“I Told You So!”

If Rainie could talk, I’m sure there are times that she’d be saying, “I told you so!”

This happened again today.  I was up in my ceramics room trying to create feet on the bottoms of some nearly finished bowls when Rainie began alerting.  I sensed she might be right because my balance and depth perception seemed a little bit off.  Upon doing my blood sugar I discovered that I was slowly dropping, so proceeded to eat a snack, and went back to work.  I wanted to push through and get this job done.  The dryness of the clay was just right – not too hard and not too soft.  But despite my intentions, she kept alerting!  I felt fine.  I had just eaten and needed to get my ceramics work done!  That was until I cut right through the semi-dry bowl with a semi-sharp tool.  She was right.  I hadn’t sensed that  my blood sugar had continued to drop and I wasn’t feeling how unstable I’d become.

As I tossed down my tools and took off my apron in pure frustration, Rainie flopped down on the floor with an exasperated sigh which loudly stated, “I TOLD YOU SO!”  

A Mother’s Letter (and, An EAC Success Story)

Laura and Darwin

Early Alert Canines has just finished another team training where two adults with diabetes were placed with blood sugar alert dogs, as well as one family with a four year old daughter with diabetes.

The young family has been home with their dog, Darwin, for almost one week.  Face Book postings are telling the wonderful story of how Darwin is reveling in his job of alerting to high and low blood sugar changes.  Sometimes when a dog first goes home with his new partner, it takes a while for the dog to adjust to the new routine, new people, and new environment.  NOT DARWIN!  In the few days he has been in his new ‘forever home’ he has alerted the mother of his new young charge, Laura, at pre-school, at home, during soccer practice and during dance class.  Good boy, Darwin!

I would like to share this ‘post’ written by Laura’s mother, explaining how difficult it is to regulate a young child’s diabetes, and what a gift Darwin has already been in their lives:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

It was brought to my attention that with all the posts recently about how great Darwin is at helping us manage Laura’s type one diabetes, as well as posting about highs and lows, that people might perceive it that we didn’t have control without him. First of all, T1D Managment is an art, not a science. The body is always changing and so do insulin needs. When Laura is getting sick, we know ahead of time from wacky numbers. When she’s stressed, we can tell from the numbers. We are constantly changing insulin ratios to try to match her insulin needs. As you can imagine, it’s a daily battle that is hit and miss. Large swings in the numbers is normal, while not ideal. One has to be most concerned about lows and chronic highs.

Prior to having Darwin we would have to rely on trying to read the signs of highs and lows from Laura’s behavior and mood. She’s 4. Sometimes a 4 year olds behavior is similar to a diabetic having a low. With Darwin, he smells a difference and he can let us know. Laura can tell us if she’s low if she’s relaxed. But in the soccer situation, she showed no visible signs of a low nor did she mention anything. Darwin helped us intercept that before it got very dangerous.

We have also used a continuous glucose monitor that works with her pump. The CGM can give us an indication if she’s on the way up or down. It’s not 100% accurate and there are delays in the readings. There is a 20-30 minute lag time generally. Darwin will, in most cases, be able to catch a low before it happens. The CGM is also one more piece of equipment Laura has to have punctured into her. As a mom, if I can get similar or better information from a black fuzzy doggie rather than a sensor stuck in her I will use the dog.

That being said, new technology is always in the pipeline for T1D management. When the new stuff comes out, Laura will have it.

In future posts I will be more clear about how Darwin has changed the way we handle things.

Type one diabetes sucks. I will use anything and everything to make sure Laura is as happy and healthy as she can be. For now and for ever.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

T1D means Type 1 Diabetes.

Type 1 diabetes (T1D) is an autoimmune disease in which a person’s pancreas stops producing insulin, a hormone that enables people to get energy from food. It occurs when the body’s immune system attacks and destroys the insulin-producing cells in the pancreas, called beta cells. While its causes are not yet entirely understood, scientists believe that both genetic factors and environmental triggers are involved. Its onset has nothing to do with diet or lifestyle. There is nothing you can do to prevent T1D, and—at present—nothing you can do to get rid of it.  (Juvenile Diabetes Research Foundation)

A person who has been diagnosed with T1D must take insulin in order to say alive.

