1:00PM GMT 08 Dec 2014
This post is on Healthwise
For people with life-threatening conditions such as diabetes, Medical Detection Dogs can be invaluable. Chosen by the Telegraph for this year’s Christmas appeal, the charity is even training clever hounds to sniff out cancer
Lydia Swanson, senior scent instructor, with Oliver, who was given to the charity by Battersea Dogs & Cats Home and is now in training to be a medical alert assistance dog Photo: Leonie Hampton
At night, Molly is beside him in his bed at home near Bicester, Oxfordshire. If his sugar levels change she will jump off the bed to where his glucose meter is kept and take it straight to his parents, barking and scratching to chivvy them along. ‘Once I went in three times administering glucose, but still she barked,’ Serena remembers, ‘and it was because she was one step ahead of me. The levels were falling so fast I couldn’t keep up, but she knew because she could smell.’
Today, as they have been from the beginning, Steven and Molly are inseparable. Unlike many medical alert assistance dogs, Molly was the family pet, specially trained by the extraordinary Buckinghamshire-based Medical Detection Dogs charity after Serena, quite by chance, heard a volunteer talk at one of Molly’s puppy obedience classes.
‘My puppy knows when my blood sugars change,’ the then eight-year-old Steven told the volunteeer. ‘And I thought to myself at that point, what is he talking about?’ Serena recalls. But when she watched she saw that Molly’s behaviour was indeed in tune with Steven’s health. Serena applied for training for Molly when she was 18 months old (other families apply direct to the charity to join a very long waiting list for an already-trained dog). It took place at home and at the charity, and lasted six months. The family has never looked back. ‘That first night when Molly was trained, she hopped into Steven’s bed,’ Serena says. ‘He’d been such an anxious child at night, but immediately he put his arm round her and said, “Night, Mum.” He felt safe. It took a while for me to trust her, but now I do. Of course I don’t leave it all to her, but many nights I don’t set the alarm any more.’
Steven Courtney, 12, who has type 1 diabetes, with his beloved medical alert assistance dog, Molly. PHOTO: Leonie Hampton
Steven Courtney, 12, who has type 1 diabetes, with his beloved medical alert assistance dog, Molly. PHOTO: Leonie Hampton
Steven and Molly are only ever separated when he goes to school (medical alert assistance dogs work better at night if they rest during the day). Ask Steven what she means to him, and he hides his face in her fur. When he looks up, trying to put into words the strength of their bond, he becomes so overwhelmed with emotion that he begins to cry. ‘She is amazing,’ he says through his tears.
Medical Detection Dogs, set up in 2008 by Dr Claire Guest, a psychologist specialising in the interaction between human and canine behaviour, is based on the outskirts of Milton Keynes. It is in a low, flat, white building down a long lane, off the beaten track. There seems to be moving shiny black and chocolate fur everywhere (the charity has a no-kennel policy) and every member of staff – many of whom are volunteers, all dressed in black body warmers bearing the medical detection dogs logo – clearly adores dogs.
| The co-founder of Medical Detection Dogs, Dr Claire Guest, with Daisy. PHOTO: Leonie Hampton |
The charity has two arms to it. The first is Medical Alert Assistance Dogs, which works on the same model as guide dogs. Dogs ‘assist’ their owners to manage their disease, whether it be diabetes, severe allergies or narcolepsy. The second is Cancer Detection Dogs, of which there are 15, which, supported by Buckinghamshire NHS Trust at Wycombe Hospital, are all in varying phases of training to sniff out the changes in urine produced by prostate, bladder or urinary cancers; and – this is in the very early stages still – changes in the breath caused by breast cancer. One of these dogs is Daisy, Dr Guest’s own labrador, who has, in all the prostate studies so far, shown a 93 per cent accurate detection rate in sniffing out cancerous samples.
The first medical paper in which Dr Guest was involved looking at the work of ‘cancer dogs’ was published in the BMJ (British Medical Journal) back in 2004; the dogs were detecting bladder cancer from urine samples. But, as she explains, while nobody discredited the validity of the paper, the notion of dogs sniffing out cancer was seen as far-fetched and the study was small. ‘We’re not suggesting dogs sit in GP surgeries or sniff around people for illness,’ she says, ‘but it could be that hospitals send us samples in the future and that the dogs’ findings aid a consultant’s general picture about how further to proceed with invasive testing.’
