Animal Assisted Therapy for Cardiovascular Conditions

Dr. Susan Smyth, Director of the Gill Heart & Vascular Institute joins Kim and Michelle to discuss the therapy dog program being used to rehabilitate heart and stroke patients. Michelle trained both of Susan's dogs, Carmine and Saleh, that work at the hospital three days a week. Carmine is one of a select few therapy dogs, (if not the only one) that is trained to walk with heart patients on EKMO. Listen to discussion on how this program was created, implemented and managed. Gives detailed information on the training involved for not only the dogs, but the human owners and handlers. Discusses the policies and procedures developed for the Gill Heart Institute to allow therapy dogs in the hospital, including the legal and insurance side of the process. Fantastic and fascinating insight into a therapy dog program done right. 

Transcript

Announcer: 0:00

Welcome to good dog nation, the weekly video podcast that's all about having a good dog hosted by Michelle McCarthy, CDBC CTAC, leading therapy, dog authority and owner of canine homeschooling and Kim merit, cofounder of good dog in a box.com. Good dog pro.com and founder of the URL doctor. This episode is brought to you by good dog in a box.com reward-based dog training and dog bite prevention products for families with kids and dogs and good dog pro.com the online content subscription and community for dog professionals with reward-based dog training products, curriculums and online courses to educate, motivate, and positively impact those that work with dogs and canine. homeschooling.com remote reward based dog training, behavior consulting and therapy dog consulting with Michelle McCarthy. Now let's join good dog nation.

Kim: 1:03

Welcome to good dog nation. I'm here with my cohost Michelle McCarthy from canine homeschooling. Hi Michelle. And we are really thrilled to have, uh, a guest today, Dr. Susan Smith. She is the director of the Gill heart and vascular Institute and the chief, uh, division of cardiovascular medicine. Susan received her medical degree from the university of North Carolina school of medicine in chapel Hill, which is where I am in chapel Hill. Yay. She then completed fellowships at Mount Sinai medical school, New York and university of North Carolina in chapel Hill. Her clinical interests are in heart disease treatment and prevention with a particular focus on disorders of blood clotting, such as uh, such as cause heart attacks, strokes, lungs and leg clots. And she has a very interesting set up at the Gil heart Institute with therapy dogs. And she and Michelle have had a connection for a long time. So Michelle, I'm going to let you tell us about the very interesting, uh, relationship you two have and, uh, the therapy dogs that Susan has. Sure. So about five years ago, I'll actually, six years ago, I had trained a black lab named bolt for a dr Erika Erlandson who was working at cha Cardinal Hill, which is a division in university of Kentucky medical center. And what was working with her. I think he'd been there about a year and I believe dr smite saw, uh, dr Erlandson and bolt in the hospital and one thing led to another and they started talking and both made a visit to dr smites warmly to her home to kind of get to know everybody. And from here, Dr. Smith or dr Erlandson said, is it okay if I connect you? Um, Dr. Smith is interested in therapy dogs and she'd like to talk to you more. I had just started raising a young black lab named Carmen. Um, Hey, he had joined my family at that point. I was like, well, he might stay with our family. I'm not sure. You know what his future's going gonna hold. I'd been racing and training dogs for, for folks for a little while. Um, and it was[inaudible] really maybe three, four weeks into him joining my family that I got a call from dr Smyth and kind of one thing led to another. He was a really wonderful dog and I just loved his temperament. And even though it's impossible to know it, you know, four months what a dog is going to do, I felt he really had the potential and the temperament to be a therapy dog if that's what he wanted when he was an adult dog. So we kind of started the adventure at that point of I'm going to raise him and train him. We'll just keep evaluating him every step of the way and see if this is the job that he wants. Um, I knew the most important thing to me was the first conversation I had with dr Smyth was that her family loved dogs and that more than anything, they wouldn't have a dog join their family. And it would be wonderful if he ended up having a job too. So my priority when I raised dogs for other people is that first and foremost, they have to want a dog. They have to really want to have a dog in their family. And if the dog has a job, that's even better. So that's kind of where it started on my end. And then from there it was really a year long process of preparing all of the staff that you K uh, Dr. Smith, you know, really having to kind of put together a program. There was a lot of communication between us. Um, she and her family were Skyping into training sessions for Carmen. He would come to group classes, need Skype in. So they were getting to know him and he had his own Facebook page. I started a page for him cause I wanted them to feel that they were having the experience in watching him grow up and getting to know him. Not just a year later, you know, here, here's your dog. Um, so it was a lot of fun because they got to see what I was seeing and Skyping into classes. They got to see him working in class and having fun. So I might, and it was a great experience and I think on UK university, Kentucky's and it was a year long process of getting ready for him. And I'll let dr[inaudible] kind of explain from, from her end, um, you know, how did you first become interested in therapy? Dogs. Like what was your, what was your reason for thinking? Yeah, this is something we'd really like to do at your heart.

