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Medical Care Considerations

Medical concerns and treatment goals should be adjusted accordingly for assistance dogs to attain the most rapid resolution and thus a rapid return to work. A mild problem or inconvenience such as soft stools for a pet may be a significant problem for an assistance dog because it can be very difficult to clean up afterward and the dog may even have accidents in areas in which pet dogs are not permitted, resulting in potential public relations nightmares and time off from work. An ear infection can pose a significant distraction to a service dog because of discomfort and constant itching and shaking of the head.

Side effects of medications can affect an assistance dog’s work. For example, steroids can impact urination; increase drinking and hunger, leading to significant distraction; and cause accidents that result in the dog being pulled fromwork. Any medication that can cause sedation or drowsiness can potentially affect a service dog’s work. Whenever prescribing medications to an assistance dog, it is important to discuss the potential side effects with the client.

Although prognosis might be comparable for two different treatment options, quicker return to function will result in less time off work and should be the key factor in considering therapeutic options. For example, long-term prognosis might be comparable with conservative versus surgical management of cruciate disease but a significantly quicker return to function may be possible with a geometry modifying procedure (such as TPLO or TTA).

Service dogs may be more prone to particular injuries based on the nature of their work. Damage to paw pads can occur from hot pavement or from salt residue on the sidewalks and streets, and paw pad lacerations can occur from broken glass present on the ground. The use of booties during work can prevent many of these injuries. Even the best guide dogs may sustain trauma from unpredictable vehicles or loose dogs.

Certain medical conditions may be incompatible with an assistance dog’s job. Medical conditions that seem incompatible with service work may not preclude continued service once well managed. For example, epileptic dogs can often continue their roles as assistance dogs once they are acclimated to medications and when seizures are well controlled. It is important, however, to make sure clients are aware when starting these medications that the dog may experience drowsiness and decreased attention to detail initially, in which cases their work should be suspended or supervised until acclimated.

Although dogs are typically neutered before becoming servicedogs, a practitioner may be called upon to care for foster breeders froma service dog organization. It is important to avoid any medications that could impact reproduction or have negative impacts on pregnancy, such as metronidazole, which has been shown to cause embryotoxicity or congenital malformations,74 or steroids, which have been implicated in the cause of congenital malformations75 and may induce premature labor.76

It is also unclear how much systemic absorption there is of topical medications containing steroids (such as topical ear or ophthalmic medications). Thus, consideration of possible side effects must be made before prescribing these in pregnant bitches.

Vision and hearing are particularly important in service dogs and should be assessed at all routine veterinary appointments. The American College of Veterinary Ophthalmologists provides free ophthalmic exams to eligible service and working dogs administered by participating ophthalmologists through the National Service Animal Eye Exam Event, which typically takes place every May. Maintaining a healthy weight and body condition is important for all dogs but should be emphasized with service dogs because it is associated with improved health and longevity and can decrease the risk of degenerative joint disease, 77 a leading cause of retirement in working dogs.78

Although assistance and therapy dogs are generally calm, highly trained, and gentle, they can still be fearful in the veterinary setting. For this reason, gentle, low-stress handling should always be used. In addition, the veterinary team must request permission from the handler before interacting with and handling the dog. Service dogs wearing harnesses or vests are typically “on duty” and should not be handled until these have been removed.

Medications and discharge instructions need to be understandable and accessible based on the client’s disability (e.g., use differentsized pill vials if more than one medication is dispensed for a dog with a blind handler). Administration of a liquid medication may be more difficult, so preloading single-use syringes or tablet/capsular medications may make administration easier and more reliable. Communications and the mode of communication need to be individualized based on the client’s disability. There should be a discussion with the client about their preferred method of communication. Minimize background noise, face the client, and speak clearly to hearing impaired handlers. Other clients may need to use pen and paper or a text app to communicate.

Consultation with veterinarians from the organizations that trained the assistance dog may be useful for several reasons. These include better understanding the prevalence of heritable disease, determining whether testing to obtain a better understanding of factors that influence a dog’s working ability has already been performed, and gaining insight into financial options that may be available to the working team. Additionally, the organization that breeds and trains service dogs may track medical conditions that occur in their dogs for purposes of future breeding selections and research to find disease-associated genetic markers.

Practitioners may want to consider offering discounts or waiving fees for assistance dogs. Most of the not-for-profit organizations training assistance dogs do not receive federal funding. Nonprofit discounting helps the client and furthers the organization’s mission to assist people by decreasing its financial burden.

