DURHAM — An important member of the team handling Kaelyn Krawczyk’s surgery at Duke University Medical Center on Wednesday doesn’t have a medical degree, or even a pedigree.
JJ the terrier mix was invited into the procedure room because her nose is more sensitive than any medical instrument at detecting when 7-year-old Kaelyn is having a dangerous allergic reaction.
“It was kind of logical, actually,” said Dr. Brad Taicher, the anesthesiologist whose idea it was to get hospital approval to accommodate JJ during the procedure, to make sure Kaelyn didn’t go into anaphylactic shock. as she has done before. “Knowing what JJ could do, we realized that JJ was not much different from other monitors we use.”
Since JJ became Kaelyn’s service dog 18 months ago, she has exceeded the hopes of even her trainer, Deb Cunningham at Eyes Ears Nose and Paws in Carrboro. Cunningham knew it was possible to train a dog to help when a person goes into medical distress. But she wasn’t sure a dog could learn to alert someone of something happening at a molecular level before the person even shows signs of a problem.
In 2012, Cunningham trained JJ, a white fluffball rescued from an animal shelter, to alert to whatever it is – even allergists don’t really know – that Kaelyn exhales or exudes from her skin when her mast cells, which normally aid the healing process, are going berserk. Kaelyn, who goes by KK, has a rare illness called mastocytosis, in which her body releases “alarm” chemicals such as histamines in reaction to heat, cold and sometimes unknown triggers. The outward signs of an attack can be as subtle as facial flushing or as severe as a sharp drop in blood pressure that, unchecked, could lead to a heart attack.
Before JJ entered KK’s life, she had three to four severe reactions a year. Since JJ came to live with the family last year, there has been only one.
That’s because JJ alerts before the reaction progresses, giving KK’s parents time to take action. Michelle Krawczyk, KK’s mom, says the dog often senses a problem before KK feels any symptoms, and long before KK is willing to confess that she’s not feeling well, especially if it means she’s going to have to stop what she’s doing to give her body time to calm down.
As KK’s reaction increases, so do JJ’s alerts. She starts by showing agitation, getting up and turning circles. As the situation becomes more urgent, she’ll bark, go find Michelle and tug on her clothes. At the family’s home in Cary, JJ can go to a cabinet and fetch a kit containing an EpiPen, which she takes to one of KK’s parents. If the family is away from home, she’ll go in Michelle’s purse and get the kit.
“JJ has made it possible for us to give KK a more normal life,” Michelle said. This year, KK is a first-grader at Green Hope Elementary School, though JJ and Michelle go with her. Michelle, a nurse practitioner and online college professor, takes a laptop, and she and JJ sit in the back of the classroom out of KK’s way, both of them quietly doing their jobs.
That’s how JJ worked on Wednesday, too.
JJ is no stranger to Duke, having accompanied KK to the hospital at least a half-dozen times for various procedures and one emergency room visit. Service animals are not uncommon in the hospital, and KK’s doctors are accustomed to her presence. Taicher, the anesthesiologist, has to fight the urge to pet her.
“I know she’s working,” he said, “but she’s so cute.”
While JJ couldn’t be allowed into a sterile operating room, she could go into a less strict procedure room. As she always does before a hospital visit, Michelle gave JJ a good bath before they checked in Tuesday night.
Early Wednesday, JJ went into the procedure room with Cunningham, the trainer, and sat on the floor under Cunningham’s chair. Cunningham watched JJ while the anesthesiologist watched his electronic monitors.
Taicher says going into sedation and coming out of it are the most likely times for any patient to react to a sedative, so he watched for any sign that KK was having trouble.
“It’s like flying on an airplane,” he said. “Takeoff and landing are when you’re most likely to experience a bumpy ride.”
Though his monitors showed no change in KK’s vital signs, JJ got up and turned circles as KK went under the effects of the drug, Taicher said – a mild alert. Then she sat back down.
Dr. Sherry Ross, who performed Wednesday’s procedure to look for a cause of KK’s recurring kidney infections, said another opportunity for KK to react was the injection of a dye to conduct a test during the procedure. No problems there, she said.
As KK was brought out of sedation, JJ got up and turned a couple of circles again.
“It was just as we expected,” Taicher said. “If we had had a script, she followed it to a T. ”
Though Ross and Taicher are aware of many medical uses of dogs, including detecting blood-sugar fluctuations in diabetics, Taicher said he was impressed with JJ’s abilities.
“It sounds silly, in this age of technology, when we have millions of dollars worth of equipment beeping around me, that we had a little dog who was more sensitive than all the machines,” he said.