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Medical Alert Dogs

Shih Tzu Medical Alert Dogs

Overview

There are many types of service dogs. Service dogs are dogs of any breed (purebred or mixed) that are trained and certified to be of assistance. One of the most interesting and helpful types of service work that dogs do is 'work' as a medical alert dog for their owner.

You may already be aware of how great the Shih Tzu breed can be at doing this. Since this breed is known for being clever, lively, outgoing yet gentle, friendly and loyal, Shih Tzu make fantastic medical alert dogs.

This section is going to include:
  • An overview of exactly what these types of service dogs do
  • An introduction to a beautiful Shih Tzu that is a medical alert dog to her owner 
What Medical Alert Dogs Do 

The official definition of service dogs by the American with Disabilities Act is: "…any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability."

When it speaks of a physical disability, medical conditions are included in this. The definition continues to note that some examples of what these dogs can do include "alerting individuals to the presence of allergens" and "retrieving items such as medicine", though there are far more tasks that can be done on an individual's need. 
There are 5 basic sub-categories:

1. Autism Service Dogs - The dog helps the owner process situations and when several elements are all happening at once, aids in alerting the owner to focus on the most important element.  

2. Hearing Dogs- The dog alerts deaf or hard-of-hearing owners to sounds. This includes everything from the ding of the microwave, to the doorbell to someone calling out to the owner. 

3. Mobility Dogs - These dogs help owners that have physical impairments that effect mobility. They perform everyday tasks such as turning lights on and off and opening doors. In many cases, a small dog like the Shih Tzu would not be cut out for such a job, since part of this can include moving larger objects such as laundry baskets and to walk closely by an owner's side to provide stability to help prevent falls. 

4. Psychiatric Service Dogs (PSDs) - These dogs assist individuals who suffer from psychiatric disorders. Only some states in the US accept PSD's as official service dogs, which limits the public places to which they have access (restaurants, etc.)

5. Alert/response dogs - The dog will know when a medical event is happening (a seizure is going to happen, blood sugar is low, etc.). He will alert the owner and then respond and assist (this can be done by bringing medication, getting help if necessary and even knowing when to call 911 via a special phone). 
Types of Service Dogs Chart
Medical Alert/Response Dogs

The specific type of service that we are going to focus on today is when a Shih Tzu acts as an alert/response dog. 
Some examples of medical conditions that dogs can alert, respond and assist with include:
  • Diabetic alert - The dog will alert an owner when sugar levels are either too high or too low. 
  • Allergy alert - For people who have severe allergies, the dog will alert the owner if an allergy trigger is in the area. This includes certain foods such as peanuts and shellfish. 
  • Blood pressure - Some dogs are able to sense when an owner's blood pressure is too high.
  • Sleep Apnea - With this condition, a person temporarily stops breathing while sleeping. The dog will nudge the owner awake and assist as needed. 
*Most of these dogs are trained to call for help via a special canine alert phone should an owner become unresponsive. 
*One of the important aspects of service dogs is that they are allowed into public areas that normally do not allow dogs. 

How a Shih Tzu Becomes a Medical Alert Dog

In the US, due to the Americans with Disabilities Act (ADA) of 1990 (which has been updated since its inception), a dog that is specifically trained to assist his handler and meets certain qualifications can be a medical alert dog. The dog does not need to be officially certified, however it is recommended as this gives more validity in regard to other people who may question the dog's role and gives the owner assurance that the dog is able to do what is needed. 

There are many organizations that train dogs for the needed commands and tasks. While some breeds are best at certain jobs (larger dogs do best with mobility issues, etc.), federal law does not restrict any breed from any type of service work. No breed, even mixed breed, can be banned. For this reason, many Shih Tzu dogs act as service dogs, either trained since puppyhood via an organization or when showing a natural ability, the dog transitions from pet to additionally being a medical alert dog. 

A Shih Tzu will undergo extensive testing to ensure that the dog has the personality, manners, obedience, socialization, and skills to serve as a service dog. A service dog must demonstrate or perform a task specifically related to the handler’s particular disability or need.  

One of the larger groups that oversee this is Assistance Dogs International. Groups such as this can match a trained dog to an owner in need of assistance, and price of this can be as low as $50 or as high as $10,000 or more.

For some fortunate owners, a Shih Tzu will show a natural ability to 'alert and respond' to a person's health condition. If this is noticed, that owner can then go through the steps needed to make things official. 

