Oscar the beagle looks like a stuffed-toy version of a beagle puppy. When I met him, I had the urge to look for a cloth tag attached to his hindquarters that tells what age child should have him, if he is machine washable, and where he was made.
Beagles are usually cute; let’s just get that out of the way. They’re even adorable when they’re surrounding your suitcase when you’re coming back to the US after visiting your relatives in Italy, and the authorities at customs confiscate your treasured hunk of Parmigiano-Reggiano cheese. It’s hard to get mad at these smiling dogs just because they snitched and robbed you of the best cheese in Italy.
But there’s something especially appealing about Oscar. He’s seven years old, but he retains his youthful looks, partly because that’s what beagles do. He’s also a little more jowly than the average beagle. I’m a sucker for drooping jowls, at least on dogs. They make a dog seem stalwart and relaxed at the same time. Maybe even noble. Oscar’s large brown eyes, each surrounded by a circle of soft white fur, help him look perpetually inquisitive and kindly.
The red cape on his back doesn’t so much announce as whisper—in a small font on the edge—that he is a SERVICE DOG ON DUTY. The cape usually comes off when he’s not in public, but Oscar is always on. He received formal training in diabetic-alert work, but he’s broadened his practice to include ferreting out other serious medical troubles.
Oscar, like Brody the seizure/cancer/diabetes/heart dog, is a doctor dog of many trades. He was trained in one specialty and has branched out to a few others of interest to his nose and—not to anthropomorphize—maybe even his heart.
It’s not just Oscar and Brody. I’ve run across a surprising number of dogs who have gone from one specialization to others. In the military, the dogs who have the most varied skill sets are called multipurpose canines (MPCs). Cairo, the dog who accompanied Navy SEAL Team 6 on the Osama bin Laden raid, was an MPC.
Multipurpose canines, used by Special Operations forces, can sniff out bombs, track people, and apprehend bad guys really well. Because the units they work with have a wide range of missions, they need to be able to “adapt to multiple situations at a moment’s notice,” explains an article on the DVIDS (Defense Visual Information Distribution Service) website.
So in homage to those canine heroes, “multipurpose medical dogs,” or “multipurpose MDs,” is how I refer to Oscar and other dogs like him.
Oscar shares a four-thousand-square-foot home with Deanne (DeeDee) Kramer, on Catawba Island, Ohio, about an hour west of Cleveland. Catawba Island is actually a peninsula, but it’s popular with boaters, and there are enough real islands around that it’s easy to get away with calling it an island.
Since I had flown halfway across the country to meet Oscar, and since there are two vast and empty guest rooms at their house, DeeDee had insisted I stay with them during my visit. “Oscar and I would love the company,” she told me when we were discussing trip dates. “And I make a really good breakfast.”
When I arrived, Oscar wagged over to me with his ever-present smile and sat on my foot for an ear rub. DoubleTree’s welcome cookies have nothing on this dog.
A couple of hours into interviewing DeeDee at the dining room table, my audio recorder ran out of juice. I dashed upstairs to my room to get new batteries. As I entered, I was surprised to see Oscar standing with his front paws on my bed, his nose near my leather laptop briefcase. He seemed surprised to see me as well. He jerked his head in my direction. His ears whipped around horizontally before flopping down to where gravity wanted them. Oscar stared at me for two seconds, then galloped out of the room without slowing down for so much as a pat.
In his gusto to exit, something had flown out of his mouth or off his fur. A sliver of red paper lay on the white rug. Not really paper but more like a wrapper. Like a candy wrapper.
Oh no. Please no.
I ran over to my bag. Reporter’s notebooks, batteries, cash, my backup drive, an extra camera, pens, gum, and a spare recorder were all in their compartments. But one tight external pocket on the back felt wet. I slid my hand in and extracted the contents: about two-thirds of a Krackel bar with slobber at the top and most of the wrapper intact. I knew Oscar hadn’t gotten more than a bite or two, because I’d had at least a couple of bites myself the day before.
It could have been much worse, but I was still concerned. I’m used to big dogs, and if they get part of a Krackel bar, it’s probably not going to hurt them. Despite the warning to never give our dogs chocolate, dogs like Gus can handle a little, especially milk chocolate. But Oscar was a little dog, and he could have scarfed a couple of big bites. Was this enough to hurt him? Was I going to be responsible for the demise of this caped crusader?
I ran downstairs to confess to DeeDee so we could take him to the vet’s or do whatever one does when a dog his size gets chocolate.
She laughed. Apparently this was not Oscar’s first chocolate rodeo.
“He’ll be fine, don’t worry! Oscar gets into things. His nose takes him places.”
Yeah, you could say that. The dining room is on the first floor on one end of the large house, and my room for the night was on the second floor on the opposite end, with the door partly shut. Oscar had not gone up with me when I dropped off my bags. But somehow he must have picked up on the scent of the crunchy chocolate bar. Maybe it left an odor trail, enticing him to follow when no one was looking.
Heeeere, doggy doggy! Come eat me! You know you want to, and you know where to find me . . .
Luckily, DeeDee was right. Oscar suffered no ill effects.
I should have known better than to bring chocolate into the home of a dog who uses his nose for a living. Especially a supersniffer multipurpose medical dog like Oscar.
This is the same dog who detected some serious health conditions on DeeDee’s friend Tina Brassel. One afternoon while Tina was over for a visit, Oscar kept nudging Tina’s side, by her breast. DeeDee couldn’t get him to relax.
