Amy Dahm, who currently lives in Washington, DC, was working as a U.S. diplomat when she was diagnosed with Cushing’s syndrome. After receiving life-saving treatment from the National Institutes of Health (NIH), she developed post-operative adrenal insufficiency, a condition that can cause life-threatening adrenal crises. Her dog, Sam, was a ‘natural alert’; he could detect her low cortisol levels through scent. Now he’s her service dog, and one of the first ever adrenal insufficiency medical alert dogs. Amy chatted with Patient Worthy about Sam, his training, and what it’s like to have a service dog.

Meeting Sam

Amy was living in Cyprus as a diplomat when she met Sam, a 15-lb Cyprus Poodle street dog. “He adopted me,” she says, “before he appeared, a fortune teller told me a man would appear on my doorstep, and he would have a white belly and dark sides, and be the most loyal man of all. It took me a little while to put it together, but she was talking about Sam!” Amy decided to adopt him and when she moved back to Washington, he came with her.

A Natural Alert

Back in the US, Amy began experiencing symptoms from Cushing’s syndrome, a rare condition caused by an excess of the hormone cortisol.

After undergoing surgery to treat it, she developed post-operative adrenal insufficiency. Adrenal insufficiency refers to a group of adrenal-related illnesses.  The most well-known form of adrenal insufficiency is Addison’s disease, which President John F. Kennedy had. It develops when the body does not produce enough cortisol. Adrenal insufficiency can be treated with steroid hormones, but patients are at risk of life-threatening adrenal crises if their cortisol levels drop too low.

“I was sitting on the couch one day, and had a huge headache,” Amy said, “Sam reacted very strongly. He was jumping on me, started pawing at my hair, and trying to nuzzle my cheek, and he was screaming. I was like, ‘oh my God get off me I don’t feel well!’”

Sam only calmed down once she had taken steroids. His reaction seemed strange, and the next day she searched online about what had happened. On the second page of results she found a description of another AI dog in the UK reacting the same way Sam had done, and realised that he had been alerting her to her low cortisol levels.

She says, “It was extraordinarily rare that he had this innate capacity for alerting.”

Sam’s Service Dog Training

Dogs who naturally alert, like Sam, are incredibly rare, and Amy wanted to take the next step of training him.

“I wanted to make him a legitimate service dog, but was having a really difficult time finding information” she says, “Then one day I was watching TV and there was a news segment on a trainer working with diabetic alert dogs. I called her up and said, ‘hey, you’re going to think I’m crazy but I think my dog alerted on me.’”

Sam started his service dog training with her soon afterwards. He was the only natural alert dog in the class; the others were Labrador puppies being trained from birth. “He really struggled,” Amy says. Sam was nine, and becoming a service dog requires thorough training, something that can be a difficult transition for a dog that is used to being a pet. It was also challenging for Amy, who had to learn how to train him and shift their relationship.  Together, they went to workshops from 9 to 5 to pick up the new cues and information. When he got to the stage when she could begin to take him out, “he did really well.” One of their first public activities was a matinee movie (Absolutely Fabulous was the first film they saw together), but now Sam accompanies Amy everywhere – to conferences, meetings, and even lobbying on Capitol Hill.

A Warning Signal

One of the key benefits of having a medical alert dog is that they can give people more time to react. “Diabetic alert dogs ‘beat the meter’, which gives a patient more time to inject and address the issue.” Amy says, “For adrenal insufficiency, since we don’t have meters, a dog is even more valuable, since we have to go off of symptoms (and some symptoms for high and low cortisol are the same, so it can get confusing). The extra time is invaluable – it allows us to take the steroids earlier and hopefully avert crisis.”

A Good Match

One of the things that makes Sam so good at his job is his sense of smell; poodles are known for their strong ability to identify scents, and miniature poodles were originally bred to sniff out truffles. It’s crucial to match service dogs and their capabilities to the disabilities of their owners, and some are even bred for this purpose. For example, Amy says that while Sam’s sense of smell is useful for his role, people who are blind or have impaired vision are likely to need a larger type of dog, one that’s able to cut through crowds.

Making an Invisible Disease Visible

Service dogs are trained to perform certain tasks, but their presence can also help in other ways. Having a service dog can act as a signal to alert the world that someone does have a condition that could otherwise be dismissed, particularly if its not visible.

“A service dog makes an invisible disability visible,” Amy says.

Facing Discrimination

Although people are becoming increasingly aware of service dogs, they and their owners can still face difficulties.

Amy says, “something I personally deal with is in restaurants they sit me at this little table for two – but you need space! […] a little consideration can go a long way.”

She says that having Sam has affected where she goes; some places are very accommodating, while others unfortunately aren’t. “There can be a lot of discrimination, and some people can be very difficult or rude or look down on you.”

A Companion

Having a chronic illness can be isolating, and some people with adrenal insufficiency can find it challenging to be in highly stimulating environments because low cortisol can cause sensual acuity. “Having a well-trained service dog can really provide a sense of acceptance, and they can be a great companion,” Amy says.

Service dogs can also help people to connect by providing a talking point to start conversations; “Having a service dog not only helps the person stay healthy and do things they otherwise could not; it also makes a person with a disability more accessible.”

Do you have a service dog story? Share your experience with the Patient Worthy community!

To learn more about Cushing’s syndrome and Addison’s disease, check out the Cushing’s Syndrome Support and Research Foundation and Addison’s Disease Self-Help Group.