And this brings us to meeting Angel!
Shih Tzu Medical Alert Dog
Angel, the Shih Tzu Medical Alert Dog

Angel is a 12 year old Shih Tzu, belonging to Linda Sanborn of Green Valley, AZ. At the young age of 4 months old, she started showing signs of having a natural ability to be a medical alert dog (Approximately 10 to 20% of canines, without any training at all, will show that they are able to sense health conditions and from there, an owner can take steps to further the training).

By the age of 1 and 1/2 years old, she became an official service dog to assist Linda and has helping her ever since. 
What she is capable of doing is rather remarkable and she has detected more than one type of health condition.

Linda has been gracious enough to tell us all about this, so let's read on to learn more about this beautiful Shih Tzu:

Q: Hi, Linda. Thanks so much for sharing this story. Can you tell us about when you first got your Shih Tzu?

A: I purchased my Shih Tzu in April 2004 from Jim and Gloria Blackburn of Ming Dynasty Shih Tzu, located in Kernersville, North Carolina. The Blackburns are show breeders and have shown many of their Shih Tzu and have many male and female champions to their name. I was looking for an AKC registered red and white Shih Tzu with black tips. I originally contacted a breeder in Texas, but after a year of not being able to offer a Shih Tzu of that exact coloring, she referred me to Ming Shih Tzu. 

I have had seven other Shih Tzu in the past. I had always picked the puppy. This time, the puppy came out, circled me, climbed up onto a 'puppy sofa' and jumped into my arms, licked me on the face and played with me. She picked me - not the other way around. I knew we were meant to be together.
Q: Can you tell us about the first time that your Shih Tzu showed you a sign that she was aware of a medical issue that you were having?

A: When we got home, she began waking me at night. Not just once but four or five times a night. First it was a bump from her while lying against my back. I would get up and let her out to pee, thinking that since she was so young her bladder was small and she needed to go often. But she kept doing this. After going to the veterinarian five times I saw the senior veterinarian. He told me "There is nothing wrong with your Shih Tzu, there is something wrong with you! She is alerting to that problem." He began explaining that she was what is called “a natural responder”. Natural responders are far and few between but they do exist. He knew because he had a service dog.

A natural responder is a dog that has the ability to sense a medical crisis happening to its owner. It isn’t a trained skill. In fact it is difficult to train a service dog to perform alert work for many medical conditions. This skill may simply be because the dog becomes so bonded with his or her owner and in tune with the owner’s medical condition that the dog develops his or hers own alerting skills naturally and can sometimes alert to a condition not known by the owner and the alert action is not recognized.
Q: Wow, so based on this, you were prompted to find out if you did indeed have a medical issue?

A: Yes, I made an appointment with my internal medicine doctor. That doctor referred me to a cardiologist and neurologist. The neurologist discovered I had sleep apnea. I would stop breathing up to ten times a night depending on how tired I was. Angel would bump me or jump in my face and breathe on me as a way to wake me. The doctor put me on a c-pap machine and for a while Angel would only occasionally bump me.
Q: And we believe that your Shih Tzu additionally was able to discover another, completely unrelated health condition?

A: Yes, a new trigger began. She would jump violently on my chest and make me gasp for my breath and shock me out of sleep. I told the cardiologist about what she was doing but he dismissed it. I was having difficulty climbing the stairs or climbing out of bed at night to go to the bathroom. But when I would get back in bed and lay down I couldn’t breathe.
Shih Tzu medical alert dog with owner
Finally the doctor did a heart catheterization. I had a blocked heart artery - what they call the widow maker was 95% blocked. They put in a stent. I believe Angel kept me from having a heart attack. 

Also, the cardiologist said my blood pressure would either go way too high if standing for a long time or if I was having a migraine. Angel would try to signal me of my problems. For instance, if I was home and I wasn’t feeling well I would struggle to stay up but she knew better. I have a ramp that is by my high four poster bed so that she can come on and off the bed by herself. She would get on the bed and bark for me to come join her on the bed and lay down when she knew that was what I needed to get my blood pressure and headache to ease.  

Another example was if we were out shopping she would jump up on me to trying to push me down. If I found a place to sit down she would respond and sit quietly beside me.

Q: Is your Shih Tzu able to help you with medication needs? 