This is particularly relevant in the area of prostate cancer, for example, where blood tests for raised levels of PSA are used as an indicator of the disease, despite a 75 per cent rate of false positives. The charity is currently in a second-stage study phase, screening 2,000 patients, and it says the dogs could be a reliable second-line screening tool in the future. ‘If it was rolled out we would get a urine sample and would run two dogs on it, then relay the result to the consultant,’ Dr Guest explains. ‘Prostate biopsy is very painful and there are infection risks. This could really help a doctor making a decision about whether to take a biopsy or not.’
| Ulrich, a bio-detection dog, in training to detect the odour of prostate cancer. PHOTO: Leonie Hampton |
In 2009, a year after Dr Guest started Medical Detection Dogs, licking envelopes and begging for appeal money from her sister’s conservatory, Daisy jumped on her and behaved in an erratic manner, alerting her to what was, in fact, a deep-seated cancerous tumour in her left breast. (Daisy has just been awarded the Blue Cross medal for her cancer-detection work.) Such early detection, Dr Guest believes, prevented the cancer from spreading and obviated the need for chemotherapy. ‘I believe Daisy told me,’ she says, although she is not sure – at the moment – how Daisy knew.
‘The science behind the two arms of the charity is the same,’ she explains. ‘Dogs can smell changes that humans can’t. I’ve been taken into a vast room full of equipment at Manchester University and been told that it has the power of Daisy’s nose. If we prove through training and studies, then extensive trialling, that dogs can sniff out breast cancer, imagine, in the short term, the second-line screening that could offer – how many lives it could save. When I spoke to a high-up government official, he said, “Why hasn’t this got funding?” And the only answer I could give was because it was all about a dog’s nose rather than a piece of equipment.’
Behind the general hubbub of the charity’s main reception rooms, there is the crucial bio-detection room where dogs come to ‘work’ every day. Currently, there are seven dogs in training to detect breast cancer. The best four will go through to the study phase. They are dropped off and picked up by foster parents four days a week, during which they each do three 20-minute sessions with Rob Harris, the charity’s bio-detection manager.
| Rob Harris, the charity's bio-detection manager, with Ulrich. PHOTO: Leonie Hampton |
The dogs always work one at a time. Today first Lucy and then Ulrich, both black labradors, give a demonstration. They are led consecutively into the bio-detection room, where there is a stainless-steel carousel with eight spokes, each holding a sample. In the case of breast cancer, this would be a breath sample on a fibre filter provided by women in the five-day window between an appointment at Wycombe Hospital for a suspected breast lump and diagnosis – so the samples are taken before the women (who have consented to take part in the trial) know whether or not they have cancer. The charity’s work in this field is supported by Giles Cunnick, a consultant breast-cancer surgeon, and Alan Makepeace, a consultant oncologist – both of whom treated Dr Guest. By the time the sample reaches Medical Detection Dogs, there has been a diagnosis.
| Lucy, a bio-detection dog, proceeding around a carousel of smells in search of the one that signals cancer. PHOTO: Leonie Hampton |
Harris knows when setting out the samples which are cancerous and which aren’t (the procedure would be blind, however, in a trial). In any one session one sample will be cancer (though sometimes there are no cancer samples to see how the dogs react). The dogs are told to ‘seek, seek’, and when they stop at a spoke that smells interesting they will sit and stare at it until released by a reward, either a ball to play with or food or the sound of a clicker. Over time the samples are honed down and made harder for them. It is vital that within the samples there are other infections, perhaps breast infections or in the case of urological cancer infections involving blood. Today both Lucy, a dog who helped contribute to the charity’s second bladder-cancer paper published in 2010, and Ulrich mostly have success.
For any future screening benefits, the bio-detection dogs need to know the difference between a cancerous and a healthy sample, rather than a healthy and an abnormal one. With cancer, Dr Guest explains, it is far harder than with diabetes because the charity does not know which part of the overall smell of a sample is cancer.
The breast-cancer project alone will cost £144,289. Each medical alert assistance dog costs £11,200 to train and an extra £750 a year to support. As yet the charity relies entirely on donations. Will the dogs be able to pick up breast cancer from a woman’s breath sample? Will doctors be able to use a dog’s ability to help detect prostate cancer to aid diagnosis? Who knows, but if they can there are fundamental implications, both in terms of a dog’s role in early-cancer diagnosis and the bigger issue of helping to provide a model for the development of electronic noses worldwide. ‘It costs about 50p to do a screen,’ Dr Guest says.
| Midas, a bio-detection dog, lives with Dr Guest and likes to sit at her desk. PHOTO: Leonie Hampton |
The charity has been training the dogs to detect breast cancer for six weeks and it will be another six months (1,500 samples later) before they might be ready to move on to a trial involving 300 to 400 women. (What they really need are more healthy breath samples from 18- to 30-year-olds.) One of their aims is to roll out the ethics proposal – the procedure it has to go through in order to involve patients and collect samples – so that other hospitals can be involved in studies too. ‘We very much want to work alongside traditional medicine and to ask questions and make discoveries that focus on and revolutionise early diagnosis,’ Dr Guest says.
