Introduction

Working, assistance, and therapy dogs (collectively referred to as working dogs in these guidelines) have high intrinsic value because they perform various practical, utilitarian, or commercial functions. As such, these animals are generally expensive to purchase and train. In addition, the physical and behavioral demands placed on working dogs often require a particularly high standard of healthcare and close monitoring by the attending veterinarian. These guidelines are intended to enable veterinary practitioners to anticipate the needs of these specialized patients and their handlers, to provide the care needed to maintain their health and serviceability, and to offer useful referral recommendations when appropriate. The terminology related to working dogs and how they are classified sometimes overlaps and can be confusing. The practice team needs to “speak the language” of the working dog community to better understand and relate to these specialized patients, their handlers, and sponsoring organizations. Thus, the guidelines begin with a section on acronyms and definitions related to working dogs and their societal roles. Although the advisory panel has attempted to clarify the definitions associated with working, assistance, and therapy dogs, some confusion and inconsistency is unavoidable owing to the lack of universally recognized nomenclature associated with this animal population.

The guidelines have four principal objectives as noted below, along with the rationale for each objective.

Improve the practice team’s understanding of the special needs of working dogs. Although practitioners may intuitively realize that working dogs have special needs, they may lack full awareness of healthcare implications and challenges of caring for this type of patient. The need to handle high-value dogs, protection dogs trained for on-command aggression, or high-energy service dogs can be intimidating to some practice team members. Care must be taken to avoid treatment decisions that impair the functionality of the dog, such as its mobility, detection skills, or alertness. Working dogs always function along with a handler, partner, or service team. The practice team must care for the patient but always in concert with the individual responsible for the dog or with the sponsoring organization. The relationship between the working dog and its handler can be exceptionally strong, for instance, in military or law enforcement settings where human life is sometimes in the balance. In other cases, the working dog is literally priceless when the animal’s performance is critical to human welfare, for example, in the case of guide dogs for visually impaired individuals. The working dog may not always be in the immediate or full-time care of the handler (e.g., customs dogs, TSA dogs, military working dogs). Some guide dog schools not only train the service dog but maintain ownership responsibility as well. Thus, treatment decisions and ownership responsibility for a working dog may fall to a sponsoring organization instead of an individual client as in the case of a conventional canine pet.

Develop an understanding of the dog’s special needs from the perspective of its handler or trainer. The working dog’s trainer or handler is an essential and committed partner in the animal’s healthcare and has a role in executing the healthcare plan. It is essential that the practice team involve the human partner by understanding his or her role in the dog’s performance and by obtaining that individual’s observations and viewpoints on the dog’s health status and needs. The working dog’s human partner often has a different and more holistic role with a greater economic stake than a conventional pet owner might have. A working dog handler or trainer is attuned to their canine partner in a similar way as a zookeeper who is in continuous contact with and responsible for the care of a rare or exotic species, or a trainer working with an elite equine athlete. The working dog’s human partner will often notice subtle changes in the dog’s performance or disposition that can indicate early-onset disease, and in this respect can differ from conventional canine pet owners. The veterinarian should probe for these observations and give ample credibility to the dog handler’s perspective. The information obtained from the handler should be recorded in a detailed patient history that can be correlated with performance. Because the handler is in contact with the dog in a highly observant role, the human partner can often identify changes indicative of the dog’s physiologic status that would otherwise escape the veterinarian’s detection.

Enhance the well-being and safety and decrease the stress imposed on the practice teams who care for working dogs. The practice team’s confidence in skillfully and safely handling working dogs is in direct proportion to its understanding of the special needs of this type of patient. A principal reason why practitioners may not fully appreciate the special needs of working dogs is that veterinary schools generally do not provide curriculum offerings on specialized care required by these animals. These guidelines seek to fill this information gap by providing recommendations on how the practice team can effectively interact with high-value working dogs and their handlers. These include the essential role that low-stress handling plays in the effective interaction between the patient and the practice team. Recording a thorough patient history, including acquisition of related video or photo documentation, is an especially important component of working dog care and involves asking questions specific to the dog’s societal or service role. Some working dog associations have veterinarians on staff that can serve as a valuable resource to the practice team, as described later in the guidelines.

Minimize the risk of infectious disease transmission and injury to working dogs by providing optimum preventive healthcare and nutrition. Working dogs often interact with human handlers or clients who are experiencing health problems that put them at risk of zoonotic diseases. These include very young or older individuals and those who are convalescing or affected by chronic conditions. Conversely, working dogs might be exposed to occupational risks associated with their environment or duties. The practice team should be aware of the circumstances of the dog’s human partner and the setting in which the dog works. Video or photo documentation of work-related concerns or responsibilities (provided by the client) may also be facilitative for the care team’s understanding of the patient’s occupational hazards encountered. This may involve educating the human handler about first aid or husbandry specific to the dog’s function, transmissible disease exposure risks (including zoonotic diseases), and other unique health risks to which the dog might be exposed.

Acronyms and Definitions

Veterinary practice teams should be familiar with the following acronyms and definitions related to working and service dogs. NOTE: All definitions and allowances are subject to change with updates to federal, state, and local regulations and policies. It is advisable to refer to the most current policy for guidance.