Hot Off the Press: EAC’s “The Scentinel”

Link

Hot Off the Press: EAC’s “The Scentinel”

Here is the May 2013 edition of Early Alert Canines‘ “The Scentinel”, a newsletter full of information on diabetes, dogs, and diabetic alert dogs.

There is one correction:  In the section called “Vet Notes” the medication called Capstar should have been Comfortis.  Both are oral flea pills but the Capstar lasts 24 hours and the Comfortis lasts 30 days.

~ Enjoy!

How do you teach “Compassion” and “Empathy”?

When I was working in the hospital as a nurse, I was always misplacing my stethoscope, only to find it hanging around my neck.  Now, with Rainie in my life, I am perpetually doing the same thing with her leash.  I’ve discovered that the neck is a very handy place to put it – so I’ll always know where it is.  Except I usually forget it’s there.  I was reminded of this as I was hurriedly trying to put everything in order to go talk to the local nursing program’s class that is studying pediatrics and chronic illnesses.  As I was attempting to get Rainie and the gear into the car, I couldn’t find the leash because it was around my neck!

 In preparation for my talk on “the psychosocial impact of choric illness on the individual, family and society” (as well as diabetic alert dogs), I asked the students to read “How Does It Feel” from this blog site.  I wanted to try to show the students the impact a nurse can have if he or she tries to put herself/himself in the position, or shoes, of the client, and look at issues from that orientation.  I discovered this is much easier said than done.  “Empathy” is something one develops with maturity and experience.

Here are some of the topics we talked about in class:

I asked what issue do they (the students) think is the biggest fear of having diabetes, or having a child with diabetes in the family.  The major response I heard was the fear of going blind from long-term complications.  This is not what I was expecting from a class that had already covered the biology of diabetes.  But, at the same time, I could see where they got this idea from – I remember the doctors talking to me about ‘maintaining my diabetic regime’, or I might go blind!!  The doctors were using the scare-tactic on me in order to get me to follow their rules.  This must be what the students are being taught in this program.  I told them I had hoped they would talk about the daily problems of the diabetic’s blood sugar of going too low.  Low blood sugar (hypoglycemia) will quickly cause altered thinking, poor judgment, dizziness, accidents, unconsciousness, and, ultimately, death.  We explored what it might be like living with this constant fear, and the life changes that must be made in order to avoid hypoglycemia and long-term complications.

Next we talked about diabetic alert dogs, and how one might fit into a diabetic’s life, and why.  (Rainie was a star!)

We discussed how the first thing a nurses must assess (measure) when meeting with a client is the client’s fear and degree of acceptance of a diagnosis, and find out what ‘burning questions’ they may have.  Without doing this first, no other teaching can happen – especially if the client is truly anxious, agitated or angry.  And, the diagnosis of “Diabetes” tends to bring with it a lot of fear and anxiety, especially if it is in a child.  We explored how, in a perfect family, the whole family might adapt to the new food requirements and exercise plans, as well as be involved in learning what diabetes is all about.  The family and the patient are the nurse’s client.

I talked about how the patient may have an appointment to meet with a nurse in order to learn or review a myriad of information, but, even though the patient may look ‘fine’, their body might be in a bad metabolic/chemical state due to blood sugar problems.  This makes the nurse’s job of teaching more difficult, and possibly frustrating for both the nurse and client/s.

