Jennifer Kolar: So excited to be here today. Really appreciate that this is a provider’s conference and it’s a very rare thing for from the provider’s perspective to welcome service dogs to the table versus being the opposite of the patient having to beg their provider to consider it. So, it’s a really neat difference, so I’m really thankful for that.

So, our plan I’ll tell you a little bit about our organization kind of as a background to understand what we do, talk about service dogs. I’ve had a lot of people asking me questions about a service dog versus ASA. Understanding how migraine response and alert dogs are trained and how they could benefit somebody with chronic headaches or migraine, and their options for obtaining and training a service dog.

So, a bit about the nonprofit that I’m a part of. I’m our president and one of our founders. We are a nonprofit that works to help people train their own dogs to be service dogs using profoundly ethical methods only with both the people and the dogs. We work with you hands on to train your own dog. We work with any breed who’s suitable. And we support a variety of locations. And these are things that are fairly unique in the service dog world.

So, lots of people have been asking me, what is a service dog? How is it different than an emotional support animal? So service dogs is a dog who has been specially trained to do at least one thing that directly mitigates someone’s disability, and that disability needs to be something that significantly impacts your day-to-day life. That’s the definition of the American Disabilities Act. The dog needs to be well behaved in all public settings. That’s it. The end. In the US, there are no other laws or requirements.

And with that, a service dog – and their handler together, it’s the team that have access – has access to most public spaces that anybody in the general public could go to. There are some exceptions such as religious institutions. And there’s different laws at employers, at schools, and airlines. The dog can be any breed at all. It can be any size as long as it has the right physique to do the job that needs to be done.

They can be trained by an organizer, a trainer, or the individual themselves. And contrary to popular belief, they do not have to have a vest, they do not have to have an ID card. That is not required under the ADA. So, one thing that everybody would love to have the panacea of yes, I can guarantee an alert dog. So the reality is if you’re working with a trainer and they tell you they can guarantee your dog will alert, you should run away.

So we don’t scientifically understand yet what it is that dogs are responding to or alerting to in a lot of different medical conditions. So epilepsy, for example, migraines – we don’t know scientifically yet in the research community what they’re responding to. We know with things like diabetes very well understood, very easy to control, very easy to train. So, what we ethically would do is we’re going to train a migraine response dog and then do additional training with them, journal, have a migraine log to see if we can find some behavior they’re doing that’s a little unusual, little out of the ordinary, and then turn that into the alert that we want.

And with migraine, the thought is they could be responding to any of the number of the prodrome symptoms – so your behavior, it could be your scent, could be your body language. But just kind of being aware that scientifically this isn’t understood yet. There’s a lot of research going into medical alert for dogs.

So, just kind of bringing back to what about scent-based alert training, because everybody kind of puts that out as the panacea of oh we can collect scent samples for everything and train everything with that. So usually we would use sweat, saliva, or breath. So I was just talking, a couple of days ago, to an expert in this field who does a lot of research on scent. And one of the things he was talking about is the way the body functions, by the time volatiles that the dog would detect, make it to your saliva or to your sweat, you’re way into the episode.

It takes a long time for the body to break those down to that point. They’re in your blood immediately, which is why getting breaths samples because your lungs are full of blood is so much more effective, but it’s a lot harder to manage and work with, and you have to find a way to stabilize that sample. So, this is something that it can be very tricky to properly work with samples and manage them and not create false positives. We, as people, don’t realize oh I’m leaning toward this thing, that’s why my dog’s alerting to that.

It’s that I’ve done something accidentally to cue them. So it can work. But I strongly encourage you not to trust any guarantee. It’s much more reliable and predictable to journal, monitor the behavior, and then try to shape it later. And then the other thing to be aware of with alert training even if they do alert, there’s no guarantee they will always alert, or that that might change. And depending on the frequency or type of your migraine, it may not be frequent enough to have a reliable alert because it’s something they need to be able to practice over and over.

So let’s talk about some of the things the dog may notice. So in the prodrome stage, there’s a lot of things. Dogs are very, very sensitive to body motion. We’re sensitive to verbal communication. Dogs are much more visual. So, they might notice aphasia that your speech is slurring that you’re talking to them, say that you’re yawning. Fatigue, that you’re irritable, that you’re depressed, that you’re staring off into space. That’s actually something we noticed they really pick up when we’re looking at training seizure response in alert dogs.

Muscle tension in your body, lots of theories about dogs and wolves in the past hunting and communicating nonverbally with muscle tension. Increased urination, increased appetite, your light and sound sensitivity – all of these things are things that change your behavior. And the goal is that, ideally, the dog is realizing it even before you are, so that you can your emergency meds onboard and stop the migraine before it gets worse. In one survey that was done in 2012, 1 in 4 people reported noticing changes in behavior with their pet dogs prior to or during the initial phase of migraine.

Now again, these were pet dogs, not kind of a blind study survey, but recognizing that there’s a lot of things that dogs do on their own. That’s a lot of things we see with owner-based training that the dog is already offering some sort of alert, and then they want help to refine it to make it reliable. Now what about during the attack stage? So, lots of things they can do, and this is where we’re talking about migraine response. Deep pressure therapy, laying across you, laying in different ways, bringing medication. Pulling blankets off and on, helping get clothes off or on. Turning off or on light. Helping you build that sensory deprivation tunnel that’s so helpful.

