The story of a boy living with Type 1 and his family's journey to raise and train a diabetic alert dog.

Saturday, December 26, 2015

Bowling with Bo

Bo's first time at the bowling stadium.
We took Bo bowling today. It was his first time in the space. The distractions were high -- people chatting and cheering, music playing, balls rolling and pins crashing. Bo worked like a pro.  He did everything we've trained him to do while working in public; he even alerted to a high of 180.

The floor around and under our table was pristine. There wasn't a crumb or piece of trash to be found. Bo placed under our table without the distraction of food and stayed there until he broke place to alert. When he first broke place we thought he was being antsy and we gave him the command under but when he didn't listen to our command, I realized he was about to alert. Sure enough, he paw swiped my leg when I allowed him to stand. (This was a good reminder to first think alert when he breaks his place in public rather than thinking he is not settling.) He ended up re-alerting 20 minutes after his first alert and Austin's blood sugar was 182. By the time we finished bowling and got in the car Austin's blood sugar was 130 -- well on its way to his target of 120.

If we didn't have Bo with us during this outing, we wouldn't have caught the 180 until an hour after Bo caught it -- which would have been our next scheduled check. As result of having Bo with us, we were able to correct Austin's high and have his blood sugar back at target by the time we finished bowling. After bowling, we went out to eat. Austin's blood sugar was at target by the time he checked it at the restaurant.
Bo resting his chin 'chill' on Austin's foot. 

Bo waiting for Austin to check after giving a high alert.

Thursday, November 19, 2015

A Major Milestone Met

Earlier this fall, I began the process of applying to have Bo registered and licensed as a service dog with the New Hampshire Governor's Commission on Disability (GCD), as outlined in NH RSA 466:8. Registration with the GCD exempts a service dog owner from the annual registration and licensing fees associated with owning a dog. I didn't seek to have Bo registered with the GCD as a way to avoid paying annual fees but rather as an acknowledgement of the thousands of hours we've invested in his service dog training.

While GCD registration is not required by law and cannot be used to verify the legitimacy or authenticity of a service animal for any purpose, the registration tag can only be used by an eligible service animal as defined by NH RSA 167-D:1.

Additionally, the application process requires the submission of documentation from a recognized training agency or documentation the dog passed the public access certification test and a letter from the person's healthcare provider stating the dog performs tasks directly related to the person's disability. 

Because Bo was owner-trained, with ongoing assistance from professional and credentialed dog trainers, we were required to submit documentation that he passed his public access certification test, as well as a letter from Austin's endocrinologist verifying Austin has Type 1 Diabetes and uses Bo to assist in managing his blood sugar.

Austin's endocrinologist wanted medical evidence of the validity of dogs detecting hypoglycemia before writing the letter to submit as part of Bo's application. To assist her in conducting her due diligence, I sent her a link to Eli Lilly Company and Indiana Canine Assistance Network 's study on hypoglycemic alert dogs. I also sent the results of a lit search on 'diabetic alert dogs.' 

The Eli Lilly study, which concluded Diabetic Alert Dogs' sensitivity to detect hypoglycemia is greater than by chance alone, provided the evidence she was seeking. And nearly two months after I had started the application process, I had all the documentation I needed to complete it. Three weeks passed between the time I submitted the letter from Austin's endocrinologist, to the time I received Bo's registration letter and tag in the mail.

Once I finally had the letter and tag in hand, I was able to pause and reflect on what it represented -- hard work, commitment, perseverance, tears, triumphs and perhaps most importantly --  love.  All that has gone into Bo's training and raising is rooted in the love I have for my child, and is symbolic of a mother's innate will to do anything and everything to help her child live a happy, healthy and long life. 

Thursday, October 29, 2015

Sometimes We Miss

It happens; sometimes we miss an early morning check. Today was one of those mornings. I awoke to my 2 o'clock alarm only to turn it off and fall back asleep. It wasn't until an hour and a half later when Bo woke me with an alert that I realized what I had done.

