Most people, when they think of dogs, they think of a big ball of fir filled with excitement and pure happiness, however; dogs are more than just a cute face. Aside from their impeccable ability to brighten spirits and offer endless cuddles, dogs have also been trained as service dogs used to aid people with disabilities dating back as early as the First World War. Today, there is a wide range of service dogs available for people with disabilities, such as guide dogs, seizure detecting dogs, and therapy dogs for disorders such as anxiety or PTSD. With this wide range of uses for service animals, it is obvious that their application in healthcare is also growing, but how helpful are these animals? And, to what extent should their presence be allowed within healthcare facilities? 

"'Service animal' is a term that distinguishes those dogs that serve individuals with physical or mental disabilities, usually on a one-on-one basis, from pets or other types of skilled dogs, such as the various types of police dogs" (Ensminger). These service dogs serve a wide variety of purposes, among the most common being guide dogs and seizure detection dogs. Guide dogs are of the oldest type of service animal, and are the most protected dogs in the world. This type of service dogs is used for those with physical and mental disabilities, such as blindness or Alzheimer's. For the blind, these dogs serve as their eyes, while for the mentally disabled; these dogs serve as part of their mental process and companions. Guide dogs are typically of larger breeds, as often times they are expected to be able to stop or lead a person or to be strong enough in the event of needed support for their human. On the other hand, seizure detection dogs are, just as their name implies, expected to detect seizures in their human handler. It has been proven that these animals are able to detect the onset of a seizure, possibly through a physiological change in their handler, in time for them to take medication to stop the seizure; this has also been tested to be true for patients with diabetes and dropping glucose levels. Although this has been proven to be true, it is still uncertain as to how the service dog detects this physiological change. "Because a dog's primary form of communication is body language and facial expressions, it is plausible that a seizure-alerting dog is cued by the patient's most minute gestures or posturing. However, with reports of dogs being out of sight of their handlers and then suddenly approaching them and alerting, one has to consider the possibility of a scent, auditory cue or some other signal independent of visual cues possibly through the ability to detect a slight behavioral change or to smell a chemical change in the body of their human." These uses for service animals are practical for everyday use, and often make the lives of individuals with these disorders easier as well as safer. 

Knowing the capabilities of these animals, it is obvious to see why thinking about using their skills more widely in healthcare is relevant. For example, patients suffering with Alzheimer's often become confused and unsure about their surroundings and are often placed in long term care facilities. In these cases, patients often become disoriented and stray away from familiar areas, which causes more confusion and upset with the patient. Alzheimer's guide dogs, because of their keen sense of direction, are able to aid the handler in getting home if they wander too far or become confused as to where they are. Research also shows that "individuals who have long since forgotten the names of loved ones are, according to anecdotal reports, often able to remember the name of a favorite dog." With this knowledge, it is safe to consider the possibly that the presence of a service dog for Alzheimer's patients would create a safer environment for them as well as a more psychologically stable atmosphere. Another example of how these animals' skills can be applied within healthcare facilities is their ability to detect physiological changes within their handler. It is relevant to consider service dogs' capability of detecting a wider range of changes and imbalances in the body. We know, through research and experimental studies, that these animals are able to warn of seizures and a drop in blood glucose levels in time for action to be taken, so why not consider other things they may be able to detect. It is possible that these animals could be used in emergency rooms or ICU units to warn of dropping oxygen levels, unresponsiveness due to imbalances in the body, and other signs of serious medical emergencies. If service dogs are able to detect these things, and we use their skills in time sensitive situations, it is possible that medical professionals would be able to react to a problem earlier, and as a result, lose less lives to trauma. 

Another important use for these animals in healthcare is their ability to connect with the patients psychologically. This type of service dog is commonly known as a therapy dog. "Therapy dogs are usually privately owned pets that have received behavioral training to provide comfort to individuals in institutional settings, including hospital, nursing and retirement homes, mental institutions, schools, facilities for autistic and abused children, halfway houses for prisoners, and other environments." It has been proven that having contact with a dog or any other animal can ease anxiety, and the "benefits have been found to be universal and probably derive in part from the physical contact with another being." "There are times when a person simply needs to feel love in some form or fashion. Animals give unconditional love to all people" (Tipp). For example, think of an ill, young child who is about to undergo surgery. In their mind they are being pulled away from their parents in a scary and unfamiliar place to be cut open, and are probably facing an uncertain outcome; this would naturally inflict fear in any person, especially someone very young. In such situations it could be beneficial to have a therapy dog present to spend time with the patient to take their mind off of the upcoming procedure. "For children, pet visitation is also thought to reduce separation anxiety and offer a pleasant diversion from anxiety-provoking treatments" (Ensminger). Because of this knowledge, it is important to consider how the dog may be able to help ease the anxiety of the child when forced away from their parents; they can feel like they are still somewhat in the comfortable presence of a friend. Therapy dogs can also be used in everyday application, such as helping with depression. "A strong attachment to a pet has been statistically correlated with less depression." People suffering from depression often feel alone and hopeless, but with a strong relationship to another living being, it is possible that these people may feel less alone. This human-animal relationship may even promote more social interactions, as studies have shown "soon after being assigned their dogs ...  patients began to interact more often and at a better level with other patients." This promotion of human to human interaction would inevitability play a significant role in lowering depression by helping patients feel more involved and less lonely. Most importantly, "the pet becomes a pillar of support and a source of strength, psychological sustenance, and optimism." The service dog allows for comfort and stability, lowering depression and ultimately increasing the depressed patient's overall quality of life. 