“I’m sorry, Tina, he never does that. I don’t know what’s going on with him.”
Tina was already scheduled for a mammogram. Doctors confirmed Oscar’s apparent suspicions: She had a small, malignant breast tumor—right where Oscar had been poking at her. She underwent a lumpectomy, but they’d caught it early enough that she didn’t need chemo or radiation.
A year later, in 2017, Tina was talking with DeeDee at the dining room table one evening when Oscar wouldn’t leave her alone. He was sitting at her feet, staring at the back of her leg, sometimes bumping it with his nose. He’d whimper and run to DeeDee and back to Tina’s leg, as if to say, Something’s wrong back here! Tell Tina! DeeDee tried to get him to go lie down in his bed, but he kept coming back, sitting, and whining at Tina’s leg.
Shortly after, Tina went in for some knee imaging to see if she was a good knee-surgery candidate. That’s when the doctor found a blood clot behind her knee, right where Oscar had been bumping her.
In mid-2018, I got a call from Tina.
“I’m at Cleveland Clinic. Oscar sent me here.”
She had been having dinner at DeeDee’s when Oscar put his paws up on her chair and relentlessly pushed her side with his nose. He’d whine, walk over to DeeDee, walk back to Tina, and push some more.
Tina didn’t want to say anything to DeeDee, but she’d been having strange pain in her side for a few days. Oscar’s actions forced her to confess.
“You need to get that seen,” DeeDee told her.
“You’re right. But why can’t he just lie on his bed during dinner like a normal dog?”
Doctors found kidney stones. Months later I learned that after numerous additional tests, Tina was diagnosed with chronic myeloid leukemia. She will probably be on oral chemotherapy drugs for the rest of her life.
“Oscar skunked me out again,” she said. “But I’m grateful. Who’d have guessed a beagle could save my life? A German shepherd maybe, but a beagle?”
Oscar wasn’t always a walking health screen. In late 2013, DeeDee’s husband, Bill, convinced DeeDee to get checked for the usual ailments that come with age. It had been two decades since her last in-depth health checks, so she indulged him.
Doctors discovered she had both colon cancer and breast cancer. Three surgeries and radiation followed.
DeeDee thinks her cancers may have primed Oscar to detect Tina’s health problems. She shrugs off the fact that Oscar didn’t alert her about her condition.
“He had his hands full with Bill.”
Oscar started life with a family in a wealthy suburb of Cleveland. The wife had never wanted a dog. After a couple of years, despite protests from her husband and child, she booted out the beagle. He was taken in by a dog trainer DeeDee and Bill had used for their previous dog.
Around this time, Bill had been making two to three trips a week to the emergency room because of his diabetes. His sugar was going to extreme lows and highs. Then he had a heart attack—his second. Bill had already had a quadruple bypass. His doctor suggested he consider getting a dog. “It might be good for you. Get you out and active.”
On July 6, 2013, the Kramers met Oscar, fell in love, and brought him home.
Two weeks later, Bill had another heart attack. When he got back from the hospital, Oscar wouldn’t let Bill out of his sight. He followed him everywhere, including the bathroom.
About a month after Bill’s return, DeeDee was sitting on the couch in the living room watching TV. Oscar dashed in and barked at her once, ran down the hall to the bathroom, barked again, ran back into the living room and barked again. She realized what he was doing and raced to the bathroom, where she found Bill collapsed, although conscious. It was his heart again, and this time he was in the hospital for a couple of weeks.
During Bill’s absence, Oscar didn’t want to eat. The pep in his step disappeared. He didn’t care about going outside. DeeDee knew he was depressed. Bill couldn’t get back soon enough for either of them.
This time when Bill returned, Oscar stayed even closer to Bill. “It’s like Bill is Oscar’s patient, and he’s always watching for any sign of a problem,” DeeDee told a friend. The dog never left his side except to go out for a quick bathroom break. As soon as he was done with business, he’d hurry back to Bill.
Bill’s heart held relatively steady. But his blood sugar didn’t. He had developed insulin-dependent diabetes in 1989 as a result of chronic pancreatitis,* and it was challenging to keep up with the highs and lows of his blood glucose. He wondered if Oscar could give him an early warning if it went too far in either direction.
In their search for good, affordable training, the Kramers ran across Service Dog Academy. They purchased access to the online videos, paid for private phone consultations, and enlisted their own trainer to help them make sure they were doing everything right.
Within a few months, Oscar had become a star service dog, alerting Bill to his highs and lows in time for him to do something about them. Bill went from frequently being rushed to the hospital to never seeing the ER.
“It was the best training,” says DeeDee. “And we end up with the cutest lifesaver in the world.”
Oscar was happy to share his diagnostic talents with others. During visits to the VA, he trotted over to diabetic veterans and gave them a high five on their knee. This was no idle greeting. He was telling them they had high blood sugar. For low sugar, he’d get close to their face and paw at their chest and whine.
DeeDee, Bill, and Oscar had more than two great years together before the day Bill coughed up blood in October 2016. Multiple medical tests followed, but they wouldn’t know anything conclusive until a biopsy.
At 4 a.m. a few days after Thanksgiving, DeeDee awoke to Oscar standing on her chest and barking. She knew the drill from before and, with her heart pounding, followed him into the bathroom. She found Bill collapsed on the floor. The ambulance raced him to the hospital, with DeeDee and Oscar right behind.