A: She is great at that! The cardiologist and internist combined had placed me on medications I was to take three times a day. Like many older people I forget and time goes past when I am to take them.  

She has an internal clock as well as she can smell the difference in my chemistry. If I go about an hour over for my medications, she will begin alerting. She herself is now on medication and will also alert me if I am overdue to give her a dose. 

It started out innocently enough. I placed all my medication on the backside of the pantry door in the kitchen door. Most of the time it would swing open. The computer was downstairs near the pantry door and I would be on the computer. She would come over and jump on my leg and bark at me. I would first question what she wanted and of course she wouldn’t leave me alone. Finally she would go to the pantry door look up at the pills and bark, thus making me realize that I needed to take my pills. I would reward her with a treat so that the skill was rewarded.
Shih Tzu on blue chair
Q: And she even added another type of alert to her remarkable skills?

A: Yes, in November of 2010 the doctors decided I needed to have two thirds of my colon removed. I had to be seen by my cardiologist before having such an extensive surgery. While talking to Dr. Duber I told him my Shih Tzu had begun jumping on my chest again at night and I was feeling really fatigued. He did some tests but couldn’t find anything except leakage at my aorta. I didn’t feel he heard what I was telling him about her jumping on my chest shocking me awake.
After the surgery had been done I was in my fifth day in the hospital when I was awakened by the crash unit around my bed. The nurse said my heart had gone to zero and two other nights it had gone to 20 and another night to 10. It occurred to me that Angel had been doing her own kind of CPR. More testing was done while in the hospital and it was determined I needed a pacemaker. It only showed up because being a pet, she couldn’t be on that floor of the hospital which was cardiac and surgery. I felt she was my guardian angel twice. She was alerting I had blocked arteries and my heart was stopping.

Q: Did your Shih Tzu have any sort of command or general training when she was a puppy? Before specialized training as a medical alert dog?

A: Unrelated to the specific training for being a service dog, I enrolled her in Petco's basic training. She went through Puppy, Intermediate, and Advanced and then received her AKC Good Citizenship training. She completed everything before she was a year old.  
Q: Though she was doing all of this naturally, you decided to have her trained to become an official medical alert dog. Can you tell us what was involved with all of that?

A: When she was 1 year old, had her AKC Good Citizenship Award and I knew she was a natural responder I sought out Delta Society for help in finding a service dog trainer near me in southern California. I was referred to Twyla Seymour in the Big Bear area of southern California. Her organization is called Angels in Fuzzy House Slippers

The steps that we had to take were:

1) First I had to get a prescription from my doctor stating she met the requirements to be a medical alert service dog for me.  

2) Before being able to start training, she had to go through a test to see if she had the personality to be a service dog.

The dogs that were in the program were allowed to crowd her and walk in and out around her barking. It scared me but not her. She didn’t flinch. They dropped garbage can lids, banged cymbals and drums, opened and closed umbrellas near her ears just to see how she would react. The last test was children passing by her on roller skates and skateboards. The children had to be able to pull lightly on her tail without her reacting. 

She passed all the personality tests. 
3) For the service dog training, there were 2 parts. If a dog is not able to complete the 2nd stage, he or she can still be a medical alert dog; however the owner is not able to receive certain tax benefits related to this. 

The 1st stage was for us to work as a team. We also learned more cues to use in large crowds; what manners to use in restaurants; how to handle stressful moments; how to go to a movie and handle loud noises such as concerts. The more environmental exposures, the more relaxed she became in any given situation. 

The second stage I could never get her to pass. Though she did not pass the 2nd part, she is still my official medical service dog; the difference is that I am not able to receive certain benefits.  
Part of the second stage test requires that there may come a time in the future that the animal may have to be separated from the handler possibly for medical reasons. So the test is the animal is taken a fair distance away from its handler, the dog is tied where the dog cannot see its handler and put in stay position. I can’t remember how long the command is but no one is left with the dog. She can’t pass this test. If she can’t smell, hear or see me she begins to panic. She will bark and tug to try to get loose to find me. 