When considering a change in healthcare, it is important to look at who will benefit the most. In my opinion, palliative care patients and chronically ill children would benefit the most. This is because more stress and anxiety typically comes along with these types of situations. A palliative care patient may include someone with late stage cancer or and individual suffering from Alzheimer's. For someone suffering with late stage cancer, they may experience pain, anxiety, and even depression. "Service dogs have shown to relieve stress, pain, and anxiety" (Ensminger). With less pain and anxiety, the patient would feel more at liberty to enjoy their last days with their loves ones rather than battling with their disease. In some forms of cancer, such as bone cancer, the patient may eventually become immobile. With immobility, comes the possibility for the person to be bound to a wheel chair, meaning they would inevitably need help getting around. The patient may desire to feel independent from the care of their loved ones and medical staff, but still need assistance. This is where the use of a service dog could be helpful. The service dog could be taught to pull the wheel chair of the patient or fetch small things that the patient might need. Also, the patient may not be wheelchair bound, but needs support to walk or move about. In this situation, a large breed dog could be trained as a guide dog of sorts to be there for the person if they need physical support to lean on while walking or doing daily activities. Also, patients suffering from Alzheimer's disease and chronically ill children could greatly benefit from the use of a therapy dog. These types of patients suffer high levels of anxiety  --  Alzheimer's patients due to confusion and children due to fear and lack of understanding about their situation. With a therapy dog present, the patient would feel calmer and less lonely, and "anything that reduces the anxiety of these patients is beneficial and adds to the care that the patient receives" (Tipp). 

Although the benefits to service dogs in the healthcare industry are extensive, there are also many arguments against this practice. The biggest issue when considering this idea is the potential spread of disease. "The CDC is concerned that animals in healthcare environments can serve as reservoirs for antibiotic-resistant microorganisms" (Ensminger). This could occur from several angles  --  the animal could not be well kept or the animal could have picked up a disease from being in the healthcare facility. Currently, the CDC states that it is the responsibility of the owner of the animal to make sure they are well kept and cleaned up after, and that seems to be working. Where we tend to see the most problems is when the animal picks up the disease within the healthcare facility. This happens simply by the service dog walking around in the area where people infected with disease have been. The best example of this is the spread of MRSA. "Research shows that service animals can pick up certain bacterial infections such as MRSA from being inside healthcare facilities. This could be from the floors, contact with people, or even from being on hospital beds." MRSA, as we know, is a highly contagious type of staff infection that can be spread through contact with someone who has the infection. If a service animal picks up the bacteria for this infection within a healthcare facility, anyone that comes in contact with the animal will have come in contact with the bacteria as well. Also, it is not likely that anyone would recognize the animal had picked up the disease until later, so it is very possible that the service animal had suddenly become a way to rapidly spread the infection within and even beyond healthcare facility. Another problem that we face when introducing animals into the healthcare industry is allergies. There are many people who are allergic to animals and cannot come in contact with them. In a place where people are sick and focused on getting well, another attack against their health is not something that would be encouraged. Also, if healthcare workers are allergic to the animals, it would likely effect their ability to work and provide the best care to the patients. 

Overall, I believe the use of service dogs in the healthcare industries is a move in the right direction. They are capable of detecting certain things such as seizures and blood glucose levels sooner than humans can, and they are able to provide support and comfort on a different level. I also believe that service dogs will never be able to completely replace any medical treatments, for example, therapy and medication for PTSD, however they will be an asset to medical teams when used appropriately. If they are used improperly, or taken advantage of, service animals could cause more problems, chaos, and liability than is present currently in healthcare facilities. In addition to the extensive attributes of service dogs, there are also many issues to be considered. These issues include patient desires and needs and even the spread of serious infection. These issues demand responses and solutions that need to be finalized before service dogs can become a permanent part of medical teams. I do not believe that the negative aspects outweigh the positive ones of service dogs in healthcare, however if the issues at hand are not given a solution, that will no longer be the case. The patient comes first, anything to aide the patient should be welcomed even if it is currently considered a common household pet. 