As Bill’s service dog, Oscar was by Bill’s side in the ICU with DeeDee every day. They’d get there at 8 a.m. and stay until 10 p.m. Oscar kept working—alerting promptly when he sensed Bill’s blood sugar was off. DeeDee felt it gave Oscar a sense of purpose that he could still help Bill.
Bill Kramer was sleeping when his heart stopped at 9:03 a.m. on December 3. Oscar wailed even before the nurses burst into the room.* It was a haunting cry, a primal baying. As medical staff poured in to try to resuscitate Bill, there was no room for a mournfully howling dog. A nurse moved DeeDee and Oscar to a room a couple of doors down. Oscar continued, more high-pitched. DeeDee and Oscar were escorted to a conference room far from Bill’s room.
Oscar fell silent.
A week later, Oscar attended Bill’s funeral service at St. Joseph Church in Marblehead, Ohio. DeeDee and Oscar followed the pallbearers to the hearse. Oscar tried to jump into the hearse to go on Bill’s last ride. Those who watched this act of loyalty say they will never forget it.
At the grave site, Oscar wailed as he had at the hospital. His cries drowned out the words of the priest. Several times he pulled toward Bill’s coffin. At one point he managed to stand with his front paws on the edge of the coffin, but after a few seconds, DeeDee pulled him back.
“He would have stayed with him. He did not want him to go.”
Three days later she took Oscar—without his cape, since he was no longer a service dog—to the cemetery. His wailing picked up where it left off. Then, to her horror, he put his head down and dug into the dirt that covered her husband. He flung several paws of earth behind him before DeeDee was able to pull him off the grave.
She called Oscar’s trainer when she got home. “Keep him away for a month because he can still smell him,” he told her.
About a year and a half later, I visited Bill’s grave with Oscar and DeeDee. It’s near a grand oak tree at the Catawba Island Cemetery. Oscar seemed to have come to terms with his loss. He sat and looked at the gravestone for a while, and then he stretched, lay down, and fell asleep.
Bill’s name and dates of birth and death are engraved on the left of the shiny black stone. DeeDee’s name and birthdate are on the right. She will be with Bill when her time comes, and the last day of her life will be added.
Etched between their names is Bill’s favorite photo. He and DeeDee are sitting on a bench. Bill is wearing a Hawaiian shirt and a baseball cap, with his back to the camera. DeeDee’s hair is in a ponytail, and she’s wearing a plaid shirt. Her back is also to the camera, but she is in profile, looking at Bill lovingly and leaning into him. They’re holding hands. Oscar is sitting on the ground next to Bill, looking right into the camera.
Since Bill’s death, DeeDee hasn’t been eating much. She doesn’t have anyone to cook for except when company comes. Her appetite seems to have been buried with Bill. Eating so little has worsened the symptoms of her nondiabetic hypoglycemia, a condition that often causes shakiness, sweating, dizziness, and rapid heartbeat. DeeDee’s hypoglycemia tends to skew toward the more serious symptoms. Her vision blurs, she gets dizzy and weak, and she can’t concentrate. If she doesn’t eat something to elevate her blood sugar—she normally carries glucose, candy, and a sugary drink in the car for these occasions—she may pass out.
While Bill was alive, Oscar didn’t seem to notice DeeDee’s low blood sugar. She rarely had episodes because she was eating normally. But a few months after his death, while DeeDee was driving their GMC Yukon, Oscar scrambled up to the front seat and pawed at her. He kept pawing until she pulled into a parking lot. That’s when she noticed a slight weakness and rapid heartbeat. She ate some of her candy and waited to feel better.
Since then, Oscar has been DeeDee’s service dog, usually alerting to her condition before she notices the symptoms. He’s also volunteering as a therapy dog at the VA.
Oscar has his cape back. DeeDee beams when she looks at her dog.
“He looks good in red, don’t you think?”
Oscar knew when Bill needed help after his heart attacks, but he never alerted to Bill’s heart attacks. If he could team up with a dog named Penny, they’d have a well-rounded cardiac care practice.
Penny had a rough start in life. The boxer–Jack Russell mix had been surrendered to a Central Florida shelter three times by the same family within a few months. Whenever she’d go back to a cage, she seemed defeated, forlorn, hopeless. When her family came to get her again, she was over the moon. But they always brought her back.
It was during one of her stays that Kevin Turner* and his wife visited the shelter. They’d lost their old dog not long before and weren’t sure they were ready for another. They were just looking. But as soon as Kevin saw Penny, he knew he couldn’t leave without her.
“It’s not something you can put into words. I just felt it in my gut,” he says. “Penny and I both knew.” It’s a sentiment shared by many who have chosen a dog and feel the dog has chosen them at the same time.
Penny fit right into life with the Turners. She was a fast learner, friendly to people and dogs, relaxed, and a bit of a clown. The only downside: “She was an unguided missile of separation anxiety,” Kevin says. The Turners lived on a thirty-foot sailboat, so they were with Penny almost all the time. But when they had to go out and leave her in a kennel on the boat, “she’d go psycho.” She shredded her bed and even bent some of the wires of the kennel. Leaving her loose inside the boat didn’t make separation any easier. She was only eighteen months old, but she had big abandonment issues.