Dr. Susan Smyth: 5:31

So several years ago we opened a new, um, pavilion of our hospital where the, the heart patients, um, are now taken care of. And so patients that are, for example, recovering from a heart attacks or having had heart surgery. And as we were designing this new floor, we were incorporating a lot of new therapies that are all aimed to try to accelerate the healing process. And so the entire floor for example, is designed around the use of art.

Kim: 6:07

Yes.

Dr. Susan Smyth: 6:09

In um, health care recovery and we have music therapy and we got very interested in the concept of pet therapy. There is a lot of good literature around the use of pet therapy in patients with heart conditions. We also in the design of the floor looked at things like how we can increase mobility of our patients, get them up walking earlier and the use of, of dogs. Um, and you know, as part of our mobility team was something that we were very interested in and it was around that time that I met Eric and bolt and things really took off from there.

Kim: 6:48

Okay. Yes. So that was at that point and I was raising Carmine and I was need to have a lot of information about what the dog's job will be because every therapy dog can have a different job. And I remember in the conversations that we had, one of them was that car mine was going to be the motivator hopefully to get people up and moving that um, and Dr. Smith can share, you know, some of the, the types of patients that are on the unit, some of there for very long time. They're very sick. Um, they're not always very motivated to want to get up and move. Um, but it changes everything. When a really cute dog shows up at your door and they ask you, would you like to go for walk with car mine versus do you want to walk the physical therapist? Um, so the dog really is a great motivator, um, for patients. So my training with both consisted of obviously a lot of socialization. Um, you know, I wanted him to have a lot of exposure to all kinds of people out in the community, clearly loved people from when he was a little puppy. Um, he had a wonderful temperament. He was very easygoing dog. He wasn't a dog that, you know, had any concerns about him developing issues. Um, he was a great pop and he was great young dog. Um, so we would go out in the community. He trained in class with me. Obviously he lived with my family, so he was exposed to lots of people. Um, lots of walking when I knew that his job would encompass walking. He not only had to be a dog who walked while on leash, but he had to be a dog who could adjust the pace of his walk based on who he was walking with. So he had to be comfortable walking very slow and then picking up the pace, um, you know, based on who was holding the leash or who was walking with him, that would determine how quickly he'd be walking. And some dogs are not comfortable walking at a snail's pace next to a patient or person who just walks very slow. But Kerman was, he just had a very, it's a very easygoing personality. Um, so training him was just, you know, I think at one point our training, and I walked him every day. I love to walk the dog. So he probably walked a thousand miles with me in the time that I had him. I had logged at at one point and we just walk and walk and walk and walk. And people would see me out in the street and we would walk. And then we walked really slow. We walk really fast and they probably thought, is she sick or so wrong with her? But she would walk in so weird. Um, we'd walk at the mall. We trained at a local hospital, so he would be used to all the things that go on in the hospital from the overhead announcements, uh, elevators, equipment, floor cleaners, vacuums, dropping things on the floor, white jackets, everything. Um, he volunteered in a couple of different parts of the hospital. So it was easy for me to see continuing to train him just what a great dog he was going to be. And also what a great family member cause he was just such a sweet dog. I just loved him. Um, so at one point, I think it was in November, a few months before he was actually going to move. Um, his handler is a woman named Caitlin King. She is exercise physiologist. Um, and Dr. Smith can explain a little more detailed what her job is at the Gail heart Institute, but she was going to become Caroline's handler. Um, and so she came up here to my home and stayed with us for a few days and was really learning how karma I learned like how did I train this dog and how does she, how is she going to work with him? And this is something that a lot of the clients that are, that I work with, they commit to this ongoing training of I can't just hand you a train dog, he's not a windup toy and say, here you go, have fun. You have to really understand how he learned and what he knows and what he responds to so that you can be an effective team and at a great time with Kaitlin, she was very excited to meet him and then she was able to go back to Gill heart and start prepping all the other staff that would have interaction with Carline's. So it was one of the best, and I say this, I've shared this with Kim on many occasions that that experience was, and today still is the best example of having a dog work in your facility. A lot of people try it. A lot of people do it. They don't necessarily do it well. They don't do it in the best interest of the dog and they don't do it in the best interest of the patients in the staff. But dr Smyth and her team have made sure that this is a very well organized well run program that covers everybody's needs, not just, Oh, I brought my dog to work and now we'll see what happens. Um, so I'll let Dr. Smith kind of shared during that that year of waiting for Carmen, which I'm guessing was a little hard because here I have him and, and he's, you know, everybody's waiting for him to come. Um, which is why I started the Facebook page so they could at least see kind of in real time, okay, this is what our dog is doing. But I know there was a lot of prep on your end to get ready for him.