There was so much we could have covered, but I only had an hour, and the instructor had asked me to show how a nurse would teach someone (a family member, a teacher, a school nurse, etc.) how to give a Glucagon injection.  (Glucagon is a hormone that should be injected into a diabetic if the diabetic’s blood sugar goes so low that she/he is not able to eat, becomes combative, is having seizures, or becomes unconscious.)  I brought two expired glucagon kits with me so the students could actually handle them, and mix the two ingredients together as if they were going to teach someone how to inject the Glucagon.  The example I gave was for the students to teach a grandmother how to give a Glucagon injection to her 3-year-old granddaughter, who was having seizures due to low blood sugar.  Before we cracked the cases open, I asked the class if anyone had ever given himself or herself an injection.  All the faces, but one, dropped with an expression of horror!  “NO!”  I asked, “Why not?”  I suggested that the next time they had to get a flu shot or tetanus shot, to ask to give it to themselves, then imagine what it might be like for a parent to have to learn how to give their first insulin shot to their child, or, as in this case, what it would be like for Grandma.  The room became very quiet … Next, we figured out how to break open the plastic box the glucagon kit comes in, uncap the syringe and needle, inject the fluid from the syringe into the glass vial containing the powdered glucagon, agitate the bottle to mix it, and now teach “Grandma” how to give the injection.  I believe my asking the nursing students to imagine doing this to themselves must have “freaked-them-out” because most of them were “all thumbs.”  After much giggling and dropping of the bottles, my time was up.

For me, this opportunity was priceless.  I haven’t “put my nursing hat on” for a long time.  As for the students, I hope they took away a slightly different perspective of life and the teaching process.

Keeping Hope Alive

I’m always amazed how a little thing, like a simple sticker in this case, can cause an “Ah-ha” moment.

Rainie and I have just returned from our weekly trip to the local farmers’ market, where, as usual, we were soon greeted by a following of kids.  From the distance, I heard little voices shouting, “Look Mommy!  There’s a dog!” or, “Rainie! Rainie! There’s Rainie!”  The kids seem to appear individually, or by swarm.  After greeting them, and inviting the shy ones (including families) to come forward, I usually introduce the listeners to Rainie by giving them my short talk, that goes something like this: “You always needing to ask before you pet ANY dog, but especially a dog wearing a jacket, because that means the dogs are working, and have a special job to do and shouldn’t be interrupted.”  Then the kids are allowed to do what they came to do (pet Rainie), and I’ll answer the myriad of questions that are posed – i.e.” What does Rainie do?”, “What kind of dog is she?”,  “What is EAC?”,  and, my favorite, “How can I find out more information about diabetic alert dogs and Early Alert Canines (which is usually asked by adults) ?”

Recently, I’ve begun offering EAC stickers to those interested, which seems to delight kids of all ages.  (The little ones assume it is a picture of Rainie, and are pleased to be able to take a picture of her home.).  Today, a girl of about 8 approached.  She was shy as she gently knelt down and wrapped her arms around Rainie’s neck.  She seemed very interested to learn about what Rainie does for me and how she was trained.  She seemed to leave only because her mom was calling for her.  She happily accepted a sticker, and Rainie and I proceeded on our way.  Not long afterword a woman, being led by the young girl, came hurrying up to us.  The mom told us that they had been searching the bustling market to find us in order to find out more about Rainie and EAC.  Apparently, her daughter had given the sticker to her, told her about our conversation, and had asked if she could send the sticker to her cousin in Michigan.  This cousin had been diagnosed with diabetes at the age of 7 months, and is now 3 and a half.  His family is having trouble with the toddler going low at night, and has been trying to find information about diabetic alert dogs, but couldn’t find anyone willing to talk with them because the boy is so young.

After explaining that EAC does place dogs with families with young children, I, unfortunately, had to tell them that due to our being so small, and the fact that we offer life-long support to our teams, EAC must limit the placements of blood sugar alert dogs to the Western United States.  The young girl then said something to the effect of: “Well, maybe other groups will learn how to teach dogs for kids from you (EAC).  All we can do is keep the hope alive.”

Three New Teams Graduate at Early Alert Canines!

“Lucy” and her boys

Yesterday, Early Alert Canines celebrated another major milestone.

Three diabetic alert dogs teams were officially ‘handed their leashes’ in an emotional graduation ceremony.*  One team consisted of “Mr. Brooks”, a petite, yellow Labra-doodle and his new mistress, a long-term diabetic, soon to be retired, who lives alone.  However, for two of these celebrated teams, the ‘clients’ are actually families with multiple diabetic members.  In one family, “Lucy”, a happy and energetic yellow Lab-golden retriever mix, watches over a family with three young boys, two of whom have diabetes; and in the other family, “Bender”, a mellow, loving, gigantic black Lab/golden retriever mix alerts to three home-schooled children and their father.