Because service dogs accompany their handlers everywhere, they typically travel much more than the average pet. USDA-accredited veterinarians treating service dogs may be called upon to assist in fulfilling requirements for international travel. These standards vary greatly from country to country and may include rigorous testing such as antibody titers, fecal floatation testing, vaccinations, examination and submission of permits and health certificates, and external and internal parasite treatments that are time dependent on travel dates.79

Depending on the organization, foster dogs (puppies or breeders) may go to local veterinarians for medical attention. Treatment decisions and veterinary bills are typically directed to the organization’s staff veterinarians. Some schools ask foster caregivers to pay the veterinary bills up front and may be reimbursed later. In addition, some organizations maintain ownership of their dogs while they are actively working with the handler. It is important to discuss who is responsible for financial and treatment decisionswhen a service dog or service dog in-training is brought to a veterinary office.

Handlers and assistance dog clients typically have a high level of attachment to service dogs because they permit people to function in ways they would not otherwise be able to.80–82 It can be difficult removing an assistance dog from its work because of this attachment and the client’s reliance on the animal. Therefore, careful consideration must be given on how the person will function without relying on the animal when the dog is hospitalized, placed on medical leave, or suspended or retired from work. Because of the extremely strong animal-client bond and the client’s reliance on the dog’s work, client discussions about retirement of a service dog because of health concerns can be very difficult. Similarly, end-of-life decisions can be incredibly difficult and emotional.83

The age of retirement can vary based on criteria for retirement from their organization and the dog’s occupation and breed. Many experts consider 9 years of age to be a traditional retirement age. The most important consideration at the end of a dog’s service life is the determination of when the dog’s limitations jeopardize the safety of the handler. In such cases, the dog should be retired.83 The most common reasons for early retirement in guide dogs are musculoskeletal conditions followed by skin conditions and nervous sensory conditions.79

Because the organizations that qualify therapy dogs are nonprofit, annual registration fees usually cover the cost of operations and liability insurance for pet therapy teams. In addition, the sponsoring organizations are typically responsible for determining that therapy dogs are up to date on veterinary exams, core vaccinations, and prevention of zoonotic disease.35

TABLE 3

Healthcare Recommendations for Assistance and Therapy Dogs
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Healthcare Category Assistance and Therapy Dog
Preventive care
  • Standard canine preventive care based on lifestyle: vaccines, parasite (including HW), etc.
  • Annual wellness screening tests (e.g., biochemistries, fecal analysis)
  • May travel extensively with owner; therefore, preventive care may require a more global approach
  • May need frequently updated health certificates for travel
Behavior
  • Be aware of and prepared to address
    • Highly trained
    • When not in harness or vest, dog is not “working”
Nutrition
  • Adjust based on activity level of their job/MER
  • Encourage compliance with AAHA position on raw diets owing to exposure of some of these dogs to immunocompromised patients
Reproduction
  • Puppy stages (before being in service)
    • Discuss age of desexing based on orthopedic risks and breeding potential
Common injuries
  • Blunt trauma: HBC, falls
  • Burns and cuts (advise booties in inclement weather)
  • Risks vary based on environment (hot, cold surfaces)
  • Local dermatitis such as harness rub
  • Bite wounds
Common diseases
  • Based on age, breed, lifestyle
  • Early intervention and accommodation for all disease processes are encouraged
  • Osteoarthritis from increased load or strain (i.e., mobility/ balance)
Handling
  • Should not be handled or examined while in harness or vest (working)
  • Understand/identify special commands
  • Presence of handler advised
Screening for heritable diseases
  • Note training facility may have already run these
  • Orthopedic, cardiac
  • Breed dependent: DM, PRA, MDR1, EIC
Mental/emotional considerations
  • End-of-life or end-of-career decisions may and require additional considerations/ accommodations
  • Fatigue and burnout
  • Breaks appropriate for intensity of work?
  • High level of attachment to handler
  • Separation anxiety
First aid
  • Toxicity (e.g., human medications)
  • Minor wounds
  • Bite wounds
Triggers for retirement
  • Hearing or vision loss
  • Addison’s disease (depending on service)
  • Any severe disease that impairs the dog’s function
  • If handler cannot handle long-term treatment needed for dog
  • Loss of interest in job
Needs of handlers
  • Disability may impair ability to treat dog (e.g., eye drops)
  • Accessibility of hospital
  • Discharge letters/ medications labeled such that client can get the information
  • Dog-proof the house to prevent FB
Needs of owners
  • Usually as above (or as below)
  • Who is paying the bill?
  • Practitioners may discounts
Needs of organizations
  • Varies depending on organization
  • Some maintain ownership
  • Update to help in breeding for the future
Possible exposure risk
  • Human pharmaceuticals

These guidelines are supported by generous educational grants from the AAHA Foundation,
Boehringer Ingelheim Animal Health USA Inc., CareCredit, Merck Animal Health, and Zoetis.

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