Dr. Susan Smyth: 12:08

Certainly was a lot of excitement both at work but also at home as we were waiting for karma. And we have two boys who were early teens at the time and we're just thrilled about the possibility of, of having Carmen come to be our dog. We M D did do a lot of prep work in the hospital. So as Michelle mentioned, we identified somebody that is car handler still today on Caitlin. Has the whole entire time. Then his handler at work, she's an exercise physiologist. She's part of our cardiac rehabilitation program and so she works with patients that are in the hospital, getting them prepared to go home but getting the rehab, what we call the phase one rehab process, making the transition to home and too often to cardiac rehab. That continues after after discharge from the hospital and as an exercise physiologist is somebody that is very familiar with things like mobility. She has an interest in an animal's herself and was very keen to be Carmine's handler, so she works with Carmine three times a week. She actually helped us write all of the policies for the ho for the Gil heart and vascular Institute for our pet therapy program. She took what was at the time existing in the hospital, which really was pretty limited material and worked with best practices that Michelle and others provided to her. Really to put together a framework for how we were going to have therapy dogs in the heart Institute in a safe and effective manner. And that really did require a fair amount of work on her part.

Kim: 13:57

So our co but Carmine and Selah. Are the only two therapy dogs in your hospital or are there others?

Dr. Susan Smyth: 14:04

No, there, there are now others, there are a number of therapy dogs and in the hospital at the time, at the time we had know what we would, what we call a Carmen and tailor our unit specific dogs. And so as I said, car, mine is specific for the heart and vascular Institute. Now he will visit other places, but his primary role is with, with heart patients sail. His primary role is with stroke patients. There are other dogs that come and visit patients across the hospital. It's at our hospital. It started actually in the children's hospital and now we have a number of, of uh, dogs that, that visit in different places in the hospital.

