Family Medicine Vital Signs

By Briana Rueda, MD

Personally, I find there is nothing more soothing after a long day of caring for others than to snuggle on the loveseat and get smothered with unconditional love and kibble-breathed kisses from my terrier.  As it turns out, I am not alone!  In fact, just the other day I had a new patient in the office requesting a doctor’s letter to allow her therapy dog to accompany her in her college dorm.  After her previous therapy pet had passed away, an increase in her panic attacks prompted her to quickly train a new puppy to step up to fill the deceased’s shoes…. or rather, paws.

Given that the utilization of animals for health promotion and medical treatment is becoming more common, I feel that it is important for all healthcare providers to be familiar with the different categories.

1) A certified service dog is a legally defined dog that is rigorously trained to assist an individual who has a life-limiting disability.  They are not considered pets, but rather living-breathing medical devices, and can therefore accompany their owner in pet-restricted places for the purpose of providing their duties.  These are the working pooches we see donning special service animal vests, assisting their owners who have vision deficits, seizures, hypoglycemic episodes, autism, mobility deficits, etc.

2) Therapy pets are domesticated animals that are considered pets.  They complete some basic training and pass a standardized exam to demonstrate their fine nature and good obedience.  Therapy pets are supported by larger organizations that set standards for the practice of pet therapy (for example, therapy pets must be bathed no more than 24 hour prior to a nursing home visit, etc.).  These pets provide therapy sessions in many environments, including hospitals, schools and retirement communities.   But because they are still considered pets, they are not generally allowed in pet-restricted public areas.

3) And lastly, there is another category called emotional support animals.  These are personal pets that provide comfort to their owners diagnosed with mental and/or emotional disorders.  These companions help their owners with anxiety stay calm.  They provide uplifting interactions for their depressed owners, etc.  They do not have to pass any specific training or exams, but do need to have generally good behavior, as not to disrupt others when they are out in public.  Often a formal letter from the patient’s physician or mental health provider explaining the need for the emotional support animal is required to bring the animal someplace where pets would not ordinarily go without permission, for example, on an airplane.

Be it in a restaurant or a shopping mall, most of us physicians have personally witnessed the remarkable jobs that service dogs do for their owners with disabilities.  However, many providers (including myself) are less familiar with benefits of pet therapy.  After researching this subject for my own knowledge, it turns out, numerous published studies have proven the medicinal benefits of pet therapy sessions.  Here is a short sample of some of the known advantages of animal interaction on human health.

• There’s a reason why the dog was named “Man’s Best Friend”. Pet therapy has been shown to improve overall mood and decrease loneliness in geriatric patients.  Furry companions can also decrease pain, as well as increase range-of-motion and mobility in our senior patients.  Both going for walks and tossing balls for fetch promotes enjoyable physical activity for both the biped and the quadruped alike.
• In geriatric patients suffering from dementia and other mental illnesses, pet therapy can help improve scores on the Mini Mental Status Exam. Additionally, it can increase communication, physical touch, and oral intake.
• Children with an autism spectrum disorder often respond well to pet therapy. Studies have shown an increase in their socialization and communication skills, a decrease in awakening cortisol levels, and a decrease in severity on the autism index scale.  Also, pet therapy can provide an overall increase in life enjoyment for the entire family of an autism spectrum child.
• Pet therapy has been used in pediatric oncology and has been shown to decrease emotional stress, change vital signs, and decrease pain.
• Furthermore, petting a fuzzy friend can lead to cardiovascular benefits. Pet therapy visits in community housing for older adults have demonstrated significant decreases in both blood pressure and heart rate in the participating residents.  Additional studies have shown that social visits with animals can lead to decreases in systolic pulmonary artery pressure and pulmonary capillary wedge pressure, as well as decreases in epinephrine and norepinephrine levels in patients hospitalized with heart failure.
• Moreover, animal interactions have been shown to positively effect patients with a variety of mental and behavioral disorders, including schizophrenia, depression, and substance abuse.

Given the research, (all cuteness and cuddliness aside) I believe all providers can agree that the magnitude of application for pet therapy is nothing short of extraordinary!  Just think, if I developed something that could decrease depression and anxiety, decrease heart rate, blood pressure, cholesterol and all-cause cardiac morbidity, increase physical activity and mobility, improve social skills, decrease chronic pain, and increase overall quality of life, and I packaged it into an enteric-coated capsule and marketed it with a catchy cartoon character in a Super Bowl commercial……it would be bigger than Big Pharma!

So what are the reasons why are some physicians hesitant to prescribe pet therapy?  High liability?  Fortunately, when using a certified therapy pet that is under the regular care of a veterinarian, the chance of zoonotic disease is very low.  Too expensive?  Local animal shelters are often bursting at the seams with pre-vaccinated, microchipped and spayed/neutered pets that would make wonderful additions to any patient’s personalized treatment plan.  In fact, many shelters offer discounted or free adoptions for their more seasoned animals.  And considering that the animals’ love and affection is conveniently free, that leaves the cost of a monthly bag of kibble…. roughly equivalent to the cost of one generic prescription medication.

Interested in speaking with your patients about pet therapy?  These local resources have graciously offered to help unite patients with a four-legged companion at a reduced cost.

-Utah Animal Adoption Center: Senior for a Senior program.

-Best Friends-Utah: Senior for Senior program.

-Humane Society of Utah: Cats older than 6 years free, and dog older than 13 months at reduced cost. Reduced cost vet care clinic.

Briana Rueda, MD is an Intern Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.