it implausible, I don’t really see the point in taking time to answer that.

  46. mousethatroared

    “Merriem Webster – “sympathetic consciousness of others’ distress together with a desire to alleviate it”

    They do not talk about the ability to alleviate distress, only the desire. ”

    Neither did I ever talk about the ability to alleviate distress. I believe I contained my discussion to the concept of the ability to recognize (and understand the severity of) the distress.

  47. windriven says:

    @Karl Withakay

    “If you don’t understand why a person in Syria is upset, it may be hard to have sympathy for them either. Surely at least of some of the conflict (and lack of compassion) that goes on in the world is due to exactly this kind off lack of understanding of others.”

    You don’t have to go even as far as Syria. There was an opinion piece in yesterday’s Wall Street Journal about Oregon’s experiment with enrolling poor in Medicaid. Cutting a very long story very short, my suggestion that the poor in this nation received inadequate care and that the care they did receive was sometimes delivered in one of the most expensive settings available, the ER was met with disbelief and derision. Hysterical derision. I was called a liar for pointing out that the US ranked 37th in outcomes. I was told that the poor get all the care they need – and darned good care too. To say I was gobsmacked doesn’t say enough.

    I never expect much from the yahoos that populate the discussion pages at WSJ and only go there when a subject of especial interest pops up. But this sort of willful neglect of the facts and total disregard for the well-being of their neighbors was shocking to me.

    Circling back around to your point, “[owes] to exactly this kind off lack of understanding of others.”, what does one do when the lack of understanding is intentional and refractory?

  48. windriven

    “[...]what does one do when the lack of understanding is intentional and refractory?”

    Since I don’t have a serious answer to your question, I’ll just quip: I don’t understand people who think like that, so I have no compassion for them. :)

  49. mousethatroared says:

    Karl – Okay, then. It’s friday night, I’m sure we all have better things to do.

  50. windriven says:

    @Karl Withakay

    “Since I don’t have a serious answer to your question”

    Yup. I don’t imagine there is an answer. I was just venting. Don’t know how we got from fleabags in the ICU to dirtbags in the WSJ. The magic of a Crislip post.

  51. Nomadic tribesmen treat appendicitis with drinking liquid raindeer stool.
    Rates of Chrons disease and other auto-immune disorders are lower in people who have contact with animals.
    Marc’s animal phobia and germophobia fails to consider the beneficial germs that are passed on from animals.

  52. Narad says:

    I was writing specifically (though not explicitly) about non-human animals’ inherently limited ability to fully understand and empathize with a human’s situation. I really find it hard to believe anyone disputes this position.

    “Empathy” is a rather recent philosophical construction. You seem to be positing some sort of Swedenborgianism.

  53. Narad says:

    Nomadic tribesmen treat appendicitis with drinking liquid raindeer stool.

    This should be good.

  54. jas23 says:

    “Most human commensals are pathogenic under unusual circumstances while many animal commensals are intrinsically more often pathogenic for humans.”

    While animals may carry more commensals that may be pathogenic for humans, just like human commensals they usually are only a problem for individuals who are immunosuppressed AND you have some sort of extreme exposure scenario such as a bite or contact with feces. In most properly run AAT programs this –>

    “the patient in the next bed is IN THE NEXT BED, not in your bed and licking your face.”

    does not happen.

    The problem is there is too much confusion surrounding the different types of assistance animals and what their legal privileges and uses are. There are three main categories of assistance animals:

    1. Service animals: these animals have protected status under ADA, and must go through specialized training. Only dogs can be considered service animals under ADA regulations, and they must assist with a specific disability.

    2. Therapy animals: In most instances, therapy animals are animals that go through specialized training and receive certification. They work within specialized programs that facility visitation of these animals in various settings (hospital, nursing home, individual visits, emergency shelters, school programs, disaster settings, etc).

    3. Emotional support animals: These animals receive no training or certification. They receive special protections when it comes to housing, but they have absolutely no public access protections under the ADA like service animals do (despite what the owners of these animals might say or think).

    My therapy dogs are certified and work with several local programs, and soon will be certified as disaster stress relief dogs. They get full baths the night before any visits, and I bring along hand sanitizer for people to use before and after contact with my dogs. I do this more for my own safety – I am prone to getting sick and I don’t want my dogs to pick something up to pass along to me once we get home since the dogs frequent my couches and bed. I don’t take my animals to hospitals for this same reason. We mostly visit retirement homes and youth shelters.

    I agree that there is some infectious disease risk posed by bringing animals into healthcare settings, but this risk may be a wee over exaggerated, at least when well established AAT programs are in place. But a cat in the ICU? I can’t understand how they let it in the ICU in the first place.