Kevin could relate. He’d had a hellish start in life himself. His father was an alcoholic with a volcanic temper. He and his four siblings and mother bore the scars from brutal beatings with fists and boots. His mother frequently had to put makeup on the children so their bruises and cuts wouldn’t be obvious, especially during school.
Kevin started drinking at age nine and says he was a “roaring alcoholic” by his teens. He eventually straightened up enough to join the Air Force. It was around that time that he realized he had PTSD. Not from his military experiences—he never left US soil during his Cold War service—but from his childhood.
Two of his siblings committed suicide. He realized he had to face his PTSD so he wouldn’t meet a similar end. Over the years, he’s gotten help, but he still has nightmares and triggers that send him right back to his father’s maulings.
One night when he was trapped in a dream about not being able to escape the wrath of his father, he woke up. This didn’t usually happen. Usually these dreams seemed tortuously long. Then he realized why he’d woken up. Penny was licking him on the face.
He hugged her and praised her and nuzzled into her. She was a good girl. She was a good, gooooood girl. Since then, she has caught him during most of his nightmares and brought him back safely.
She was a special dog. He’d soon find out just how special.
While walking up some stairs on a larger vessel they’d moved to, Kevin felt out of breath. Much more so than he’d ever experienced. He stopped to catch his breath at the top. He tried to continue but was too winded.
Penny was with him, as always. When he stopped again, she took great interest in his right forearm. She licked at a small spot so intensely that he looked to see if there was food on it. There wasn’t. It looked just like the rest of his skin. She licked it for a long time, occasionally stopping and gazing into his eyes. He didn’t know what to make of it.
This happened a couple more times. He’d get exhausted after a minimum of effort, and she’d go right for the same spot and lick it as if it had peanut butter on it and she wanted to remove every molecule. As she was licking, she’d stare into his eyes.
He realized she might be onto something. But he wasn’t sure what.
One morning he got to the top of the stairs and felt so out of sorts he sat in a chair. There was a little pressure in his chest and a nagging pinprick of pain in his heart area. Penny started in on his forearm again and looked at him. He knew what she was telling him.
Things are wrong. You need to get help.
Just then he felt a pain radiating down his left arm and realized Penny might be right. Their docked boat is only a five-minute drive to the closest hospital. Rather than wait for an ambulance, he drove himself to the emergency room.
After an EKG and some other tests, he learned he’d had a heart attack. Further tests revealed a 98 percent blockage in a coronary artery. Doctors told him it was a miracle he’d walked in with this level of blockage. It’s often a widow-maker, they said. They inserted two stents to keep the artery open and put him on anticoagulants.
During the first several months after the procedure, Kevin had a few angina episodes. But unlike most people, he had an early-warning system. Penny would go right for his forearm with her usual intensity, and within fifteen to thirty minutes, the angina came on. Because of Penny, he always had his nitroglycerine ready, and at the first sign of angina, he’d take it and feel better.
She was right every time.
His last angina episode was a couple of years ago. She hasn’t gone for his forearm since.
But Penny isn’t letting her skills get too rusty. While they were out recently, a man asked if he could pet Penny. He knelt down and she poked her nose into his forearm and licked at it just like she used to with Kevin.
“I don’t mean to intrude, but do you have heart issues?” Kevin asked.
“Funny you should mention that,” the man said. “I was just diagnosed with congestive heart failure.”
“You might want to go see your doctor or get to an ER,” Kevin told him. “What I’m about to tell you is going to sound crazy, but please hear me out . . .”
The ability of dogs to sense impending heart attacks is purely anecdotal at this point. And the dogs who seem to have alerted their people to heart attacks weren’t trained to do so. They’ve been pet dogs, or service dogs trained for other issues.
Dogs are sometimes trained as cardiac-alert dogs for other conditions that involve heart symptoms, such as a syndrome where people get a rapid increase in heartbeat as well as light-headedness or fainting when they go from reclining to standing up. But I searched for people training dogs to alert to heart attacks, and asked around the service dog world, and didn’t find anyone doing this.
Heart disease is the number one killer in the United States and the world. Wouldn’t it be great if dogs could tell us if our arteries are getting clogged, or if we’re going to experience a heart attack or cardiac arrest? Dogs already help our heart health by getting us out for walks and reducing stress. If dogs could be trained to recognize some forms of serious heart conditions, chances of surviving a cardiac event could dramatically increase.
One of my favorite stories of dogs alerting to heart attacks is from a segment on Arthur C. Clarke’s Mysterious Universe, a TV series in the mid-1990s. I ran across the story because it happened to come right after a little story about Baby Boo (named just Baby in her segment) and her discovery of Bonita Whitfield’s melanoma.
The piece featured a Southern California firefighter named Lorenzo Abundiz who went hiking in a desolate hilly area with his two rottweilers. Usually one of them, Cinder, liked to hike out in front on the trail, but on this day she kept turning around and trying to walk back down the trail. She’d never acted like this before.
The hilly hike usually takes about four hours, but Lorenzo thought Cinder might be sick and turned around after a half hour. Cinder didn’t lag on the way back. “She immediately became the leader,” he said.
When Lorenzo got home, she was staring at him, and he was worried about her. He didn’t want to take any chances, so he got up to call the veterinary office. “Immediately I felt like something just grabbed my lungs with all their might and just like two hands squeezing everything.” He fell to the ground.
Then he felt Cinder nudging his hand, and he felt the phone. He barely managed to dial 9-1-1. The paramedic was interviewed for the show and said Lorenzo’s blood pressure was dangerously high and he was in “great danger of having a massive heart attack. I think he was on his way to that.”