All of these dogs are alerting to both high and low blood sugars.  Lucy and Bender have been trained to alert one of the parents if their charges’ blood sugars are dropping at any time, day or night.  One of Lucy’s ‘guys’ cannot sense his blood sugar at all (called hypoglycemic unawareness), and her special skills and talents are especially important for this ‘human partner’.  In the five months since the dogs have been placed in their new homes, there has been a decrease in the number of ‘dangerous lows’ and ‘unbelievable highs’, and an overall improvement of the diabetics’ blood sugar levels.  These are very busy dogs!

We like to say that diabetic alert dogs (DADs) are life-saving dogs and a diabetic’s best friend.  They are trained to alert when a diabetic’s blood sugar drops rapidly so that steps can be taken to prevent serious situations.   And low blood sugar can lead to unconsciousness and death.   So, yes, they can literally help save lives.

They also help to save lives in a more figurative manner. Their warnings help to bring a sense of peace of mind and security by providing yet another ‘warning system’ to keep the diabetic’s blood sugar in check.  The dogs can often sense the fact that the blood sugar is going to drop, before it actually does, thereby giving a truly advanced warning of impending danger.  They provide a sense of companionship for the diabetic, and another “set of eyes and ears” (and nose – in this case), for parents of diabetics.  For the parent of a young diabetic, the dogs help allow for a more restful day and secure sleep, knowing the trained DAD will alert them, even waking them up at night, and bring the parent to the appropriate child if there are multiple diabetic children; and for parents of older diabetic children, say, in college, it is a comfort for the parent to know that, even when away, their child has another ‘early warning system’.  And for the ‘more mature’ single person with diabetes, the DAD helps provide the same physical security and companionship, peace of mind for self, family and friends, and the knowledge, to all, that self or loved-one has another helping ‘nose’ and is never alone.

CONGRATULATIONS to all the teams, old and new.  May you continue to have a life of fulfillment and happiness, and peace of mind.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

* To achieve “graduation status”, the new teams must demonstrate an 85% or better alerting accuracy rate.  This means that the dog must correctly alert t >85% of the blood sugar changes tested and recorded by the diabetic client, in multiple and various situations; and the client must recognize the alert and respond appropriately.

 

 

February Edition of the Early Alert Canines “The Scentinel”

“http://library.constantcontact.com/download/get/file/1108404407988-37/February2013.pdf

Welcome to the 3^rd edition of Early Alert Canine’s “The Scentinel”.

For some reason, seeing the newsletter in print makes me reflect on what we/EAC have accomplished in the two years and three months since the initial group of us first sat around a kitchen table to begin visualizing what we wanted Early Alert Canines to be.  (We even needed a name.)

We knew we wanted to create a non-profit organization to train and place low blood sugar alert dogs with adults with diabetes, as well as families with young diabetic children.  And we wanted to be far-reaching in the clients we serve. Thus far, in our first year of placing these life-saving dogs, we have graduated 5 certified teams, with three more graduating in March.  We have teams in Oregon, Los Angeles and throughout the bay area.  There are also 3 teams with families with diabetic children – thus far.

A training center was needed.  What a chore this was.  And we did it!  We’ve created a beautifully remodeled site, not far from a large shopping mall, public transportation and San Francisco.  The location provides many of the learning opportunities needed for training the dogs and teams.

Our trainer wanted to continue the research needed in training diabetic alert dogs, and provide documentation of her process.  Even though Carol had previously trained and placed over 60 DADs, the opportunity to train these dogs for families with very young children was new.  Needless to say, large strides have been made in this area.

Of course, there was, and is, the continued need to develop the non-so-obvious infrastructure that an organization requires – office work, applications, work, outreach, fundraising, developing our reputation, attaining dogs, etc., etc………
Thank you for coming along for the ride.   Please enjoy the newsletter!