  55. goodnightIrene says:

    @jas23

    Thanks for the clarification, but I think there might be some variation by state. Washington has some really goofy woo things codified into law. Chemical sensitivities has its own Official Day and is recognized way beyond what medicine would grant it.

    Here in Wisconsin, a woman brought her dog to my shop and very defiantly informed me that she had the absolute right to bring it anywhere she went–for emotional support. The little thing had a STROLLER. I told her I have allergic asthma and not to let the door hit her backside on the way out. I was not sued or contacted. Maybe the dog gives her the confidence to be an annoying bitch.

    Anyway, one of my newest fears is being bedridden in a home and some cheerful sort brings in the therapy dogs. I’m happy to hear you bathe them because that would help a lot to avoid dander, so I hope this is a universal practice.

    I think I’ll play it safe at the home and keep an Epipen nearby in case someone brings in a cat, rabbit or one of those tiny horses. I had to have Epipen for all of these when I had allergy testing, and sometimes following the shots as well– (horses, not specifically tiny horses).

    By the way, what kind of therapy do the therapy animals provide? Is it more than emotional support?

  56. ConspicuousCarl says:

    jas23on 04 May 2013 at 1:33 pm

    “the patient in the next bed is IN THE NEXT BED, not in your bed and licking your face.”

    does not happen.

    Maybe not when it is a trained service animal controlled by a professional handler, but it does happen when a nursing home has a house pet.

  57. jas23 says:

    @goodnightIrene:

    yes, many states have their own regulations as well, I think what I was trying to illustrate was that these things terms have legal definitions and aren’t interchangeable, despite the fact that they are often incorrectly used that way. This site is a good resource for state regulations regarding service animals and emotional support animals for the northwestern states:

    http://www.dbtacnorthwest.org/tools/pwdtools/serviceanimals/matrix

    I hope there are equally clear and concise sites for the rest of the states but since I live in the NW those are the resources I am already aware of for regulations.

    My therapy dogs are registered through Therapy Dog International (TDI), although there are other national organizations and many cities have local regulations. TDI has very specific rules that must be followed during visitations to facilitate the health and safety of everyone. Most important rule: when visiting we don’t just dally up to every person, only people who have an interest in meeting the animal. I prefer to be located in a specific area and have people come to the dogs, but I will go to people’s rooms on request, never uninvited. I’m sure not all programs or handler’s do it quite right, but my experience thus far has been that the program directors and handlers are very conscious of making sure we provide a positive experience for everyone and have great respect for those who do not wish to be near the animals.

    And yes, my animals are for emotional therapy/stress relief only. We also occasionally do school programs where we come in and kids who are shy or struggling in reading can read out loud to the dogs. Soon, we will be certified to provide stress relief for disaster victims and responders as well. My experience with AAT has not been for any purpose other than this, and it is a shame that some people/programs are getting it mixed up with CAM by claiming benefits beyond this since that will inevitably hurt the validity of these programs in the long run.

  58. Blue budgie says:

    I would rather an animal visit in hospital than kids and “ronmates” talkative relatives . another peeve-anyone stranger relative pervert or criminal can just walk in to hospital and go right to patient ward. NO protection for vulnerable patient. I doubt a visiting dog has ever assaulted a patient or stolen their wedding ring

  59. windriven says:

    @jas23

    I’m sure your animals are well-trained and well-groomed. I would even concede that animal contact may be emotionally positive for some patients. But facts are facts. Animals shed, they carry diseases and in general don’t belong in hospitals. Some people are allergic to their dander.

    Restaurants generally do not allow animals in seating areas other than service animals and that only since ADA. I would not object to a guide dog for a blind person accompanying a diner into a restaurant that I was patronizing. I would accept that as a necessary evil as it allows the blind patron access that s/he otherwise couldn’t have. But some nut with a pouch poodle because it gives its owner the warm and fuzzies? Not a chance.

  60. goodnightirene says:

    Thank you jas23 for elaborating, but I still have questions about the efficacy of this “treatment”. You do not mention allergies, for which the only accommodation is strict avoidance. It is not clear to me that the precautions you take (which may or may not be effective for allergic persons) are codified or simply your own personal effort to be considerate. I have no doubt that you are careful to not put the animals in contact with people who don’t wish to interact with them–great, but this doesn’t deal with my issue of allergies, and more specifically the more life-threatening allergic asthma.

    I remain with Dr. Crislip on this. Medical facilities are not the place for other species. One person’s stress-relief is another person’s stress-inducer.