Kim: 14:52

And just to clarify Carmine and Selah, live with you. They are your personal family dogs. And then you take them to work and at work they have a separate handler that actually works with them and the patient

Dr. Susan Smyth: 15:08

that is correct. So they are dogs, for the most of their life. Regular dogs then do regular dog things, um, three times a week. So Monday, Wednesday, Friday they, my husband brings them into work. He has a very set routine that he does with them. They walk around the campus and then they come into my office and we actually have multiple people that keep an eye on them. And so they, we have several of our staff in the office that are available to take care of them. They each have handlers that, that take them up to visit with the patients. As I said, um, Caitlin, who's been Carmen Tandler from the beginning sale is actually had a couple of different handlers and so we've had to go through some transitions there. She a, as I mentioned, works with stroke patients and has a slightly different role. Carmine really focuses on walking with our, our patients and getting them up and moving. Selah works on gross motor movement with stroke patients. And so she'll climb out to their bed and let them patter. Um, brush. Um, you know, being able to, to manipulate a brush is, is a skill that stroke patients can start to work on in the hospital. Um, she'll bounce balls with the patients. Again, those type of, of gross motor movements that a stroke patient very often needs to relearn how to do. And then as you know, as I mentioned, when they're, they, they typically, um, work for several hours in the morning. It's pretty exhausting work for them. And then there are folks in the office that keep an eye on them. You know, while my husband and I are, are busy working and so there's really a team of people around the dogs. It, um, it's frankly not something that my husband and I could do on our own. We have full time jobs and, and have multiple people who also have full time jobs. And so it's a combination of a lot of different people working with the dogs.

Kim: 17:14

So I'm curious what kind of training the handlers went through versus your other staff in knowing how to deal with the dogs when they arrived and, and, and,

Dr. Susan Smyth: 17:25

yeah, so absolutely. And so they have all worked, uh, remotely or in person with Michelle. So Kaitlyn actually went and spent time with Michelle too to work on certain skills with Carmen. The handlers are all certified with the dogs and so they, they, and that requires that they've worked with the dogs and they've trained with the dogs. And so it's a fairly, we go through interviews with, with the, the handlers as well. And so it's a fairly rigorous process that they've had to go through and then they have to pass a task that they can be a certified handler. And, and what kind of certification is that? Who is that through? So the testing, the actual therapy dog testing for their handlers is through Alliance of therapy dogs. So it's a, it's a very rigorous test. It's not something where, Oh, you just can your dog sit and walk with you on a leash. They're really being observed as a team interacting with patients, being in the facility. How is the dog, what is their comfort level? How is the dog responding to what's being asked of them? Because again, we don't want to put a dog in a job, they're not suited forwards. Right? It's bad for everybody. So, um, obviously the dogs, both Carmen and Saylah lived down in Kentucky and were working for a year minimum before they were tested. So they had to really get to know their job, get to know the handlers, the new routine, and then they went through the formal testing process, which is really required for liability purposes.

Michelle: 19:07

You know, the teams need to be tested, they need to be certified handlers, they need to have the insurance that comes with that. Um, but you know, again, it's, it's just, it's a long process and I don't know that a lot of people realize how much preparation goes into it, how much training, coordination of staff developing the, the dog's job description. And I think those job descriptions can just keep evolving. Selah is, at least when she was with me, she was a different temperament than Carmine. She's, she's a little spunkier. Um, I always would joke if you would, you know, get Carmine to do an interactive game. He would just kinda, you know, kind of look at you like, Oh, that looks like a lot of fun. Why don't you go get that ball? Um, but Se.

Dr. Susan Smyth: 19:51

Selah is just, she's just got this spunk and she was a very interactive dog and I could tell when I was raising her, I could really see her doing, uh, participating in physical therapy and participating in specific skill training.

Michelle: 20:07

Cause that's just her temperament. She's just this fun loving little dog. Um, Carmine, he just had that slow, steady, consistent temperament, which is also critical for a therapy dog. So they have very important jobs. They have different jobs and they have the temperament to match their job. So dogs are successful when we give them a job that they're good at, just like people. Um, so what I loved about them and even seeing them, you know, a couple of years later, is that there's still really the same dogs that I raised. They're just the sweetest, kindest dogs. Um, and it's a lot of fun to see what they're doing. They have great jobs.[inaudible]

Dr. Susan Smyth: 20:50

they certainly have very different personalities and their, their personalities really do match what they do at work. Um, Carmen is a phenomenal leash Walker, and in fact, we'll walk off leash right next to you. He, as Michelle said, he will pace to whatever speed, uh, an individual is walking at w whereas sail, uh, wants to please. And so she is very eager to interact with people and, um, you know, she's very much a people pleaser and, and, uh, so I, I think the jobs that they have really do suit what their skills and their personalities are. Folks at work are always surprised when they see video or pictures of car mine doing things like swimming in a pool or running around the backyard because he is so laid back at work. And so, uh, and, and there, there go on.