I immediately got up and followed him to Austin's room. There I fumbled in the darkness as my hands navigated Austin's nightstand in search of his pack. Finding it, I removed the meter, test strips and lancet then gently grasped Austin's hand and pricked his finger under the meter's illumination.

While I waited for the number to register, Bo stood in front of me with the frisson of anticipation.

The meter beeped and it read 79 — smack in the middle of Bo's low reward range. Once again, he nailed it.

"Good low Bo," I said.

Recognizing my words with the fervor of what was coming next, he began wagging his tail with an intensity that shook his rump.

"Let's get a treat." I said after giving Austin juice.

He followed me to the refrigerator and waited patiently for me to open the meat drawer and dish out his reward.

"He's low. Show me low," I said as I fed him bites of chicken between his paw swipes and bows.

He ate the last piece and I closed the refrigerator door.

"All set," I said.

But instead of returning to Austin's room, he stood looking at me with eyes asking for more.

"You wanna play?" I asked extending my arm to the top of the refrigerator to get his reward toy.

I grabbed the plush toy, tossed it and he ran after it. "I'm gonna getcha," I whispered.

He took the toy in his mouth and began jogging around the dining table. I followed behind him in a child-like game of chase. After a few laps, I ended the game. He brought the toy to me and exchanged it for one last treat before returning to Austin's bed.

Before leaving them, I re-checked Austin's blood sugar. It was 121. I kissed Austin's cheek, covered Bo with a blanket and returned to my room full of gratitude for the team we've become.

Sunday, October 25, 2015

Video: Aha Moment

I've been working with Bo to teach him to differentiate between the 'drop' command and the 'release' command. When we give him the command to drop, we want him to drop what is in his mouth on the floor or ground. When we give the release command we have our hand on what's in his mouth, so it gets released in our hand rather than dropped on the floor or ground.

We use drop when he has something we don't want him to have. For example, sometimes he tries initiating play with a sock, hat or pillow -- things that are not toys. We use release when he is bringing us an object that we cue him to retrieve. For example, a juice box or a scent stick.

Up until recently, he had been dropping balls regardless if we gave him the drop or release command. Last weekend, when I was practicing with him inside the house. He retrieved the tennis ball, came to me, held the ball in his mouth and waited for my response. I put my hand on the ball and said release. He immediately released the ball into my hand.  It was a true aha moment for me. He got it -- he demonstrated his ability to differentiate between the two verbal commands despite having an object that he had previously been accustomed to drop upon retrieval.

We continued playing the game. I tossed the ball and he retrieved it each time demonstrating his ability to differentiate between my command to either drop or release the ball. It was a wonderful feeling seeing the results of our training and practice. There is nothing like an aha moment to provide inspiration and encouragement to keep going.

In this video, Bo we are practicing the release command with a scent stick that doesn't have a live scent in it.

Austin Works Bo in Classroom

Bo and Austin attended religion class last Sunday. The three hour class provided many opportunities for boy and pup to work together in a classroom environment. I continue to be the biggest distraction to Bo when Austin is working him. These are some pictures from the evening.

Changing classes.
Entering our classroom.
Leaving large group in the gym.
Navigating the snack line.
Hanging out during large group lecture.

Monday, October 12, 2015

Research Study: Dogs Can Be Successfully Trained to Alert to Hypoglycemia Samples from Patients with Type 1 Diabetes

This is a link to a study conducted by researchers Dana S. Hardin, Wesley Anderson and Jennifer Cattet.

From the Article's Abstract: 
Hypoglycemia (Hypo) is the most common side effect of insulin therapy in people with type 1 diabetes (T1D). Over time, patients with T1D become unaware of signs and symptoms of Hypo. Hypo unawareness leads to morbidity and mortality. Diabetes alert dogs (DADs) represent a unique way to help patients with Hypo unawareness. Our group has previously presented data in abstract form which demonstrates the sensitivity and specificity of DADS. The purpose of our current study is to expand evaluation of DAD sensitivity and specificity using a method that reduces the possibility of trainer bias.
Read full article at:

Low Alert and High Alert in the Middle of the Night

We were battling high blood sugar early last night and by midnight all our efforts to correct the high had caught up. Bo alerted me at 12:04 am. Austin had a friend sleeping over, so he was sleeping downstairs on the sofa bed instead of in his room. Bo was with the boys downstairs, so when he woke at midnight he came upstairs to alert to me in my bedroom. I checked Austin and he was 70. I treated the low with 15 g of juice, decreased Austin's basal rate, rewarded Bo, cued him to get back in bed with Austin and then went back to bed myself.