They can lick you repetitively. So if you have a dog that’s licking repetitively, that is encouraging blood flow away from your brain that also can help with pain and just kind of distraction. Mobility – a lot of people deal with vestibular issues with being dizzy, with struggling getting up and moving. They can go get help. So there’s a number of things that a dog can do. And depending on the situation of your migraine how they manifest, these can vary. So here’s an example of one of our client’s dogs doing deep pressure therapy. And so this lab will lay there as long as she wants. And you can train that in lots of different body positions and different ways, and that’s actually something pretty easy to train. But having that pressure to hold you down, having that pressure to ground you can make such a difference.

Now let’s talk about the postdrome stage. What can they do after? Deep pressure therapy I mentioned, grounding – they can curl up against you, you can curl up against them. They can lay across your feet. Lots and lots of things that dogs can do to help ground us. Again, bringing medication, reminding you to drink water – a huge, huge one when you’re dealing with this and trying to get out of this state. They can have medication alerts, and mobility and balance support. Even if it’s not a giant dog that can do full mobility work, they can do proprioception and counterbalance. So they can lean into you. If you kind of are wobbly, they can lean into you, they can push against you. So, just with helping stabilize a little bit.

And one thing I wanted to mention is while yes, I’m part of the service dog organization, not everybody needs to train their dog to the level of a service dog to have this benefit. Yes, you won’t have public access with your dog. But if you suffer considerable migraine at home and you have a dog there, there’s no reason you can’t train your pet dog to do pressure therapy. There’s no reason you can’t look at the behavior of your pet dog and see are they pulling on my clothes right before I start having auras? There’s no reason your pet dog can’t do this and then provide you benefit at home.

So I would encourage you, even if you have a dog that you know wouldn’t be suitable in public, you don’t want to go through that level of training, they might have reactivity to other dogs or people, they could still help you. So, some of the things to think about in an alert versus response dog – and this is why I want to bring this up because people initially think oh I want an alert dog – well dogs can do so much more than alert. And so, if you really think about what can they do yes in alert they can potentially help prevent an attack altogether by letting you take your preventative medication in time.

This is especially beneficial for people without auras or sudden onset migraines. They can help you find a calm and dark space to get to, get out of the environments that are going to escalate your migraine. Response, which is something we can reliably teach, may lessen the duration of the attack. It helps distract from the pain. It could prevent potential injury. And overall – kind of like we’ve heard from some of the other people here – it gives you more sense of control of your life. It gives you more confidence that you aren’t having to rely on another human to do something for you. That you can have your dog go and throw that blanket over the light on the nightstand. You can have the dog go turn the light off for you. You can have the dog go get you something to drink or just lay there with you and just be there.

It’s scientifically shown that just the act of rubbing and petting on something that’s tactile – we use this a lot with kids with autism too – releases pheromones that are calming and soothing. So petting a dog will calm you by that act. So, options for getting a dog. And there’s a whole other conversation about if a service dog is right for you. But options for getting a dog: 1) foundations; these are ones that breed and raise dogs. A lot of the guide dog foundations you’ll see, and then there’s a number that work with different conditions where you usually get a fully trained dog. This may be minimal cost – it may not be depending on the organization – but they often have very long waits and a lot of restrictions. You need to live in a certain area, have a certain condition. And I have yet to see a foundation that provides migraine dogs. It’s just not a common condition that their focus on is the primary condition.

Private training services – it’s a lot easier to qualify; you’re hiring a private trainer to do what you want. It can be very costly. You can easily spend $20,000/$30,000 if you’re starting with a puppy. You’re talking at least 2 years of training. If you buy a dog that someone advertises a dog that’s available and you buy a dog, there’s a lot of risk of getting an improperly or incompletely trained dog. There’s, unfortunately, a lot of fraud out in industry. I see this especially with people preying on parents of kids with autism. That they will sell a dog for $15,000/$20,000. The parent gets the dog, the dog bites the kid. Returns the dog, they just resell it the next person. There’ve been various court cases and lawsuits around this.

And there’s no guarantee the dog will be suitable. Say you start with a puppy, or you start with a dog that you’ve rescued and work with them, you don’t know – even if you’re giving yourself the best odds genetically with a puppy – you don’t know what they’re going to experience and how they’re going to develop. Owner trained that’s the model that we support and view. You get to choose your own dog, and you get to train them the way you want. In our model, we’re very focused on using all positive reinforcement methods, which is the tradition of the service dog industry. The cost is a whole lot lower, but it’s a lot of work. And it can be hard to find consistent training support. And again, there’s no guarantee that dog’s going to be suitable. So, you’re kind of weighing all these different odds.

So kind of finishing about that, just to let you know about our program, and I have brochures here, and we’ll happily talk to you about all of your options of different programs. What we do is we work with people whose dog is at least 14 months of age. Just a basic candidate for citizen level of obedience. There’s lots of solutions for basic obedience training. We don’t need to solve that problem. That problem’s solved. What isn’t solved is that we work with you for at least 6 months hands on teaching how to self-advocate. Teaching you all the disability mitigating tasks that your dog need. Teaching you how to work in all the parts and places you go in life and then continue to support you ongoing.

And as our nonprofit, we do that for $700, which is, of course, a significant loss for us. We’re not trying to make money on clients. But this is one model – we developed this to try to address that need that there are many people who would benefit from a service dog who don’t qualify or can’t wait for a foundation or who couldn’t afford working with a trainer. And so, that is, I think, everything. So, find me and a number of people have been coming up. I’ve been happy to let Theo be off duty and get loves and rubs, and he’s been loving it. We’re on social media. But happy to talk to you and brainstorm about your particular situation and help from there. Like I said, I love the notion of combining these different modalities and the thought that a provider would be recommending or considering a service dog as another tool is really, really hopeful to me.

Voice-over: Thank you for tuning into Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

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*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.