  61. goodnightirene says:

    @windriven and elburto

    I don’t see how a dog (especially a little lap dog) sleeping on the couch or in a bed is bad behavior or equivalent to barking at, jumping on, biting, owner not picking up poop, or whatever other bad manners are often seen with dogs. I know lots of people with lovely, well-behaved dogs who have them on furniture or beds in their own homes and both the dogs and the people seem very happy with the arrangement.

    Many years ago when I had a little dachshund, she lived on the couch or in the kids’ beds–they love to be under blankets and will look a way under any such lying on a couch, bed, or in their baskets. My son has two of them and they send me pictures all the time of the pups sleeping on one of the (also asleep) kids and it is truly “awwwww” inducing. Although I can’t spend much time in his house (I take my trailer to visit them), I’ve never seen the dogs misbehave in any way. My son is very strict with his children and no less with the pets.

  62. jas23 says:

    @goodnightIrene

    The preparation and precautions I take on visits are in fact codified in by the certifying organization AND the site specific AAT program. I think there is a misconception that AAT programs consist of random people who bring any such animal into a place and force them on everyone in that facility. Individual facilities have their own programs run by facility personnel and they schedule volunteers to come in at specific visitation appointments. I in no way mean to undermine that fact that there are poorly run AAT programs, but that is typically the fault of the facilities volunteer director failing to have proper protocols in place, not the volunteers themselves. Those programs often do not last long. I’m actually quite surprised by the assumption that people who volunteer their time for AAT programs would lack such considerations, it is not like we do it for our own emotional health, we are trying to make a positive impact on other people who enjoy the program.

    As far as allergies go, in my experience most facilities that have allergic individuals will hold the visitation outdoors or in a large common area where those individuals can completely avoid contact during that time. Walking a dog down a common hallway to get to a requested room is unlikely to pose a threat to person’s allergies unless the animal is not properly groomed (again, a requirement by both the certifying organization and the site specific program). ***I have no idea how hospitals run their programs because I do not volunteer in hospitals.*** One rehab shelter I worked at shut down the program when a new resident came in with allergy induced asthma and resumed the program after that individual moved out. A few residents from that facility scheduled visitation at a nearby park through their facility director during the time the program was halted, and it was great that the facility was able to accommodate that since the residents could not leave the facility without facility chaperones. I have a number of individuals that have really bonded to my dogs and view them in a way as their own. When I got my newest puppy, many of my regulars talked for a year about their excitement to meet her (dogs must be >1yr to become certified with the organization I am certified through).

    Unfortunately I think this article lumps actual AAT programs together with individuals with personal ESAs (emotional support animals) without recognizing these are two separate things. To stereotype and generalize for a moment – people with ESAs tend to be the individuals that want to bring their animal anywhere and get belligerent, claim ADA protections, and have no consideration of others (perhaps their emotional probs prevent them from feeling empathy for others?). Federally at least, those animals DO NOT fall under ADA. While ESAs may be of benefit to some individuals, the term is often abused by people who want to bring their animal everywhere, and psychiatrists who recommend ESAs to their clients are likewise not always good at clarifying regulations surrounding these animals. At least in my county, for an ESA to be protected by the Fair Housing Act the person needs to show medical documentation of the need.

    But it is not really fair or appropriate to dismiss the benefits of well run and organized AAT programs or AAT in general because there are a*holes in the world that abuse the system because they don’t want fluffy to every leave their side.

  63. jas23 says:

    and i apologize for my atrocious spelling/grammar in that last post…it’s finals week ;)

  64. windriven says:

    @irene

    I can’t speak for elburto but my position is that each trainer needs to establish the relationship that will exist between the human and the canine. I believe in a relationship based on mutual respect but also one that does not indulge in anthropomorphism.

    My Lab was crate trained from a puppy; that crate is her space, her safe place. I do not intrude on it when she is in it. For instance, when I vacuum she heads immediately for the crate (what is it with dogs and vacuum cleaners?)

    She has free rein in the house except that she is not allowed in the kitchen (because she would be underfoot and could be burned or cut with a dropped knife if she tripped me or something was dropped. It also discourages her from claiming bits of food that leap to the floor. She is not allowed on the furniture. She has a crate in my bedroom and in the great room and she invariably retreats to one of those when she wants to sleep or wants to get away from bothersome visiting children (a rarity as she loves kids until they get overly demonstrative). She has an identical crate in the back of my Forrester.

    She is not allowed on the furniture or in or on the bed. But then she has never showed the slightest interest in doing that even when visiting dogs jump gleefully on the sofa (I discourage that too but am unwilling to declare open warfare with my eldest daughter over it.

