A patient's best friend

Hank has taken over for Finn, a service dog that helped Ashley before dying from cancer this year. Hank cost the Grim family more than $10,000.
Hank has taken over for Finn, a service dog that helped Ashley before dying from cancer this year. Hank cost the Grim family more than $10,000.
Posted: September 08, 2013

Ashley Grim suffers from a variety of medical problems, among them scoliosis, difficulty swallowing, and unstable blood pressure, so she has had to endure being poked and prodded more times than most children.

Yet Ashley also has a harder time coping with medical settings than most children, as she has been diagnosed as being on the autism spectrum. When she went to Children's Hospital of Philadelphia for a procedure last year, the experience of being placed under anesthesia was too much.

"No, no," the 12-year-old girl cried, becoming more and more agitated as medical personnel started to administer the drug.

So anesthesiologist Ronald S. Litman tried a novel approach. Ashley's trained service dog, Finn, was already in the room, and Litman asked the girl whether she would feel better if Finn "helped" to deliver the anesthesia.

Problem solved. Ashley's mother, Lorie, held the dog's paw and used it to press the syringe, and the girl was reassured as she drifted into unconsciousness.

That episode of canine-assisted therapy might have been a first, as far as Litman knows, but the mere presence of service dogs in hospitals is thought to be a growing phenomenon. That includes the traditional use of such animals by blind people, as well as dogs for patients with developmental issues or physical disabilities.

More broadly, the presence of animals reflects the latest wrinkle in the long evolution of what is called "family-centered care" - inviting children and parents to be participants in the process, Litman said.

It was once rare for parents to be allowed to stay overnight in a child's hospital room, for example, whereas now it is expected. These days, some hospitals will let parents into the emergency room as doctors and nurses are performing life-saving measures such as CPR.

Litman, along with colleagues Aditee P. Ambardekar and Alan Jay Schwartz, described Ashley's experience in a recent issue of the journal Anesthesia & Analgesia.

The dog helped deliver the anesthesia in an outpatient gastroenterology suite, not in an operating room, so there was no concern about sterility, Litman said. The physician said it was no different from having a person come in the room wearing street shoes.

Plenty of people like having a dog around. In the case of children with autism, there is science to support the practice.

Researchers at Fondation Mira, a nonprofit in Ste.-Madeleine, Quebec, that trains service animals, reported in 2010 that the presence of a trained dog can lower stress levels in children with an autism-spectrum disorder.

The scientists determined that by measuring levels of cortisol, a stress hormone, in patients' saliva. More recently, they have found dogs have a similar stress-reduction effect on the mothers of such children, when compared with those in a control group that did not have dogs, foundation psychologist Noël Champagne said.

Some mothers even report they sleep better.

"The presence of the dog in the family is helping to reduce anxiety and stress," Champagne said.

Ashley, now 13, was at Children's Hospital recently for another visit, once again with a canine companion.

Finn died of cancer this year, but she now has Hank, an Australian Labradoodle that joined the family in May.

As nurse Andrea Crimmins took Ashley's blood pressure, Hank stood and assumed a protective pose.

Later, as girl and dog left the examination room, another patient was rolling by the doorway in a wheelchair. Hank immediately froze, and Ashley stopped with him.

Then, when nurse practitioner Kathy Sharp listened to Ashley's breathing, the dog sniffed the hem of her white lab coat before settling on the floor.

Ashley, who lives in Seven Valleys, Pa., near York, said she appreciates the animal's presence.

"It makes it much easier," she said. "It can be very comforting when you go through a procedure."

The cost of the service dog, more than $10,000, was not covered by insurance. Lorie Grim said the family held a fund-raiser to offset the cost.

They got the first dog in 2010, after talking with Children's cardiologist Jeffrey R. Boris.

While a prime responsibility of Finn (and now Hank) was to allay Ashley's anxiety, Hank can even sense when Ashley's blood pressure is spiking, her mother said.

Ashley's blood pressure is unstable because she has a condition called postural orthostatic tachycardia syndrome, Grim said.

Recently, Ashley stood a bit too quickly to make her bed, and almost immediately Hank started to tug on the girl's shirt. Grim said she measured her daughter's blood pressure, and it was high - 154 over 110.

"I look at Hank to be my second set of eyes and ears," Grim said.

At the hospital, medical staff say they welcome service animals, too. Sharp, the nurse practitioner, said they have a clear impact on patients.

"It just makes the situation so much nicer," Sharp said. "They're calmed in a way that you can't explain."


Contact Tom Avril at 215-854-2430 or tavril@phillynews.com.

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