If Cinder hadn’t coaxed him down the trail, both Lorenzo and the paramedic believe he would have died on the hike. There was no doubt in Lorenzo’s mind that Cinder knew what she was doing. “We just need to take time to listen to our animals,” Lorenzo said.
What was it that Cinder, Penny, and other dogs might have been sensing? (I’m going to assume that at least some of these dogs I’ve learned about were really sensing heart trouble and it wasn’t just coincidence.) Could it be heart rhythms? Blood pressure? Scent?
Maybe it’s all of these, or something else, but chances are that scent is key.
Researchers are studying the volatile organic compounds associated with cardiovascular disease. (Unlike the scientists looking into cancer VOCs, the heart researchers haven’t used dogs so far.) A 2018 paper in the Journal of Breath Research describes how the authors were able to discriminate older patients with congestive heart failure from healthy people, and even from those with chronic obstructive pulmonary disease (COPD), by their VOCs. Other studies examine cardiovascular disease biomarkers in exhaled breath.
If any doctor dogs are looking for a specialty, canine cardiologists may soon be in high demand.
Dogs alert to diseases, but they don’t need to know the name of what they’re finding. You don’t tell a dog, “Please sniff out the urine that has prostate cancer” or “Buddy, be a good chap and tell us if this is hypoglycemia.” With dogs, it’s about odors, not names of diagnoses. As long as motivated, focused dogs get good training linking a scent with a reward, they’ll have a decent chance of being able to sniff out the scent. Just ask any self-respecting explosives-detection or narcotics-detection dog.
Or you can ask Koira, a multipurpose MD who saved the life of her young man on hundreds of occasions—even when doctors had misdiagnosed him.
When he was a child, Paul Willis loved to entertain his friends with demonstrations of his flexibility. He would twist his arms and legs in bizarre ways that made them squeamish. He’d easily put his feet behind his head. He could fit himself into the tiniest spaces—the overhead compartment of the bus, inside school lockers—by folding himself like some high-tech gizmo.
On a couple of occasions he walked by a classroom window pretending his leg was broken by facing it in the opposite direction. When the kids ran to the window in alarm, he twisted it back around, smiled, waved, and walked off.
He figured he was just flexible—like his mother, only more so. But after a while, his joints and bones and muscles and skin began to hurt. If he was awake, he was in pain. His parents sought help, but no one could figure out what was wrong.
Shortly after his seventeenth birthday, he was diagnosed with hypermobile Ehlers-Danlos syndrome, an inherited connective-tissue disorder caused by defects in the protein collagen. His mother, Vivian, would turn out to have it as well, but her physical problems were minor compared with Paul’s. Besides the pain, his joints would dislocate with ridiculously little pressure. It got to the point where he couldn’t hold a pen without some of his finger joints coming undone.
Just as debilitating were the gastrointestinal symptoms, especially severe nausea and digestive problems—common issues with this form of Ehlers-Danlos syndrome. He missed nearly all of the last two years of high school because of the effects of the illness, and had to go through a special program to get his high school diploma.
By the time he was eighteen, he was in a wheelchair most of the time.
When he was nineteen, he was hit by another cruel condition. He had been having a good day, so he accompanied his mother to get a gift for a friend at Toys R Us. While there, he developed a debilitating headache. Vivian found him a seat just in time for half of his body to go limp with paralysis. He drooled on the side that had lost all muscle tone, and one eye swiveled off at a disturbing angle, out of sync with the other one.
She asked him to smile, and only half of his face moved. Her first thought was that Paul was having a stroke. They were only one highway exit away from their favorite emergency room—they’d gone there for multiple dislocations—so rather than wait for an ambulance, she had the store employees help him onto a flat-platform shopping cart and wheel him to her car.
At the emergency room, the doctor immediately called a Code Stroke, and the room filled with ten medical staffers, with everyone hurriedly working on Paul. Vivian couldn’t keep track of what was going on; it was all happening so fast. All she knew was that her son’s life could be in danger. She couldn’t believe this poor kid who’d already had such a rough go of it might now have suffered a major stroke.
But MRIs and CT scans of his brain showed no evidence of a stroke or any other brain damage. By the time Paul got back to the emergency room, he was able to move his pinkie finger. Within a couple of hours, the episode had ended. The on-call ER doctor diagnosed him with a hemiplegic migraine and discharged him.
Hemiplegic migraines are rare. Their hallmark symptom, besides a headache, is extreme muscle weakness, usually on one side of the body. It’s often mistaken for a stroke. Paul’s parents hoped it would be an isolated incident, but less than a week after his first attack, he had another episode. This time there was no headache, just sudden paralysis of half his body.
Local specialists confirmed the migraine diagnosis and sent Paul to the Mayo Clinic, where it was reconfirmed.
But soon the paralysis stopped playing by the rules and started involving his whole body. Paul would get no warning of an impending paralysis. No headache, no weakness, no aura.
If he was standing up or walking, he’d drop hard to the floor. It was as if he were a marionette whose strings have been instantly severed. If he was sitting, he would slump over. He’d usually dislocate something, often multiple joints.
He remained conscious, aware of everything going on around him. But he didn’t panic. He was logical about it. He knew he wasn’t having a stroke, so he figured there was nothing to worry about except getting his dislocated joints back in place once he could move again.