    Dachshunds have short hair where as Labs shed copiously. Your grandchildren clearly do not suffer allergies related to canine dander. And ultimately, it is your business not mine. I would not and I suspect that elburto would not criticize any owner over furniture policies in their own home. In my view your only responsibility to the general public is to keep your animals from barking at night (or incessantly at any time), from rummaging around outside of your yard or control, from unloading solids on property not your own unless a plastic bag immediately collects the issue, and from jumping on or otherwise having physical contact with other people unless specifically invited to do so.

    For me these things are easier when there are clear guidelines set from early puppyhood. As with children, there need to be clear rules and enforcement must be consistent. Most dogs respond extremely quickly to this. They are, after all, quite social animals and they rapidly come to learn the rules.

    My eldest daughter allows her dog – a 70 pound mixed breed – to sleep in bed with her and her husband. Not on the bed. IN the bed. She generally makes an effort to enforce some other rules but they aren’t consistent. The animal – a potentially fine dog – doesn’t have a clear understanding of what is expected. I’m not blaming the sleeping stuff but …

  65. inconscious says:

    When did SBM turn into a forum for a doctor that isn’t fond of domesticated animals to rail on patients getting comfort from said animals?

    Why not focus on the real source of major nosocomial infections? I.e. people.

  66. WilliamLawrenceUtridge says:

    @ inconscious

    You should read this.

  67. windriven says:

    @inconscious

    “When did SBM turn into a forum for a doctor that (sic) isn’t fond of domesticated animals…,”

    Oh, its been 3 or 4 years ago now as I recall. And what a fine addition he’s been.

    If you have evidence to dispute Dr. Crislip’s position on the bacterial baggage of canis lupus fleabagus, cite it. You’ve been around long enough to know that’s how it works here.

  68. Mark Crislip says:

    “Why not focus on the real source of major nosocomial infections? I.e. people.”

    Cause the topic was pets. Duh.

    I don’t like walnuts

    Well, why not focus on the real source of nutty deliciousness that is peanuts?

    I do focus people. That’s my other not so secret life. Just saw the recent data: in 2008 we had over 450 nosocomial infections in our 5 hospital system where I am in charge of infection control. last year? 150. I have the W-2 to prove it. Infections have gone down every year for the 23 years I have been Chair. Maybe we can get it to zero before I retire. I don’t want my patients to get any infection in the hospital: from staff, from visitors or from vermin, er, pets.

    An oddly, there has not been a single advance in infection control that has been related to application of a SCAM. Go figure.

    http://www.sciencebasedmedicine.org/index.php/compare-and-contrast/

  69. goodnightirene says:

    @windriven

    I don’t get the long rundown on your personal dog rules. Everyone has his/her thing about dog behavior in the home, so why go on about your abhorrence of dogs in beds? My doxie sheds a LOT–which is why she has her own little bed in the bed. Since I’m an anthropologist I must clarify that anthropomorphism applies to wild animals–nor do I see letting the dog in the bed as anthropomorphism in any way. I don’t let her in there because I think she’s human or attribute human characteristics to her, or (goddess forbid, dress her in silly “dog” clothes), but because she is a lap dog and used to being with people–that’s the whole basis of the dog/human relationship.

    Personally, I abhor those crates and would never, ever use one, but I accept that they are all the rage and considered by many to be the ideal mode of keeping a dog (evidence?). Seems to me it’s just a convenience for people who are gone a lot. I’m home most of the time, so see no need to confine my dog–who pretty much confines herself to the couch or her basket.

    No, the grandkids don’t have allergies, but if they did, it wouldn’t help much to keep the dogs off the furniture as I can attest as an allergic asthma sufferer. I’ve gone through years of twice-weekly shots to barely tolerate this little dog and cannot yet be around a cat for more than 1/2 hour (which is up from about two minutes).

    I always appreciate your comments and sardonic wit, and am somewhat taken aback at your strong reaction to this topic. I promise not to let my dog jump on your couch (actually she’d have to be put there being too small to make the leap), but yours can have a crate at mine even though it will pain me. Fair enough?

    @jas23

    Thanks again for all of that. I have no quarrel with your intentions or the good that many people may derive from your efforts, but I still agree with Dr. Crislip on this issue. Thanks for pointing out that people with allergic asthma are far more vulnerable than those who “just” have allergies and I’m pleased that this was taken into account and accommodated at the facility in question. Many people don’t get this distinction.

    I very much appreciate the information of the distinction between what you do and those wretched souls who behave exactly as your describe with their ESAs and I will no longer be intimidated by them.

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