Too busy to remember to test

This past weekend, Rainie and I attended a symposium in order to talk about diabetic alert dogs and Early Alert Canines.  Since one of the sponsors of the event was the Lucille Packard Children’s Hospital, there were many, many kids with diabetes attending, along with their families.  Since EAC is one of the few diabetic alert dog organizations that places dogs with young children, my table was incredibly busy.  And while I talked, Rainie was getting a lot of attention – so much, in fact, that she actually fell asleep under our display table with her head in a little boy’s lap.

It had been a very long and worthwhile day.  I was exhausted as I left the conference hall, but stopped as yet another young girl (about 5 years old and diagnosed with diabetes for 11 months) approached to pet Rainie. While the mom and I talked, Rainie began to ‘nudge’ me.  I praised and rewarded her, as I told the little girl that Rainie was alerting me to my dropping blood sugar – completely forgetting to treat myself.   Over time, Rainie began nudging me more and more while I continued praising her and talking about the wonders of diabetic alert dogs.  As Rainie escalated her alerts to where she was jumping at me, the little girl said, “I think you better go test your finger!”

She and Rainie were right.  My blood sugar had plummeted! *

*Please remember that low blood sugar (hypoglycemia) causes altered and illogical thinking.  This is due to too little blood sugar infusing the brain.  For a more complete  description please see “What Does It Feel Like?”

The “Mobile” of Life with Diabetes

“What is diabetes?” and “Why do diabetics need service dogs?” These are questions I’m often asked and have lectured about many times.  Until I read the lead article in the last edition of Early Alert Canines “The Scentinel”, I’d never thought of talking about diabetes in terms of what life with diabetes entails.  I had always spoken from the scientific or physiological orientations of diabetes – describing what is physically wrong with the body, and what a diabetic needs to do in order to take care of  themselves from a medical perspective.  Although I’ve lived with diabetes my entire life, and know every aspect as well as anyone can, I’ve never thought about describing diabetes from the “psychosocial” perspective.  (Psychosocial is a fancy word that means the psychological, social, and non-biological impact a disease has on an individual, family, and the society.)

Beyond the fact that the diabetic body does not produce insulin (or enough insulin), life with diabetes is a difficult and complex balancing act – for some reason, I’ve always visualized it as a mobile.  We must try to balance the insulin we give ourselves (for type 1 diabetes, or deal with not enough insulin if you have type 2), with the food we eat and exercise we get.  Some of the other factors influencing the balance are illness, growth, emotions, stress, medications, amount of sleep, hormones, etc.  And, if that isn’t enough, part of taking care of the disease includes constant monitoring with finger sticks, gathering data, counting carbs, pumping or injecting insulin, and/or taking other medications, calculating ratios, thinking backward while projecting forward, and correcting imbalances, as well as talking with doctors and reaching for support.  Oh, and I forgot to include trying to lead a “normal” and active life.  Keeping the ‘mobile’ of life with diabetes is, to say the least, challenging.

Another aspect of life with diabetes is less apparent to the observer. It is the stress and fear of living with this chronic disease.  There is the fear of “losing control” or having low blood sugars.  Untreated low blood sugar can lead to loss of balance and coordination, confusion, impaired thinking, bad decisions, vision changes, agitation, loss of consciousness and possibly death.  Friends and family members share these concern about the diabetic – especially parents of young diabetics.  Parents often wake-up multiple times a night to check their child’s blood sugar to ensure the child’s safety (and to try to increase their own peace of mind).  Diabetes affects the child because she knows she “doesn’t feel good” but may not realize it is because her blood sugar is out of control.  And children are often ostracized for having  diabetes because they are ‘different’.  We often check our blood sugar because of “feeling funny” or before driving, taking tests or doing physical activity to try to avoid problems and ensure everyone’s safety  Also, there are the physical discomforts (which makes me cranky) and ever-present fear of long-term complications which come from the blood sugar’s varying highs and lows.  All of these affect the diabetic and those who love and care for this person.