At 1:33 am I woke to Bo alerting again. This time Austin was 173. I had reduced Austin's basal rate too much but thanks to Bo I was able to take care of it before it got really high.

Last night was just another one of the many times Bo has helped us keep Austin safe through the night. I love our pup.

Sunday, September 20, 2015

Incognito in Public

Bo incognito in public.
Last Saturday I forgot Bo's service vest when I took him to Austin's football game. Instead of going home to get it, I worked him incognito. Strangers didn't give him a second glance while we were walking to the stadium. There was no staring, pointing or whispering when we made our way to the bleachers. I took a seat among the fans from the opposing team to maintain our anonymity. A woman sitting next to me turned to me with a smile and said, "He is so well-behaved." I smiled and thanked her. When the crowd burst into cheers, the same woman turned to me and said, "He's so calm."

When I eventually joined my friends they observed Bo wasn't wearing his service vest and asked if they could say hello. I gave them the go ahead and Bo the okay to say hello. They indulged him with rubs and praise. In return he gave kisses, sniffs and tail wags.

A woman I didn't know was sitting on the bleacher below me. Unbeknownst to her, Bo was sniffing her jacket. I stopped him and apologized to her for his nosiness. She replied, "He is probably smelling my dog. May I pet him?" I told her yes. She complimented him on his good behavior and pet him as she talked to him. Her husband who had been sitting to the left of me and behind her didn't speak until he was leaving. He stopped in front of Bo, looked at him and said, "You are the most well-behaved dog I've seen." Bo looked at the man as if he knew what he was saying. I smiled and thanked him.

This outing made me realize the pressure I put on myself with regards to ensuring Bo exemplifies all service dog qualities in public. It was a unique experience for me to see Bo through the eyes of strangers without the expectations associated with being identified as a trained service dog.

I observed Bo air scenting with each passing breeze but he never alerted. When Austin got off the field, he came to ask me for money to buy food. He had just checked his blood sugar and was 103.

At my feet on the bleachers.

Watching football.

Bo settled at my feet on the bleachers.

Saturday, September 19, 2015

Football Practice + Trampoline Park + Pizza + Cake = A Crap Shoot

Austin rewarding Bo for a low alert.
Austin had a football walk through early in the evening yesterday. Afterwards he and some buddies went to a friend's house for pizza before heading to an indoor trampoline park for a birthday. I knew maintaining Austin's target blood sugar of 120 was going to be extra challenging given the activity and food that was planned for the evening. I hoped the activity would kick in when the pizza high kicked in -- balancing one another.

When Austin left the house for football his blood sugar was 123. By the time he got to his friend's house at 7:15 pm and was ready to eat pizza, his blood sugar was 117. He was off to a good start for the evening. At 8:00 pm he suspended his basal for one hour -- the duration of his time at the trampoline park. When he got back to his friend's house at 9 pm and was ready to eat cake, his blood sugar was 96. He bolused 50 g for the cake, which caused him to drop to 68 at 11 pm. Bo was sleeping and missed this low. We treated the 68, reduced his basal, gave him a peanut butter toast, set our 2 am alarm and went to bed.

I don't know if I turned off the alarm and fell asleep or if it never went off -- but I missed it. I woke at 2:15 am to Bo alerting me. Austin was 85. Thanks to Bo's alert, I was able to treat Austin's low before it became dangerous and reduce his basal rate. As a result, he woke at 6:45 am nearly on target with a blood sugar of 122. By 7:30 am it was 105 and at 9:30 am it was 121.