If all this sounds like a tough life for a dog, Harris is keen to set the record straight. ‘The work is mesmerising,’ he says. ‘We are talking about dogs who are able to scent at parts per trillion.’ The bio-detection dogs evidently love their job. Seeking out a new smell – a skill that one day, if it is harnessed to a screening programme, might save lives – is the best kind of game for them. As any owner knows, there’s nothing a dog loves more than playing a game and being rewarded with a treat.
Tara Bedford with Willow, the only dog in the world trained to assist someone with airborne nut allergies. PHOTO: Leonie Hampton
Tara Bedford with Willow, the only dog in the world trained to assist someone with airborne nut allergies. PHOTO: Leonie Hampton
In the front of the building, 35-year-old Tara Bedford with her black lab, Willow, visiting from Surrey, and Carolyn Gatenby with her black lab, Simba, are sitting chatting to charity workers. Bedford’s dog has been with her for only four months and has already changed her life, she says. Ten years ago Bedford developed a nut allergy, which in 2010 became so severe that she couldn’t even breathe the same air as somebody who had been exposed to nuts or who had washed their hair in almond shampoo.
As a consequence, between 2010 and 2013 Bedford was rushed to A&E 40 times with anaphylactic shock. Her partner, Emma Coles, 43, approached Medical Detection Dogs in desperation. As both of them re-tell the devastating impact of the allergy on their lives, they begin to cry. Willow sits loyally by Bedford’s feet, gazing up at her. ‘I am more sure now than ever that all this has a very protective element to it,’ Dr Guest observes. ‘[For a dog] it is like they are protecting one of their pack.’
Willow took nine months to train – the charity did not know whether detecting airborne nuts was even possible for a dog. But it was. Willow was ‘phenomenal’ and is apparently the only dog in the world trained in this way. While it is early days, Bedford is already starting to feel more confident with Willow by her side. ‘If she smells nuts she will literally push me away with her nose,’ she explains. ‘In the short time I’ve had her I’ve been to hospital nowhere near as many times as I would normally.’
| New recruit Buddy, a Yorkshire Terrier puppy, is a rescue dog. PHOTO: Leonie Hamptonon |
The waiting list for medical alert assistance dogs is three years long, and more and more people are contacting the charity asking for help. Volunteers are working throughout the UK to raise awareness, and the Duchess of Cornwall is now a patron. All applications are assessed in order of urgency. ‘My vision for the charity is to shorten our waiting list to under a year,’ Dr Guest says, ‘and I would like more staff to train the dogs, more facilities and to have the means to provide successor dogs.’
At the moment there are 40 dogs at the ‘puppy walking stage’, which is the very early form of training, and there are five in ‘advanced training’.
The dogs, when ‘working’, all wear red coats and have access rights to shops, hotels, etc in the same way as guide dogs. (They have normal lives when they are not wearing their coats.) Many of them are, in fact, ex-guide-dogs-in-training. These are labradors rejected for being too ‘sniffy’ (guide dogs need to be assertive and not distracted by their noses). But there are also cocker spaniels and there is even a little rescue Yorkshire terrier about to be trained up. The main criterion is that a dog is a ‘sniffer’.
| Carolyn Gatenby’s type 1 diabetes is so severe it was thought she might go into a nursing home until she was paired with her black lab, Simba. Now she volunteers at Medical Detection Dogs. PHOTO: Leonie Hampton |
For Carolyn Gatenby, too, her life has been turned around. She has very severe type 1 diabetes, and her body would give her no warning of her fluctuating sugar levels. She would often go into a coma for up to five hours, and passers-by would leave her on the pavement, thinking she was drunk. When her mother died – her principal carer – it was thought that she was so vulnerable that, aged just 48, her only option was to be moved from her sheltered housing and placed in a nursing home. Simba was, Gatenby saw, her very last chance at a normal life.
Gatenby has since moved from Yorkshire to Buckinghamshire to volunteer at the charity, bringing Simba (who she has had for four years) with her every day. ‘He has given me my life back,’ she says. ‘He sleeps with me. He gets me up during the night; he brings me my blood kit and he will not let me go back to sleep until I’ve done it. You just can’t believe it until you actually see it. And once you’ve seen it full on, it melts your heart.’
Medical Detection Dogs is one of three charities supported by this year’s Telegraph appeal. To make a credit/debit card donation, you can call 0151-284 1927; go to telegraph.co.uk/charity; or send cheques/postal orders to Telegraph Christmas Charity Appeal, Charities Trust, Suite 20-22, Century Building, Tower Street, Liverpool L3 4BJ. On Sunday 7th December Telegraph staff will take donations over the phone: call 0800–117118 between 10am and 6pm
Go to Healthwise for more articles