His parents were not surprised that he handled these episodes with a certain amount of serenity. He’d always been a calm kid. And now, with the average paralysis lasting an hour, he was just as levelheaded.
The worst paralyses lingered for eight hours. When Paul came out of the longer ones, he would tell his parents how boring it was to be stuck in a body that wouldn’t move. The family tried to keep him entertained. Someone might put on a movie for him. Or they’d joke with him.
When an episode ended, they’d get to the work of putting him back together again. Depending on how he fell, he could look like the Scarecrow in The Wizard of Oz after the Witch’s minions got through with him—body parts all helter-skelter, twisted in ways that would be impossible for most people.
Since Vivian, a geologist, had left her environmental-consulting job to be at home with Paul full-time, she was usually the one to start repairing him. If he dislocated both shoulders, she would pop one back in. It made her feel queasy, but once his shoulder was back and he had a hand free, Paul took care of the rest of his joints.
It was an awful way to live, but the family tried to make the best of it, keeping their sense of humor alive for Paul. After a trip to Los Angeles for an upright MRI, he became paralyzed while his parents were pushing his wheelchair along a sidewalk. They wheeled him into a tourist shop and put ridiculous hat after ridiculous hat on his head, asking if he liked or wanted each of them. One blink meant yes, two meant no. Even though he was trapped inside his body, he enjoyed the diversion.
Then one day during a paralysis, Paul stopped breathing. He could handle everything else, but not this. The inability to breathe was the start of a new and frightening turn in the disorder. Someone always had to be nearby, ready to use a manual bag-mask ventilator or race to get his bilevel positive airway pressure (BiPAP) machine, which he used at night to make sure he breathed when he was sleeping.
The only way he could communicate during paralysis was by blinking. As usual, one blink meant yes, two meant no, and now the new blink code—rapid blinks—meant he could not breathe.
It was too much. If someone wasn’t always near him in time to ventilate him until he started breathing, he could die.
While desperately researching alternative ways to help her son, Vivian found out about dogs who can alert to migraines. They already had a couple of dogs, and while they were sweet, they were not medical dog material. Vivian thought if Paul could get a migraine-alert dog, they could have some warning about the paralyses. Even a few minutes would be enough time to prepare. She knew it was a long shot, but they had to try everything.
As Oscar the beagle’s folks did when they were looking to train their dog to be a diabetic-alert dog, the Willis family ended up finding dog trainer Mary McNeight. Mary ran the then-Seattle-based Service Dog Academy that focused on training diabetic-alert dogs. Her own service dog had gone from helping her with her hypoglycemia to spontaneously alerting to her migraines with no training.*
Once Mary realized dogs could alert to migraines, she decided to try to help people train their dogs using the scent of their saliva before or during a migraine. She used a similar technique to help people train their dogs for diabetes.
She knew it wasn’t scientific, and that some might scoff at her techniques. But she says with the right dog—usually a puppy who can be trained early on scent—and rigorous, reward-based training by highly dedicated owners, it has worked most of the time.
“I was so surprised at first,” says Mary. “But if trained dogs can find whale poo in the ocean, it shouldn’t be a shock that trained dogs can find something right beside them. We won’t ever explore what dogs are capable of unless people like me say, ‘Hey, let’s just try this and see if it works.’”
She says that in her experience, as long as there’s some kind of biochemical change, there’s a chance a dog could alert to it. “We’re not talking trick knees,” she says. “But there’s a lot of potential for dogs to be able to alert to illnesses in areas we haven’t thought of yet. We just have to try.”
Paul’s migraines were different from those of any of her other students, but Mary was fairly confident there was hope, although she couldn’t guarantee success. She directed the family to a breeder that was about to have a litter of goldendoodles. This breeder was known for producing high-quality, successful service dogs, and Mary felt one of these pups would give Paul the best chance.
Paul’s family was able to secure a puppy. When Koira was seven weeks old, the breeders hand-delivered Koira from Idaho to the Willises’ Southern California home. They were driving Koira’s brother and a couple of Great Danes to the area, so the Willises’ house was on the way.
Koira’s name was originally going to be Dog. Paul had always wanted a dog with the name Dog. But she wouldn’t respond no matter what they tried. He eventually gave up and decided to name her Dog in another language. He settled on the Finnish word for “dog,” and Dog became Koira.
She was the size of the family’s little bunny when she arrived. They all fell in love with her immediately. She was sweet, affectionate, and calm, even as a newly arrived puppy.
Training began the next day, using homework Mary had given them.
Every half hour, Paul would chew on a cotton ball. Unless he had a paralysis within a certain window of chewing on the cotton ball, he would throw away the sample. Mary felt this would give the puppy the best chance of smelling a change in Paul. She had taught the family a special technique to create many samples from one. This was important since they wanted to give Koira fresh, new samples, not ones she had alerted to before.
They trained her to associate the smell of the scent with good things—just as Luke’s pup, Jedi, had been trained for his diabetes. Vivian punched a hole in a paper bowl and set it inside another paper bowl that had a cotton ball with Paul’s preparalysis scent. They fed Koira a little kibble at a time in the top bowl so she could pay attention. Each new meal got new bowls and a new sample. Food was always paired with Paul’s “pre-paralysis.”
After a couple of weeks, the family began training Koira to paw at the sample as someone held it. They hoped this would eventually become her alert. It was a work in progress when they packed up and headed to Seattle, for classes with Mary. Koira was three months old.