It's always a crap shoot for us when it comes to balancing the effects of physical activity on blood sugar when coupled with high carb and fat foods like pizza, which causes high blood sugar hours after consumption. Overall things worked out well this time. Bo missed the low at 68 but we were all awake to catch it. He caught the low of 85 at 2 am when we missed the alarm.

Managing Type 1 with a DAD is truly is a team effort. We are not perfect, nor is Bo but together we do a good job keeping the boy's blood sugar in safe ranges. It's hard to imagine taking care of T1 without Bo's help.

Thursday, September 17, 2015

Bo Goes to Class with Austin

Bo 'chilling' in Austin's classroom.
Last Sunday, Austin and I took Bo with us to religion class -- a once a month, three hour class held in our church's activity center. The class is comprised of  a hundred or so seventh and eighth grade students, parent volunteers and church staff. The format consists of large group lectures and small group discussions. The students gather for the large group in a gymnasium set up with tables and chairs, and in classrooms for the small groups. They get a snack break and have time to socialize. In many ways, the environment mimics a typical school setting with crowded halls of kids passing one another, food crumbs on the floors, bells, public rest rooms, gym bleachers and classrooms. Sunday was Bo's first time in class but not his first time in the space. 

Bo handled the noise and activity beautifully. He settled under the table in the group lecture and under the desk in the classroom. A few times he rested his head on our feet in what we refer to as 'chill' position. He even alerted.

Bo hanging with Austin when class ended.
My presence continues to be a distraction to Bo when Austin is handling him. Bo will stop walking with Austin to look back for me. He did this when Austin was leaving the gym with him to go to the classroom. I was about 20 feet behind the two of them.  

When Bo alerted in the classroom, he broke place to come to me and alert rather than alerting to Austin. In talking with Helen about Bo's preference to alert to me over Austin, she suggested having Austin be the person to give Bo his high value food reward when he alerts. This week, I started bringing Bo to Austin every time he alerted and prompting him to alert to Austin. We appear to be making progress; tonight Bo alerted Austin while they were awake in bed.

Bo 'under' in the large group setting.

Bo settled at Austin's feet in the gym

Monday, September 7, 2015

Video: Bo Releasing Object in Hand

I've trained Bo to release objects into my hand as opposed to releasing them and letting them fall on the floor. This is helpful when it comes to him retrieving and bringing a juice box. When we started working on this skill, it looked much different. He would take the stick and release it right away before I grabbed hold of it. Now if he accidentally drops it before I have it in my hand, he will pick it up again and hold it in his mouth for me to take.

Video: Finding Hidden Scent Sample

Austin was out of the house this morning, so I took the opportunity to do scent training with Bo. I put Bo on his place and then hid the sample out of his view. I returned to him and gave him the 'find low' command. This is one of the videos I took of him finding and alerting to the low sample.

Sunday, September 6, 2015

Taking Bo to School

Guest post from Austin:
School has recently started and while I miss summer, I enjoy seeing my school friends. This did however get me thinking about Bo going in to school. I know he recently passed his Public Access Certification Test (PACT), so he is definitely qualified but is he really ready? Am I ready? I really want him to come to school with me but I'm not sure if I can focus and still watch Bo. I believe I can do it but I still need to keep up in school too. After just two days working Bo when we went to Dallas, I  was worn out. I think the time zone difference and less sleep made it worse but it was still a lot of work for me and Bo. If I am doing that five days a week for six hours that is a lot to balance. We hopefully will start working Bo in school for one hour at a time. I hope my mom and Helen will be able to schedule a time for Bo to take the PACT with me in school.


Saturday, September 5, 2015

College Campus Offers a Host of Distractions

Boy and Pup at Dartmouth College
Austin has been asking about Dartmouth College for the past year. Today, after a hike of Mt. Sunapee and lunch at Salt Hill, we decided to drive to Hanover and walk around Dartmouth's campus. It was a beautiful day and the Green was speckled with college students playing lawn games, reading, and lounging in the afternoon sun.