Kim: 21:50

Yeah, they're very different. And I think that, you know, that's the most important part of having these dogs who have these big jobs is they have to also be allowed to be dogs and they come home on their days off. So what do Carmen and Selah do on their days off?

Dr. Susan Smyth: 22:05

They just hang out at the house and, and play together. One of the reasons that we really were keen to get a second dog was so that Carmen had somebody at home to, to interact with and play with. We had typically had two dogs in the past and so, and, and you know, the dogs being able to just run around in the backyard and play, we thought, you know, it's uh, it's very stressful for them to be at work. And you know, those days off are very important. And so they, our dogs on their days off, they play together, they play with the boys. Uh, they swim in the pool, we'd go for long walks around the neighborhood and Selah has her same exuberance in the[ Vinaudible] pool, doesn't she? Oh, she, the first time she saw our PO, she dived right in. Carmen was a car mine since that car, a little more leery, although now he loves to swim. He was a little more leery going in the first time. She just, I mean literally dove into the pool and uh, kinda hasn't stopped since. I'm curious what the feedback has been

Kim: 23:17

for your hospital to have a program like this and what, what it's like from the patient's side to be in the hospital

Dr. Susan Smyth: 23:25

and there'd be therapy dogs. Absolutely. I think it's been transformative and so, uh, both for our patients but also for the staff. And so I, I like to share something that really touched me and was actually somewhat surprising to me. I had one patient who told me that that Carmen's visits had been so very important to them as they were going through the situations that they were going through in the recovery process in the hospital. And that when Carmen came into the room for the first time, they realized that they couldn't be as bad off as they thought that they were. If a dog, something is normal as a dog could walk into their room and[inaudible] for them. It made them feel really hopeful that that things couldn't be so bad because here was this black lab that was able to come in to see them. I should explain that our, the, the, our hospital's a very high acuity hospitals so we take care of patients that really can't be managed at other hospitals in not just our statement, the region of the country that we're in. And so we have patients that are on things like ECMO, which is extra couple Oriel membrane oxygenation. That's what ECMO stands for. It's the machine that literally takes blood out of people's body. It oxygenates the blood and pumps it back in and we have people that walk in our, on our floor on ECMO. It's sort of the highest level of support that's possible when your heart and your lungs are no longer working. Carmen walks with patients on ECMO and so you know, for a dog that's very sensitive to smell, I mean I think all most dogs are, are, are, are, are very smell sensitive. There is an overwhelming smell of blood on our floor because I mean people are living on these machines that are circulating their blood outside their body. And it took Carmen a long time to get used to that and to get to the point where he could walk with these patients. But he now routinely does that. And you know, again, I think the, the benefit for the patients has been absolutely enormous. We've had patients that literally were in the hospital for months not being able to get out of bed and we encourage them first to sit and that if they could sit, Carmen would come and sit next to them and eventually got those folks to the point where they were walking with Carmen. And you know, you, there's no words that can express that.