I am amazed to write all of this!  I feel like I should be overwhelmed; yet, for me, everything I’ve written about is part of my daily life

Rainie love

Now, to attempt to explain why someone like me (someone with diabetes) would have a service dog:  A diabetic alert dog’s fundamental job is to alert the diabetic, or diabetic’s care-taker, to sudden changes in blood sugar so that precautionary measures can be taken.  My diabetic alert dog, Rainie, alerts me to both highs and lows in any location – in the house, while I’m asleep, while we’re out and about, on airplanes, in restaurants, hospitals, libraries, at the movies, etc.  When she warns me, I am able to take steps to avoid the situation worsening and becoming dangerous.  I tell people that when Rainie alerts me, she is warning me to pay attention to my blood sugar – it is changing quickly.  With her, I feel safer.  I have another ally and tool to assist me in monitoring my diabetes.  She is my constant companion.  I no longer feel alone, or as overwhelmed in dealing with this disease.  Parents who have alert dogs for their diabetic children have another way to monitor their child.  Since parents have no physical sense of their child’s blood sugar levels, the dog’s alerts give them advanced warning, insight, and, hopefully, peace of mind.

I’d like to repeat what Devin stated in her article:  “Though it is critical for every diabetic to understand the underlying cause of his or her condition, we might generate greater public understanding if we start talking less about what doesn’t work in our bodies and more about everything we do to set that right. The next time someone asks about your diabetes, try telling them what you are doing to take care of yourself (sic). It might give them a better understanding of diabetes, and it will certainly clue them in to how totally awesome you are.”

“Always Trust Your Dog”

“A good companion shortens the longest road.”  ~ Turkish Proverb

Rainie near the fire.

It’s been the sort of day when it’s nice to be able to sit by the fire and read, and have the enforced time to get paper work done.  At times, when I looked out the window, all I could see were gray clouds and rain. It was hard to remember that the hills are finally turning their bright ‘spring’ green after enduring the dry, dull yellow-browns of a long, dry summer.  We’ve been lucky.  Despite the winds, the power hasn’t gone out.  The weather forecasters had warned of heavy rains in our area; but I preferred thinking about my friend’s advice of going to the lumber store to buy what’s needed to make an Ark.  I love the rain and the winds, and watching Rainie lie belly-up in the warmth of the fire.

Finally the rains abated to a mild drizzle around 4:00.   I must admit that I, like Rainie, needed to get out and stretch my legs.  After donning the required rain-gear, we went to the park.  The hills were freshly rinsed to their stunning greens, and the birds were crazily darting about as Rainie and I began our walk along the slick paths (while happily stomping through every puddle – both of us).  I could read the joy in Rainie’s face as she raised her nose in the crisp wind.   Surprisingly, the kids were already out with their snow-saucers and surfboards, careening down the river of mud pouring down the amazingly steep hill.   Rainie stood at the bottom, nose pointed,  twitching toward the teens.  I gave her the command to “Go say hi,” and she charged up to the muddy sledders, greeting each one as if she were ‘checking them out’.  I was wondering, “Did she remember?” On this same hill, last year, she alerted a boy who was unaware that his blood sugar had dropped dangerously low while sliding in the mud.

Suddenly she turned and bombarded back down the hill, stopping at my feet, and alerting me.  Had she actually been smelling me, but associating it with her past experiences with the kids?  Who knows?  I reached into my pocket, pulled out my meter to test my blood sugar, and discovered I had no strips!  Oh no…  Rainie was adamant, dancing at my feet, and jumping toward my face.  I figured my blood sugar must be dropping quickly, but I felt fine.  Yet, in my head, I heard my trainer’s voice saying, “Always trust your dog!”  I popped some glucose tablets into my mouth as we turned back toward the car.  Rainie, however, wouldn’t stop alerting the whole half-mile back.  And when we got to the car, she wouldn’t get in.  This is not a good sign – She’s done this before when my  blood sugar’s been too low to drive.  Deciding to “trust my dog,” I ate more glucose and sat in the car for about 15 minutes, watching the rain come down with gusto.  Finally, Rainie settled into the wheel well, and let me drive us home.

Asleep in the wheel well.