Acronyms and Abbreviations

AAA

Animal-assisted activity

AAI

Animal-assisted intervention

AAT

Animal-assisted therapy

ADA

Americans with Disabilities Act

CBRNE

Chemical, biological, radiological, nuclear, and high-yield explosives

CBP

Customs and Border Protection

DEA

Drug Enforcement Administration

EMT

Emergency medical technician

ESA

Emotional support animal

FHA

Fair Housing Act

HMO

Health management organization

HUD

U.S. Department of Housing and Urban Development

K9

Canine

MPC

Multipurpose canine

MWD

Military working dog

NRC

National Research Council

PTSD

Post-traumatic stress disorder

S&R

Search and rescue

TSA

Transportation Security Administration

USAR

Urban search and rescue

USDA

United States Department of Agriculture

Definitions

• animal-assisted activities (AAA). The term for animal-assisted activities delivered in a variety of environments by specially trained professionals,paraprofessionals,orvolunteersinassociationwithanimalsthat meet specific criteria and provide opportunities for motivation, education, or recreation to enhance quality of life. (A compilation of definitions of AVMA Animal-Assisted Interventions is available online.¹)

• animal-assisted therapy (AAT). A goal-directed intervention in which an animal meeting specific criteria is an integral part of the treatment process delivered or directed by health or human service providers working within the scope of their profession. Animal-assisted therapy is provided in a variety of settings and may be group or individual in nature.¹

• assistance dog (assistance animal). Assistance animals do work, perform tasks, provide assistance, or provide psychological support for a person with a physical or mental impairment that substantially limits at least one major life activity or bodily function. An assistance animal is not a pet. (Eligibility requirements for an assistance animal are described in 24 C.F.R. §§ 5.303; 960.705; FHEO-2010-01, Assessing a Person’s Request to Have an Animal as a Reasonable Accommodation Under the Fair Housing Act. Office of Fair Housing and Equal Opportunity, U.S. Department of Housing and Urban Development, January 28, 2020, pp 1–19).

• canine handler (dog handler, K9 handler). A person who has successfully completed a recognized course of canine handling in a specific discipline and maintains those abilities through field applications, maintenance training, certification, recertification, and department-, agency-, or organization-required continuing canine education.²

• detection dog (detection canine or K9). A dog trained to detect and alert to the presence of certain scents or odors for which it has been trained. May be referred to as a law enforcement or search and rescue service canine, which is not to be confused with dogs covered by the ADA (e.g., medical detection dog).³

• dual-purpose canine (dual-purpose dog or K9). A canine trained in two disciplines (e.g., a narcotics detection dog also trained for apprehension).³

• emotional support animal (ESA). An animal of any species that provides therapeutic emotional support for individuals with disabilities in which the use is supported by a qualified physician, psychiatrist, social worker, or other mental health professional based upon a disability-related need. ESAs do not qualify as service animals under the ADA or under a recent ruling by the U.S. Department of Transportation because they do not require training to perform a particular task. (Regulations involving ESAs are available at FHEO-2010-01, Assessing a Person’s Request to Have an Animal as a Reasonable Accommodation Under the Fair Housing Act. Office of Fair Housing and Equal Opportunity, U.S. Department of Housing and Urban Development, January 28, 2020, p 1–19, and at 24 CFR Part 5, Pet Ownership for the Elderly and Persons With Disabilities; Final Rule. Department of Housing and Urban Development, Federal Register, Vol. 73, No. 208. October 27, 2008, pp 63834–63838 and Service Animal Final Rule, U.S. Department of Transportation.)

• multipurpose canine (MPC). A military working dog employed by U.S. Special Forces.³

• protection dog (protection canine or K9, operational canine or K9, security dog or K9). A broad term encompassing many individual types of dogs trained to alert to and deter human or animal threats. Protection refers to the behaviors associated with defense of self or other group members including humans when threatened or when a potential threat is perceived. Examples include police dog, law enforcement canine, private security dog, patrol dog, and livestock guard dog.³

• sensory threshold (behavioral threshold). The amount of a stimulus that is necessary to produce a response from a dog.³

• service dog. Any dog that is trained to do work or perform tasks for the benefit of an individual with a disability including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, or trained or untrained, are not considered service animals. (Service dog regulations are described in 28 C.F.R. §§ 35.104; 36.104, Americans with Disabilities Act Title III Regulations. Department of Justice, September 15, 2010, p 33).

• single-purpose canine (sole-purpose canine, K9, dog). A dog trained in only one discipline, typically based on odor/scent detection (e.g., search and rescue dog, medical detection dog).³

• therapy dog. An umbrella term for a dog that is used in animal-assisted activities or goal-directed interventions of animal-assisted therapy and is not recognized by the ADA as a service animal. (See 28 CFR 36, Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities. Department of Justice, Federal Register, Vol. 75, No. 178, September 15, 2010, pp 56268–56269; 73 FR 34508, 34553 (June 17, 2008); and AVMA Legal context for assistance animal use – definitions⁴).