Koira gave her first alert at the rental car counter at the Sea-Tac Airport. She had been calm, as always, but became a jumping bean, bouncing all over Vivian and then Paul, and licking Paul’s face rapidly while he was sitting. They’d never seen her like this before. Within a few minutes of getting into the rental car, Paul slumped over in paralysis. It was a relatively brief attack, and he could still breathe.
“Afterward, we’re thinking noooo, that was just coincidence,” says Vivian.
They settled into the hotel, and Koira began the same oddly energetic behavior again, jumping around and licking Paul’s face.
“By that time we’re like we know what she’s doing. We gave her a whole bunch of treats,” says Vivian. A few minutes later, Paul became paralyzed.
When Mary heard that Koira was trying to tell Paul and Vivian about an upcoming paralysis, she was thrilled. She decided it was time to refine the alerts, and by the end of the four-day course, Koira had learned a more proper alert. She would paw at Paul, gently but insistently, and stare at him as she did so, as if searching his soul.
In a matter of months, Koira was solid with her alerts. She could warn Paul thirty minutes ahead of an impending episode. If Paul wasn’t paying attention, she automatically sought out someone else. And if he collapsed and no one was around, she’d make it her job to find someone.
“She is a wonder dog,” says Paul. “She saved my life so many times. Besides that, I was relieved not to have to crash to the floor anymore.”
But there was no rest for Paul. Shortly after Koira was able to alert to his episodes, he developed a disorder that was equally dangerous and far more painful. Instead of his muscles completely losing tone and being unable to move, they did the opposite. They gripped and contracted all over his body. Imagine the most agonizing charley horses or foot cramps, only in every muscle.
He had the worst form of dystonia. It took over his body, including his throat and mouth, twisting him out of control. About a quarter of the time, he was unable to breathe. With paralysis, emergency ventilation was straightforward. With dystonia, it was difficult to get air into him without strength and determination.
As if all this wasn’t bad enough, because of his Ehlers-Danlos, these muscle contractions caused numerous dislocations, with multiple bones often being thrust out of their sockets. Like his paralysis, his dystonia attacks came on with no warning. Sometimes an attack would start in one large muscle, but there was no time to do anything before it snaked its chokehold around his body.
A neurologist at the University of California, Irvine, thought it was impossible that he was getting these dystonia attacks because of a physical problem. “You can’t have these seizures concurrent with a paralysis disorder,” she told them. “It doesn’t work that way.”
She thought he had a condition called conversion disorder, where anxiety or trauma causes psychological symptoms to “convert” to physical ones. She didn’t want to treat him further until he got psychiatric care. He and his parents were livid. “Just because standard testing couldn’t find something, the experts shouldn’t assume it’s a mental illness,” says Vivian.
A psychiatrist saw him twice. For his second (and what would turn out to be his final) visit—when she decided he didn’t have conversion disorder—Paul purposely wore a T-shirt imprinted with the caption “I’d love to stay and chat, but you’re a total idiot.”
He never went back. His parents supported the decision. But they despaired that Paul had to face another strange and life-threatening rare disorder with so little help. He’d been through so much. Why him? And what could they do?
One day when Koira was alerting to a paralysis, Vivian had a thought.
“Wouldn’t it be nice if she could alert to dystonia?”
“Maybe she can!” Paul said before paralysis struck.
They consulted with Mary. She told them it shouldn’t be a problem to train Koira on a second alert and encouraged them to try.
They did the training much the same way, only with a different alert. They chose “sit pretty,” where she would sit on her haunches with her two front paws resting in front. At first she would fall over, but after she strengthened her core muscles, she was a rock.
A couple of months after they started training, Koira sat pretty on her own for the first time. Five minutes later, Paul was in full-body dystonia.
They didn’t dare to get excited. They thought it could be a coincidence. But when it happened again a week later, Vivian had Paul’s alprazolam ready, and it significantly diminished the episode. Shortly after, they trained her to fetch his medicine pouch when she detected the scent, so Paul would be able to self-administer the medicine.
Paul was having about three to six dystonia episodes a month, and ten to thirteen paralyses. Koira never missed a paralysis alert. Paul could be showering behind a closed bathroom door, and she would scratch at the door until she got his attention. Sure enough, a half hour later, he was down. She rarely missed a dystonia alert either—only if she was too far away or sleeping.
Even with Koira’s help, the attacks—on top of the Ehlers-Danlos—were taking a toll. The medicine for dystonia was slowly losing its effectiveness. And his paralysis could be brought on by something as simple as turning his head.
The family decided to consult with a New York neurosurgeon known for his work with Ehlers-Danlos to see if he could offer any ideas on how to help Paul. During a videoconference with him, he suggested they try traction the next time Paul was paralyzed.
He asked them to take hold of Paul’s head and pull it up and off his neck.
They thought it was ridiculous. None of them wanted to try it. How could pulling his head up stop his paralysis? They ignored his advice until just before their next video appointment, when they realized they hadn’t done their homework.
The next time Koira alerted to Paul, he sat on the couch in the living room and waited for the paralysis. He sat in a position where he wouldn’t slump over and fall onto the ground.
When the paralysis descended, his mom got behind him and carefully lifted his head up toward the ceiling. At first nothing happened, but then she hit the sweet spot, and Paul could talk and move again. She was so shocked she almost dropped his head back down.
“You can move?”