Kim: 26:18

No, there isn't an I, my father had valve replacement surgery twice and I know the type of, he, he was not as bad off as what you're talking about. But yeah, I mean it's, it's just a level of care and a recovery process that is extreme. And I can imagine to have a dog there, bring some sense of normalcy and really just makes you feel good. So Kim, I'm going to attempt to play a video that was

Speaker 6: 27:07

[ Video music]

Video Talent: 27:07

We have a new member of our team and that new member of our team is Carmen and he is our pet therapy dog. And Carmen is a wonderful addition to the team, especially with all of our patients that have been here for a long time. It gives them something to look forward to that isn't medical, it isn't hospital walls. It's funny, the medical personnel. So he gives that emotional support to all these patients and we can use him as a motivating factor. There was a patient that had been here for approximately four months, and so we had been visiting with her on and off. We'd walk with her multiple times. Um, but she said that she had two little Wiener dogs at home that were waiting on her and that she loved Carmen so much and that he was her motivation to get home to her little puppies. I actually just brought him into my patient's room. She's seemed a little bit depressed today, so I thought it'd be a good idea for him to come say hi. And she has a dog at home of her own. So we got him up to the chair and she was able to pet him and he gave her a nice wet kiss on her hand and it made her smile. We have had patients that have been in the bed from months that have felt that they were too weak to get up out of bed and Carline has come in and worked with them and gotten them not only out of the bed, but gotten them to walk. And then even from walking, Carmen has spent several extended periods of time with these patients now off the floor down, for example, in our lovely gardens outside the cafeteria. And so he's been able to help those patients go from literally being bed bound to being able to enjoy a meal outside in the sun. So he does all of these wonderful things at home that he, that he does here at work for all of us. I think that it's wonderful for all of us to, to remember that there is incredible power of healing in animals.

Kim: 29:07

That pretty much says it all right there. Okay. Really, really that's such a, such a unique, um, do we have any, are there any statistics or do you have any information as to how many other hospitals in the U S have a program like this or anything close to it? I don't, I don't know. Michelle, if you, if you do, so how many hospitals in the United States are able to walk patients on ECMO? The way you have a special cert, you have to go through special. We do. We do. And we were really

Dr. Susan Smyth: 29:42

at the forefront of, of some of that with some, with some surgeons that really promoted this, it, it actually took our nurses well over a year to become comfortable with that process, let alone then inserting a therapy dog. And so there, there are fairly few hospitals in the ICT that perform that, that offer ECMO, let alone that, that ambulate their patients on it. And so I'm not sure there's another therapy dog in the, in the world that walks with ECMO patients that that would be something I could actually look into.

Kim: 30:19

Yeah, fairly my, yeah. And my research, you know, I know that there are therapy dogs who've been involved in different cardiovascular studies and, and I'm sure they visit lots of different areas of hospitals, but I've not heard of a single dog, a therapy dog that walks with patients on ECMO. Cause when you think about just the team of people required to do that, so the dog has to acclimate to his job and then the, all the distractions as you mentioned, the smells, then he's got the noise of any equipment involved and then you have multiple people. So it isn't just Carmen and the patient and the handler, it's probably lots of other people involved. So it's a very distracting environment to put a dog in and expect them to be comfortable. Um, so I think it's not something that a lot of places take on because it requires a lot of coordination. Dr[inaudible], thank you so much for joining us today. Uh, I've, the information that's been shared I think is so valuable to, uh, not only other dog professionals, but for anybody who's thinking about a dog in the workplace program and uh, you know, thank you ladies for uh, for sharing.

Dr. Susan Smyth: 31:36

Absolutely. I have to say, I feel like we talked a lot about three. Can I get[inaudible] to come over and maybe we can get her the turnover.

Kim: 31:45

Here she comes. Oh, there they are. And how old are these dogs now? So Carmen will, he will be five in December. I'm going to be five. Caroline will be five and she will be little after she turned three in April. Yeah. So they were roughly like two years apart in age. Ah, awesome. What a beautiful guy are very sweet puppies. Again, thank you so much and thank you sailor for saying[inaudible] at the end. And uh, please join us again next time everybody. Thank you for watching. Thanks for having me.

Announcer: 32:58

If you'd like to participate in the rest of today's conversation. For professionals who work with dogs and receive continuing education credits from participating organizations for listening, visit good dog pro.com and subscribe today. Use coupon podcast to get 40% off your first month or annual subscription.