• Categories of Working, Assistance, and Therapy Dogs

  It is helpful for practitioners to define working and service dogs according to their specialized function or work environment, as follows:

  • Working dogs, further categorized as detection or protection animals. As the name implies, working dogs are trained to accomplish specific, defined tasks.

  • Assistance dogs, categorized as either service dogs or emotional support dogs. Assistance dogs help persons with a diagnosed psychological or physical limitation who benefit from interaction with the dog. Service dogs have a specific job to accomplish, whereas an emotional support dog does not have a specific job but provides support by their presence alone.

  • Therapy dogs perform either animal-assisted activities (AAA) or animal-assisted therapy (AAT). AAA dogs have been described as “happiness delivery” animals, performing duties such as hospital visits and de-stressing interactions with people. AAT dogs provide goal-directed therapy, often directed by a healthcare professional such as an occupational therapist or psychologist.

TABLE 1 Practice Team Attributes and Skill Sets for the Care of Working, Assistance, and Therapy Dogs

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Working Dogs: The Detection Dog

Examples

The discipline of detection dogs is expanding even as this report is developed, and therefore, providing an expansive list of all types of detection dogs would not be practical. Detection dogs are often categorized by the specific odor/scent or category of odors/scents for which they are trained to detect, for example, explosives, narcotics, live humans, human remains, invasive or endangered plants or animal species, contraband and weapons, ignitable liquids, medical conditions, and tracking (Table 2). They can also be classified by how they work (e.g., trailing, tracking, and air scenting). Finally, detection dogs can be categorized by the industry or sector for which they work (e.g., agriculture, conservation, and search and rescue).

TABLE 2 Examples of Detection Dog Sensory Target Odors

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Working Dogs: The Protection Dog

Assistance Dogs: The Service Dog

Assistance Dogs: The Emotional Support Dog

Therapy Dogs

How Working, Assistance, and Therapy Dogs “Earn a Living”: Protection Dogs

Protection dogs by definition are trained to alert to and deter human or animal threats. The job of protection often demands that the dog works closely with its handler to assess a situation, react and move quickly, remain determined in the face of danger, and possess a balance of stamina, power, and agility. Protection dogs could be required at any point to sprint, jump over obstacles, turn sharply at top speed, scale walls and fences, move on unstable surfaces, and perform powerful bite and hold maneuvers, all of which can produce both significant mental stress and the physical stress of excessive biomechanical forces on the dog’s mouth, joints, and spinal column. Breeds typically used for protection are highly intelligent, energetic, and reactive and have the body conformation to develop the fitness capacity necessary to meet the physical demands of the job.

A common scenario for a protection dog is for law enforcement backup and possible apprehension of a fleeing suspect. The handler typically loads the dog (if not already on patrol riding in the back of the police car) and heads to the scene. The dog may become increasingly excited for the anticipated work and the thrill of the chase, which could lead to stereotypic behaviors such as rapid circling in the travel kennel and excessive vocalizations. Once on the scene, the dog may need to approach the situation slowly and methodically with the handler or may be required to move explosively into action. The dog may have to sprint long distances and conclude with a physical encounter engaging the suspect, which may include bite apprehension. The hours of proper training and physical conditioning come into play at this time, and the goal of the team is to successfully meet the needs of the situation without injury to dog or handler. Once the situation is resolved, the team then must return to a calmer, cooled-down state and prepare for the next challenging situation.

The characteristics needed to build a successful protection dog can present a challenge for the veterinary personnel caring for the canine team. These dogs may have behaviors such as increased reactivity or potential aggression in response to treatments that may cause discomfort. Always incorporate the handler, use low-stress handling, and consider preemptive sedative and analgesic drugs as necessary, knowing that they could collectively temporarily influence the dog’s working performance. For the safety of the veterinary team, muzzles should be used when working with protection dogs to help avoid bite injuries. Even a muzzled dog may strike with full head force (known as “muzzle-whipping”), which can lead to some painful concussive injuries to veterinary personnel. In light of these risks, the inclination is to often overhandle protection dogs, which makes them more reactive and aggressive. This is a common scenario that emphasizes the importance of low-stress handling techniques. Experienced veterinary personnel and dog handlers will develop a coordinated and calm flow of movements around the dog while performing the physical exam and various procedures and treatments. The handler should be consulted frequently in developing a hands-on plan for working with the canine partner. For example, it is particularly important to discuss rewards or any food or treat techniques to be used during the visit. Furthermore, it is critical not to separate the handler from the dog unless absolutely necessary. If so, the veterinary team should plan to administer sedative drugs before separating the two parties and to ensure the handler is present during recovery.

How Working and Service Dogs “Earn a Living”: Detection Dogs

How Working and Service Dogs “Earn a Living”: Service, Assistance, and Therapy Dogs

Assistance dogs serve to assist their handlers, which can be further characterized by their specific roles such as guide dogs, hearing dogs, and mobility assistance dogs. Therapy animals serve to benefit humans other than their handlers in a variety of professional and nonprofessional settings.