The second part of this test she fails is the required test in the car. Because most service dogs handlers have a handicap that requires some time to unload from the car, the handler has to have time to get out of the car and then open the back door and give the command “okay “or “come”. The minute we get to the garage she is at the side door. 
Shih Tzu wearing service dog vest
Angel, wearing her service dog vest and ID tag, showing that she is a medical alert dog
When I open my door to get out she is scratching at the door to get out. We have tried giving the command sit and stay, not opening the door until she does do those things but once I open the door she is almost in my arms before the door is completely open! It is frustrating. She is so smart! She has never been left in the car! So I can’t imagine what she is thinking.

Luckily, the second stage of the test is not required for the certification to be completed. The second stage of the test does have benefits though; you can receive tax benefits for the dog's food, dental, vet bills and grooming.

Q: Now that your Shih Tzu is older, have things changed in regard to how she is as your service dog?

A: She will be 12 on December 16th this year. She is still alerting to my needs. Our life is at a slower pace these days. She has almost as many medications as me. But until she stops alerting, as long as she can see and hear, she will still be my service companion. We are both now seniors. We both care for each other needs.  

She still plays with her toy ball that talks to her. She can make herself totally flat and crawl on her belly under the dinning cabinet to push the ball out from under the cabinet. All you can see is this collection of fur and legs flying like she is swimming to get the ball. The way she maneuvers to get out from under the cabinet is amazing. I wish I had a video of it for later memories of my baby girl. 

Like many Shih Tzu, she can do tricks. But this isn’t a trick... This is an announcement that it is getting time for her treat or medications. She lays her belly flat on the marble floor. Her head is down on the marble floor flat. The legs out to the side and tail straight out to the back. She is looking straight at you without lifting her head. She does a low woof and her belly lifts up without lifting any other part of her body. Count to ten and she does it again and she repeats this until you acknowledge her demand or tell her wait! This is why her AKC name is “An Angel in the Making”.
Medical alert Shih Tzu dog standing
Q: You mentioned that she is taking medication? How is her health?

A: Unfortunately, she has Cushing’s disease now. She is on two blood pressure medications. Some of the medications are Trilostane, Tacrolimus eye drops, Occu-Glo Rx vitamins for her eyes, Denamarin and more. She still keeps both of us on the clock for medications. We disguise her meds in small melon ball scoops of canned Hills DD Diet coated with powdered dried liver.  

She is hungry all the time now. It is a challenge to distract her from this part of Cushing’s. She has had this disease now over a year. They tell me her Cushing’s is in the pituitary gland. 
She has two specialists - a dermatologist treating the skin part of the Cushing’s disease, and Ophthalmologist since her eye was cut when groomed many years ago and has dry eye syndrome – in addition to a regular veterinarian.

Thank you so much for sharing the story of how your Shih Tzu came into your life and played such an integral role in monitoring your health and perhaps even saving your life. She is quite remarkable and it was great getting to know both of you! 

A Final Thought

If you have a Shih Tzu and believe that your dog has a natural ability to assist you with a health condition, you may want to consider exploring this to find out if he/she would be able to serve in this fashion.

If a Shih Tzu has the capability to sense your health status, it will be a natural instinct and not something that you can force or train for.  

It is estimated that between 10 and 20% of canine pets have the ability to sense when an owner is ill, however this is still being studied to find out exactly how they can do this. It is theorized that the dog is able to sense chemical changes that occur in the owner's body, is able to pick up on minute bodily cues that would be imperceptible to other people or a combination of both of these things.

Once it is determined that this ability exists, certified training will take things one step further and allow you to see if your Shih Tzu is able to perform these important tasks with reliability and consistency. Once official, your dog can wear a vest (not mandatory, but helpful in many situations) and you may be able to receive certain tax breaks since of course, every bit helps!

By law, a Shih Tzu that is a service dog would then be allowed to accompany his owner into any privately owned business that serves the public. This includes a wide range of places such as food and retail stores, pharmacies, restaurants, movie theaters, even concert halls and in taxi cabs. Any 'no pets' ban does not apply. 

Also, the owner or manager of any establishment may ask you if your Shih Tzu is a service dog, however is not allowed to insist on seeing documents. He/she may ask you if you have a disability or medical condition but is not allowed to ask the specifics of what it is. 

While just about all medical alert dogs are extremely calm and good natured, if one were to bark or cause a commotion, the owner can be asked to exit the premises. 

As a final note, there are some people who take advantage of these laws and feign that their dog is a service dog; and of course that is highly unethical and is an insult to the integrity of those that are truly working in this capacity, keeping owners healthy and even saving their lives. 
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