“Yes!” Paul said, and wiggled his arms and kicked his legs to show her.
“And everything feels normal?”
“Yes, totally normal!”
“This is amazing!”
“I know!”
“Is it OK if I put your head back down? It’s getting heavy.”
“Yes.”
When she lowered his head back down—it was like holding a bowling ball and she couldn’t keep it up for long—he became paralyzed again. She felt terrible that his ability to move was in her hands in such a literal way.
“Can you move now?”
He blinked twice—their signal for no.
“Do you want to try again?”
One blink.
They repeated the success. A few days later, when Paul’s dad was home, they were able to take a video of another paralysis and demonstrate the wonders of manual traction. They sent it to the neurosurgeon, who was as delighted as his parents were to see such clear evidence of what he thought the problem could be.
After more MRIs, CT scans, and a test traction system complete with pulleys, the neurosurgeon determined that Paul’s paralysis was not caused by any kind of a migraine after all—and that it was, in fact, related to the dystonia. Even if his scans had not showed anything clearly—he said they often don’t in cases like his—the doctor would have been confident in his diagnosis because of Paul’s symptoms, and his improvement with the traction.
The cause of both disorders seemed to be a pathological instability of his craniocervical junction—where the skull and the upper spine connect. People with Paul’s type of Ehlers-Danlos syndrome often have troubling spinal instability. The craniocervical junction tends to be where the most severe symptoms appear.
His mother explained the root of the problem to his sister in the simplest way:
“Basically his brain stem is being squashed.”
They marveled that Koira, trained to alert to what they thought were hemiplegic migraines, had been able to sniff out the chemicals associated with something completely different. Human doctors usually need to know a diagnosis to treat a disorder. Doctor dogs just need the scent.
“It turns out it doesn’t matter that we didn’t know what Paul really had, as long as the scent was consistent, and it was,” Vivian says. “We are so amazed by Koira, so grateful. Without her, Paul would not be here now.”
During the next year, Paul would undergo two surgeries to fuse his spine from his skull to his C6 vertebrae, with his skull held in the correct position by bars and other hardware. The paralysis and dystonia initially disappeared after the first surgery. Koira didn’t have much to do other than keep him company. She seemed depressed. She didn’t want to play as much and stopped listening to commands.
“It was like she felt she lost her purpose. She couldn’t help him anymore,” says Vivian. They started training her to do things like turn on and off lights, and fetch certain objects. Having a job seemed to help pick up her spirits.
But six weeks after the surgery, the paralysis and dystonia came back. Even though it had been so long since Koira had needed to alert, she was on it, pawing at him and giving him warning. His first paralysis was fierce, sending him to the emergency room because he passed out, had a seizure, and stopped breathing. Even with the alert, he dislocated four fingers and a collarbone. Doctors implanted a breathing pacemaker so his diaphragm would keep working during paralysis.
Since the second surgery, in June 2017, he hasn’t had an episode of dystonia or a paralysis related to his craniocervical instability. But Koira is still gainfully employed.
For a few years, Paul had been having less-troublesome episodes of paralysis—different from the ones that had come without warning. This had been diagnosed as hypokalemic periodic paralysis (HKPP), which would start as weakness he often dismissed as regular fatigue, but would render him a rag doll if he didn’t get potassium into his system stat.
Koira had never picked up on those, probably because they had a different odor. Not long after Paul’s second fusion, a couple of dog-loving friends were visiting and suggested the family train Koira on the HKPP episodes. It would give her something to do, and would help Paul know he needed to take immediate action. These paralyses didn’t happen often and seemed to be triggered by physical exertion. But the family decided to do what they’d always done. They gave it a try.
They trained her for a few sessions with cotton balls infused with Paul’s saliva taken a few minutes before an HKPP episode. The next time he had one of these paralyses, she alerted. The family was thrilled.
Her alert for HKPP is different from her other two alerts. She stands on all fours and hops her front legs up and down a couple of inches, like an excited dog inviting another dog to play. You can’t miss it.
Besides helping with his HKPP, Koira has also become a mobility-assistance dog for him. The worst complications from his Ehlers-Danlos may be gone, but it’s still a serious condition, making it difficult for him to change positions or pick things up.
Now that she’s down to just one detection job, and an intermittent one at that, Koira has taken quickly to her new responsibility. She helps brace Paul when he gets out of bed, or when he needs to go from sitting to standing, or when he needs help with balance. She also picks up objects for him.
He started school again that fall, taking a couple of classes at community college to see how it would go. Just three years earlier, it had seemed impossible he’d ever be able to do anything without a wheelchair, or even hold a pen again without dislocating several joints in his fingers. His life was a series of unpredictable brushes with death, and the worst pain he’d ever experienced. And here he was, walking into classes like most of the other students, only with a canine companion. He could write again, thanks to intensive physical therapy for his hands. And he didn’t have to worry about death lurking around every corner.
This dog had been there for the worst of it, helping him survive against the odds. Now she was at his side for this next adventure. She has proved to be a great social lubricant, helping Paul meet several new friends.
He has now gone back to school full-time, with a goal of getting a degree in economics. Koira goes to all his classes with him. He’s hoping that in addition to everything Koira still does for him, she might be able to help get him a girlfriend.
“Look at everything she’s managed. If she knows I’d like a girlfriend, she might do something about it—right, Koira?”
Koira, who had been sitting next to him on the couch, leaned against him and licked his cheek.