The selection process for assistance dogs depends on their role and from where they originated (i.e., a not-for-profit organization versus independently trained). Many nonprofit organizations that train assistance dogs have their own breeding programs. These organizations select the best individuals for breeding based on health, temperament, and trainability. Orthopedic, ophthalmic, and cardiac screening tests are used in combination with breed-appropriate genetic tests to select breeding stock as well as working stock. Temperament evaluations are done at specified times to determine the dogs’ suitability for the type of work they are being raised to perform. Dogs in breeding programs for assistance dog schools may reside at special breeding facilities or be housed with volunteer foster homes or caretakers.

In contrast, therapy dogs can be pet dogs whose owners have enlisted as volunteer therapy teams (AAA), usually under the supervision of a registering AAI organization, or belong to or work with health or human service providers working within the scope of their profession (AAT). These dogs are certified by the registering organization using a standardized behavior evaluation. They should be tested in the working environments in situations they may encounter and demonstrate minimal signs of behavioral stress.³⁴ Therapy dogs should demonstrate good-to-excellent social behavior without concern regarding their own safety or that of the patient and be reliable, predictable, and controllable.³⁵ In addition, they need to be certified as healthy and free of zoonotic diseases by a veterinarian.^36,37 Each AAI organization sets its own standards and requirements for therapy team registration, including handler education training and registration fees.

Assistance dogs formally trained through nonprofit organizations are typically raised by volunteers who expose the puppies to as many people, environments, and experiences as possible to help ensure calm, confident puppies.³⁸ The puppies should experience the challenges of everyday life such as crowds of people, playing children, other dogs, varieties of surface, elevators, and stairways. These puppies should learn how to ignore common distractions. Additionally, they should be comfortable traveling to different environments (from rural settings to busy city streets) and remain relaxed when receiving care and restraint (daily grooming and veterinary visits). Formal intensive and specific training begins when dogs return to the training facilities after puppy raising.

No specific training is mandated for pet dogs to become therapy dogs because a calm temperament and social personality are more critical aspects of therapy animal standards. However, therapy dogs often undergo basic obedience training, such as the American Kennel Club’s Canine Good Citizen, to prepare for the specific behavior evaluation administered by the individual AAI organization.³⁹ In addition, many dogs will have advanced skills training for specific tailored tasks that meet identified goals in AAT. It is critical that the handler receive basic education training in zoonotic disease management and monitoring the therapy dog for stress behaviors.^28,29

Assistance dogs are invaluable because they enable individuals with disabilities to carry on with simple everyday tasks and address life-threatening medical situations. These dogs enable at-risk individuals to function effectively in order to lead happier, healthier, more productive lives and serve as their handlers’ lifelines and connection to the public.

While therapy dogs are pet dogs that bring joy and benefits to those that they visit, the handler/owner also benefits greatly from the bond. The relationship between dog and handler is likely strengthened because of the additional time and energy the handler spends with the therapy dog during these activities. In addition, the handler and dog derive their identity by volunteering as a team, a partnership that brings about a sense of pride and joy by making a difference in the lives of others.

Assistance dogs work in a wide variety of environments because they are permitted in almost all public locations where handlers go, including public transportation. Therapy dogs also work in a wide variety of environments that have been preapproved by facilities and AAI organizations. In contrast to assistance dogs, therapy dogs do not have public access or transportation rights because they are considered to be “pet” animals.

TABLE 3 Healthcare Recommendations for Protection, Detection, Assistance, and Therapy Dogs

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TABLE 3 Healthcare Recommendations for Protection, Detection, Assistance, and Therapy Dogs

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TABLE 3 Healthcare Recommendations for Protection, Detection, Assistance, and Therapy Dogs

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TABLE 3 Healthcare Recommendations for Protection, Detection, Assistance, and Therapy Dogs

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TABLE 4 Common Health Risks to Detection Dogs Based on Working Category

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Medical Care Considerations: Protection Dogs

A trained, healthy working dog is an extremely valuable asset to an organization or individual and can save lives when appropriately deployed in a wide variety of situations. Keeping the canine team healthy and injury-free is paramount in maintaining the effectiveness and well-being of the dog, the handler, and those dependent upon the outcomes of the team’s actions. Extensive resources are involved in training these specialized dogs, so there also is incentive to maximize the time in which they are at peak performance. A comprehensive preventive medical care plan is the cornerstone of health for any working or service dog. Protection dogs are no exception.

Job requirements, environmental exposures, and travel requirements are important factors to consider when building an individualized care plan for a working dog. The 2017 AAHA Canine Vaccination Guidelines provide an excellent resource for information regarding vaccine recommendations that translate directly to optimal working dog care.⁴⁰ Veterinary teams that are involved with canine breeding and puppy raising programs that support the supply and demand for adult working dogs have special considerations for planning preventive care programs that may deviate from pet puppy programs. All working dogs should receive recommended core vaccinations, along with strong consideration for noncore vaccines based on risk factors and locale. Most working dogs are additionally vaccinated for infectious upper respiratory diseases and leptospirosis from the noncore group, and remaining noncore vaccine options should be evaluated on an individual basis.

The veterinary team can refer to the 2011 AAHA-AVMA Canine Preventive Care Guidelines as another valuable tool for planning preventive healthcare programs for working dogs.⁴¹ In addition to vaccination, programs should include parasite prevention, dental evaluation and treatment, weight and diet evaluation, fitness evaluation, and behavioral and performance evaluation. Establishing routine health exams is important in early detection of issues that may affect sustained performance, and the AAHA-AVMA Canine Preventive Healthcare Guidelines recommend a minimum of once-yearly health exams. Although there is a paucity of data that defines an ideal interval for health exams in working dogs, it is the advisory panel’s opinion that exams should be considered twice yearly for this population. As a component of these exams, it is important to obtain a thorough history about the dog’s performance from the handler. Video or photo documentation of work-related concerns or responsibilities (provided by the client) may be facilitative for the care team’s screening of the patient’s needs. Although handlers may not have the knowledge to medically assess their canine partner, they are often so closely bonded with their dogs that they detect very subtle abnormalities in the dog’s movements or behavior, well ahead of what the veterinary team can detect symptomatically.

As a component of preventive care, dental health is critical in sustaining the protection dog’s ability to perform bite work duties. Because protection dogs routinely train by performing bite exercises on aids such as bite sleeves or suits (which often contain an inner core of metal mesh to protect the human decoy), coupled with the fact that they can create an extraordinary amount of occlusal force during maximal bite pressure, the potential for traumatic damage to the teeth is increased. A detailed review of the mechanics of the bite can be found in J. Bradshaw’s article in the 2017 July/August issue of Working Dog Magazine.⁴² The teeth that are most involved with creating functional grip and power in the bite, namely, the canine and carnassial teeth, should be preserved whenever possible following dental injury. The practitioner involved in working dog care should maintain a close working relationship with dental specialists who can provide advanced care such as root canal therapy when teeth are damaged.

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It is important to discuss the policy of neutering with the working dog or breeding program manager, as many (particularly male) working dogs are left intact for an extended period of their working careers. There has been much debate about health outcomes of early neutering in dogs. Recent meta-analyses point to an increase in overall risk of hemangiosarcoma, lymphoma, mast cell tumors, and osteosarcoma in both sexes. This must be balanced with the known prevention of reproductive cancers such as mammary, uterine-ovarian, and testicular cancers when the dog is neutered. Additionally, gonadal hormones play an important role in normal musculoskeletal development, and removal of the hormone source during the developmental period is generally thought to worsen the risk of heritable orthopedic disease.⁴³

Overall fitness is of critical importance in preparing the protection dog to perform efficiently and safely in the line of duty. Weight management is one of the first steps in promoting high functionality in working dogs. The veterinary team must develop a practiced eye for evaluating lean yet well-muscled working body conditions. Caloric requirements should be specifically calculated for the working dog and adjusted as necessary to maintain a lean, ideal body condition, and often on a recurring basis. A useful formula to start the process is the National Research Council’s (NRC) calculation for metabolic energy requirement for the active dog: 132 kcal/day × MBW, where MBW is the metabolic body weight calculated as (kg^0.75). Routine activities for the protection dog tend to be rigorous and involve running, jumping, abrupt direction changes, moving on unstable surfaces, and high impact. Given these requirements, an overweight protection dog may be at particular risk for impact-related injuries through both ballistic movement and high-velocity bite work, as excessive weight increases forces within the involved joints.

There are no studies in working dogs correlating fitness training to injury prevention. However, based on human studies, it is reasonable to expect that proper physical conditioning would serve a role in decreasing sports- or performance-related injuries.^44–49 Additionally, proper physical conditioning is important in the management of heat stress and may lessen the occurrence of work-related heat injuries. Working dogs are sometimes surprisingly ill-prepared for the physical demands of their jobs. In such cases, the veterinary team should have a detailed discussion of any fitness training that is conducted by the handler. Exercises for protection dogs should include a balance of sprint and moderate endurance training, strength exercises targeted at the core muscles of stability (primarily back, abdominal, and hip) and the cervical region (supporting safe and effective bite work), and functional neuromuscular exercises that promote balance and proprioception. Additionally, the importance of warming up before job performance and cooling down at the conclusion of duty needs to be communicated. Recent work by Farr et al. describes a fitness assessment and conditioning plan for working dogs that can aid the practitioner in developing a program of exercise for the canine team.¹⁰ Specialists in canine sports medicine and rehabilitation can also serve as valuable consultants for creating programs to promote working dog fitness. The American College of Veterinary Sports Medicine and Rehabilitation (https://vsmr.org/) is a useful resource for veterinary care focusing on conditioning and rehabilitation.

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Veterinary teams providing care to working dogs should be prepared to deliver urgent care for common injuries and toxicities. Although dermatologic disease, gastrointestinal disturbances, soft tissue and musculoskeletal injuries, and heat injuries are commonplace in the realm of working dog medicine, the protection dog is especially vulnerable to traumatic injuries such as gunshot wounds and penetrating injuries from knives. The veterinary team must be prepared to triage and stabilize such wounds if the dog is presented for emergency care. Swift and coordinated emergency care has saved the lives of many working dogs, so that the canine team can reunite as a functional unit. It is important to also address any behavioral issues that arise as a result of traumatic events. Dogs can develop their own form of post-traumatic stress that can endanger their careers if the condition goes untreated.⁵⁰ Traumatic injury can also result in the death of the working dog, an event that is particularly difficult for the handler and other team members. The veterinary team must be prepared to navigate the death of a working dog with an understanding and profound empathy for the rituals that are observed in honoring the loss of a four-footed partner.

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Medical Care Considerations: Detection Dogs

Many detection dogs spend their careers in the local communities in which they serve. However, specialized detection tasks such as search and rescue (S&R) may result in the need for travel across the United States and internationally. Preventive medicine should include addressing likely risks associated with the deployment environment. Search dogs that work in wilderness areas or respond to natural disasters will require some noncore vaccines, including leptospirosis and potentially Lyme disease.^40,51 Some detection dogs are kenneled or gather in large groups for training and should be vaccinated for canine infectious respiratory disease syndrome. Regional endemic diseases (e.g., tickborne diseases, fungal disease, heartworm disease) in deployment areas should be anticipated, with preventives provided if available or postdeployment monitoring conducted. All detection dogs with the potential to travel should be on routine flea-and-tick preventives and heartworm prophylaxis. Routine (annual) health monitoring (e.g., chemistry profile, complete blood count, urinalysis, fecal parasite evaluation, heartworm and rickettsial disease screening) is recommended. Annual thoracic radiographs were of low yield in detecting occult disease in dogs responding to the 9/11 terrorist attacks and are of limited monitoring value.⁵²

Detection dogs are some of the most highly trained yet uncooperative patients presented at veterinary practices. Many detection dogs are highly energetic and arousable, which is desirable for a fearless dog working in noisy environments with unstable surfaces or multiple distractions. These dogs are “spring-loaded” and when in “work-mode” are difficult to restrain or calm. They may be predisposed to compulsive behaviors.⁴⁹ Handling to prevent these dogs from exceeding a threshold of excitement can be challenging. Several techniques can facilitate a smooth evaluation.^11–13 The handler should be actively involved in the examination and procedures in which they can safely participate. The handler has a unique bond with the dog, and the dog may become anxious or exceed a behavioral threshold if the two are separated. Additionally, the handler may use trained commands that can facilitate an assessment.

Although examinations can be performed on the ground, some dogs are more cooperative on an elevated, nonslip surface (photo). (Tip: Have a yoga mat to cover the exam table.) Use of a high-pitched voice may inadvertently initiate a “work-mode” for the detection dog. Instead, use quiet voices and slow, calm movements, and if approved by the handler, use treats. (Tip: Frozen peanut butter on the inside of a coffee cup is a great way to occupy the dog during an examination; see photo.) Detection dogs that are kenneled, rather than living with the handler, may have special environmental enrichment needs to prevent unwanted behaviors.

Nutrition should focus on appropriate body condition (4–5 out of 9).^8,9 Because canine athletes are at risk for degenerative conditions like osteoarthritis,^53–56 lean body condition will contribute to longevity and slow the progression of arthritis. Dietary omega-3 fatty acids should be considered for the anti-inflammatory effects,⁵⁷ particularly for detection dogs with high-physical-impact jobs. Many detection dogs develop work- or stress-related diarrhea. Although a complete fecal evaluation (i.e., flotation and stained direct smear) for parasites (Giardia, Clostridium, and Campylobacter) is indicated, many dogs will respond favorably to the use of probiotics.⁵⁸ In anticipation of a stressful event (e.g., deployment to a natural disaster), prophylactic pro- and prebiotics may be beneficial. Unlike metronidazole, which has been reported to decrease olfactory sensitivity,⁵⁹ there is no known negative effect of probiotics on olfactory function. There is limited information on the direct impact of medications on canine olfactory function, and the translation of information available in human literature is unknown.^60–62 Although dietary changes have traditionally been discouraged, benefits of microbiome diversity suggest that dogs should rotate between 2–3 balanced diets, each with fat, protein, and carbohydrate content appropriate for the intensity of the work environment.⁶³

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Detection dogs traverse a variety of environments and surfaces. In buildings, on vehicles, or in disaster settings, the dogs are frequently required to stand on their hind limbs (see photos).

Most dogs lack the appropriate fitness and core strength to support their lumbar spines in this position.¹⁰ Repetitive motion of the lumbosacral spine, inadequate stretching of the iliopsoas muscle, and coxofemoral laxity may result in back and hip pain that can be challenging to diagnose and treat. A fitness and conditioning program to enhance core strength and flexibility may help prevent injury and increase working lifespan.¹⁰ Musculoskeletal injuries can occur from sudden movements, sprains, strains, and overuse. Although pet dogs typically recover from relatively minor injuries, detection dogs should be treated as performance athletes. After therapeutic pain control, detection dogs should follow a rehabilitation plan to prevent deconditioning from prolonged rest and to regain the strength and flexibility to safely return to work. Any intervention, treatment, or procedure should account for the potential impact on the dog’s overall performance and anticipated return to work. Minor cuts and scrapes are among the most common injuries in detection dogs.^64–66 Some work environments preclude the use of foot protection, making foot injuries common and challenging. Nails, including dewclaws (important for traction and grip), should be kept trimmed to prevent injury. Detection dogs are at risk of heat injury. The working temperature of these dogs commonly exceeds 105°F,^67,68 temperatures that are tolerated, but the dogs work on the brink of heat exhaustion. Heat stroke was one of the most common preventable causes of early retirement in military working dogs.⁶⁹ Veterinarians should play a role in its prevention and be prepared for emergency treatment. Handlers should be educated on the physical signs of heat stress, including excessive panting, extended and flattened tongue, squinty eyes, laid back ears, retracted lip commissures exposing the molars,⁶⁷ and prolonged skin tent over the cranium,⁷⁰ so that they can end activity and initiate cooling. Common heat-induced behavioral changes include shade-seeking and failure to return directly to the handler after a retrieve. Weight control, physical fitness, hydration, and acclimatization are important contributors to heat tolerance.

Detection dogs are at risk for toxin exposure. Of particular concern for drug detection dogs are fentanyl and other synthetic opioids. Although dogs are 10–20 times less sensitive to the effects of opioids than people, inhalation of fentanyl or the more potent synthetic opioid carfentanil can lead to toxicity.⁷¹ Signs associated with exposure, ranging from panting, increased noise reactivity, salivation, and defecation to hypopnea, hypotension, collapse, and death, are dependent on the amount absorbed. With opioid toxicity, the dog can act as a fomite and potentially expose the handler, first responders, and veterinary personnel to hazardous levels of opioids.⁷²

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One of the most difficult tasks as a veterinarian is to deliver news of a terminal condition or a career-ending injury to a detection dog. A working dog and handler have a unique bond. The handler often spends more time with their canine partner than with any human. In addition, the dog may be responsible for saving someone else’s life, including the handler’s. The extensive amount of training further deepens the bond and communication between the handler and the dog. In the 9/11 response, first responders that deployed with a working dog had a lower incidence of post-traumatic stress disorder (PTSD) symptoms than noncanine first responders. However, if the dog died within 3 years of the 9/11 deployment, the handler’s risk of PTSD increased.⁷³ It is important to appreciate this unique partnership between handler and dog as well as the necessity of the dog’s purpose in its work.

Medical Care Considerations: Service, Assistance, and Therapy Dogs

Medical concerns and treatment goals should be adjusted accordingly for assistance dogs to attain the most rapid resolution and thus a rapid return to work. A mild problem or inconvenience such as soft stools for a pet may be a significant problem for an assistance dog because it can be very difficult to clean up afterward and the dog may even have accidents in areas in which pet dogs are not permitted, resulting in potential public relations nightmares and time off from work. An ear infection can pose a significant distraction to a service dog because of discomfort and constant itching and shaking of the head.

Side effects of medications can affect an assistance dog’s work. For example, steroids can impact urination; increase drinking and hunger, leading to significant distraction; and cause accidents that result in the dog being pulled from work. Any medication that can cause sedation or drowsiness can potentially affect a service dog’s work. Whenever prescribing medications to an assistance dog, it is important to discuss the potential side effects with the client.

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Although prognosis might be comparable for two different treatment options, quicker return to function will result in less time off work and should be the key factor in considering therapeutic options. For example, long-term prognosis might be comparable with conservative versus surgical management of cruciate disease but a significantly quicker return to function may be possible with a geometry-modifying procedure (such as TPLO or TTA).

Service dogs may be more prone to particular injuries based on the nature of their work. Damage to paw pads can occur from hot pavement or from salt residue on the sidewalks and streets, and paw pad lacerations can occur from broken glass present on the ground. The use of booties during work can prevent many of these injuries. Even the best guide dogs may sustain trauma from unpredictable vehicles or loose dogs.

Certain medical conditions may be incompatible with an assistance dog’s job. Medical conditions that seem incompatible with service work may not preclude continued service once well managed. For example, epileptic dogs can often continue their roles as assistance dogs once they are acclimated to medications and when seizures are well controlled. It is important, however, to make sure clients are aware when starting these medications that the dog may experience drowsiness and decreased attention to detail initially, in which cases their work should be suspended or supervised until acclimated.

Although dogs are typically neutered before becoming service dogs, a practitioner may be called upon to care for foster breeders from a service dog organization. It is important to avoid any medications that could impact reproduction or have negative impacts on pregnancy, such as metronidazole, which has been shown to cause embryotoxicity or congenital malformations,⁷⁴ or steroids, which have been implicated in the cause of congenital malformations⁷⁵ and may induce premature labor.⁷⁶ It is also unclear how much systemic absorption there is of topical medications containing steroids (such as topical ear or ophthalmic medications). Thus, consideration of possible side effects must be made before prescribing these in pregnant bitches.

Vision and hearing are particularly important in service dogs and should be assessed at all routine veterinary appointments. The American College of Veterinary Ophthalmologists provides free ophthalmic exams to eligible service and working dogs administered by participating ophthalmologists through the National Service Animal Eye Exam Event, which typically takes place every May. Maintaining a healthy weight and body condition is important for all dogs but should be emphasized with service dogs because it is associated with improved health and longevity and can decrease the risk of degenerative joint disease,⁷⁷ a leading cause of retirement in working dogs.⁷⁸

Although assistance and therapy dogs are generally calm, highly trained, and gentle, they can still be fearful in the veterinary setting. For this reason, gentle, low-stress handling should always be used. In addition, the veterinary team must request permission from the handler before interacting with and handling the dog. Service dogs wearing harnesses or vests are typically “on duty” and should not be handled until these have been removed.

Medications and discharge instructions need to be understandable and accessible based on the client’s disability (e.g., use different-sized pill vials if more than one medication is dispensed for a dog with a blind handler). Administration of a liquid medication may be more difficult, so preloading single-use syringes or tablet/capsular medications may make administration easier and more reliable. Communications and the mode of communication need to be individualized based on the client’s disability. There should be a discussion with the client about their preferred method of communication. Minimize background noise, face the client, and speak clearly to hearing-impaired handlers. Other clients may need to use pen and paper or a text app to communicate.

Consultation with veterinarians from the organizations that trained the assistance dog may be useful for several reasons. These include better understanding the prevalence of heritable disease, determining whether testing to obtain a better understanding of factors that influence a dog’s working ability has already been performed, and gaining insight into financial options that may be available to the working team. Additionally, the organization that breeds and trains service dogs may track medical conditions that occur in their dogs for purposes of future breeding selections and research to find disease-associated genetic markers.

Practitioners may want to consider offering discounts or waiving fees for assistance dogs. Most of the not-for-profit organizations training assistance dogs do not receive federal funding. Nonprofit discounting helps the client and furthers the organization’s mission to assist people by decreasing its financial burden.

Because service dogs accompany their handlers everywhere, they typically travel much more than the average pet. USDA-accredited veterinarians treating service dogs may be called upon to assist in fulfilling requirements for international travel. These standards vary greatly from country to country and may include rigorous testing such as antibody titers, fecal floatation testing, vaccinations, examination and submission of permits and health certificates, and external and internal parasite treatments that are time dependent on travel dates.⁷⁹

Depending on the organization, foster dogs (puppies or breeders) may go to local veterinarians for medical attention. Treatment decisions and veterinary bills are typically directed to the organization’s staff veterinarians. Some schools ask foster caregivers to pay the veterinary bills up front and may be reimbursed later. In addition, some organizations maintain ownership of their dogs while they are actively working with the handler. It is important to discuss who is responsible for financial and treatment decisions when a service dog or service dog-in-training is brought to a veterinary office.

Handlers and assistance dog clients typically have a high level of attachment to service dogs because they permit people to function in ways they would not otherwise be able to.^80–82 It can be difficult removing an assistance dog from its work because of this attachment and the client’s reliance on the animal. Therefore, careful consideration must be given on how the person will function without relying on the animal when the dog is hospitalized, placed on medical leave, or suspended or retired from work. Because of the extremely strong animal-client bond and the client’s reliance on the dog’s work, client discussions about retirement of a service dog because of health concerns can be very difficult. Similarly, end-of-life decisions can be incredibly difficult and emotional.⁸³

The age of retirement can vary based on criteria for retirement from their organization and the dog’s occupation and breed. Many experts consider 9 years of age to be a traditional retirement age. The most important consideration at the end of a dog’s service life is the determination of when the dog’s limitations jeopardize the safety of the handler. In such cases, the dog should be retired.⁸³ The most common reasons for early retirement in guide dogs are musculoskeletal conditions followed by skin conditions and nervous sensory conditions.⁷⁹

Because the organizations that qualify therapy dogs are nonprofit, annual registration fees usually cover the cost of operations and liability insurance for pet therapy teams. In addition, the sponsoring organizations are typically responsible for determining that therapy dogs are up to date on veterinary exams, core vaccinations, and prevention of zoonotic disease.³⁵

Education and Training of the Practice Team

Summary

The working dog is not the typical patient that companion animal veterinarians encounter in clinical practice. Working dogs have a utilitarian function that generally requires specialized temperament and training, involves intimate interaction with a handler or client, exposes them to exceptional physical and emotional demands, and sometime places them in high-risk environments. As a result, a practice team with working dog patients should have a training strategy that equips the staff with the knowledge and skills to effectively and compassionately examine and treat these important animals. Veterinarians are sometimes asked to certify the health status or behavioral suitability of working dogs, a demand that they should approach with caution. Any certification of the health status of a working dog should be based on a thorough exam and an evidence-based diagnosis. No sector of veterinary practice places a greater premium on effective communication with the presenting client than the care of working dogs. The working dog’s handler has an intimate knowledge of the animal’s physical status and functionality and is a principal source of information on the patient’s history and presentation status. The practice team must establish credibility with the working-dog client and earn that individual’s confidence and trust in order to maintain an effective and enduring veterinarian-client-patient relationship. When these skills and relationships are in place, the health-care of working dogs represents one of the most rewarding and valuable services that a veterinary practice can render.