I handled Bo when we first got there but Austin took over after about 15 minutes. We walked down one side of the Green, through the busy Main Street sidewalks, and between class buildings before taking a break on the lawn in front of the Fisher Ames Baker Library. The energy of the college campus was palpable and walking among the students spurred conversations about college life. As we passed classroom buildings Austin asked, "How do you know where your classes are?"  Then while walking by the Visual Arts Center he announced, "You would never see me in that building." A Geisel School of Medicine sign prompted a conversation about the difference between undergraduates and graduates. 

Our visit was brief but no less enjoyable.  It provided many opportunities for boy and pup to practice the public access skills they've learned over the course of our journey. They did great too -- working with confidence and ease -- among a host of distractions. In fact, if I dare say so myself, they rocked this outing! 

Friday, September 4, 2015

Lowest A1C Test Result Since Before T1 Diagnosis

I received Austin's latest A1C test results this week and I was so happy I could have cried. His average blood glucose control for the last three months was 7.1 (which converts to 157 mg/dL). It's the lowest it has been since before his T1 diagnosis. While it's still not as low as I'd like, it's below the American Diabetes Association's A1C target of 7.5  for children with Type 1  -- for that I'm very happy.

I credit his 7.1 A1C to Bo's alerts and the fact he and Austin spent most of the summer together 24/7. Their 'togetherness' provided the opportunity for Bo to catch more reward range blood sugars than during the school year when they are apart from 8 am to 3:30 pm. 

What I consider most remarkable about Austin's 7.1% A1C is not the fact that it was achieved with the help of Bo's nose but rather it was achieved without a continuous glucose monitor (CGM), without a disproportionate number of hypoglycemic events, and with the presence  of growth and puberty hormones. 

If Austin had a continuous glucose monitor it would provide valuable blood glucose trend data that would help us fine tune his basal rates more precisely. We have talked about getting him a CGM but he is vehemently opposed to having another site on his body. (He has an insulin pump site already.) 

When it comes to A1C numbers, Austin's endocrinologist wants to see a low result but does not want that result to be the effect of a large number of low blood glucose events. Thankfully, Austin's 7.1 A1C was a result of staying mostly between 90 -200. Bo is trained to alert on highs starting at 170 and when he is with Austin he is typically alerting right between 170-185. 

At 13, Austin is in the throngs of hormonal changes that are known to make diabetes management even more challenging. As we adjust Austin's insulin therapy during this period of rapid growth, it's helpful to have Bo alerting on high and low blood sugars before they pass from 'not ideal' to dangerous. 

The next milestone on our journey is registering and licensing Bo with the NH Governor's Commission on Disabilities as a trained service dog. Once that happens, my plan is to begin talking with Austin's school about scheduling short visits to trial boy and pup working together while class is in session. There is no guarantee that Bo will alert to Austin in school but I'm hopeful. If boy and pup are able to successfully work together under the distractions of a busy junior high, I'm confident Bo's nose will help us maintain or even reduce Austin's A1C through the school year.

Sunday, August 30, 2015

A Major Milestone Met

Bo passed his public access certification test with me last Friday. I took the test with him at a local Walmart Supercenter.  A friend joined me to take video and help out with the test items. Helen administered the test and brought her Collie Paddington to help with a test item requiring another dog.

When I originally scheduled the test date with Helen, we talked about whether Austin or I would test with Bo. Austin wanted to take the test and felt he would be more relaxed than I would. I felt that I would be a distraction to Bo if I was at the test but not handling him. Helen told us it didn't matter to her but cautioned us that if he were to fail, she was required to document it.

Austin and I originally decided he would test with Bo but when I had to reschedule the original test date to the following week, I realized Austin would be in school. After explaining the situation to Austin, he agreed that I should go ahead and take the test with Bo rather than wait for a date that would work with his school schedule.

Unloading from vehicle in a busy parking lot.
I was nervous the morning of the test. I tried to distract myself by keeping busy. I took Bo for an off leash walk and then I did some training with him before walking him on leash.  I also played with him outdoors. He rested on the 40 minute ride to meet Helen. Once the test started my nerves calmed and I felt confident in Bo's ability to work in public.

Bo worked with the distraction of another dog in the store.
He unloaded and walked through the parking lot. He waited on command at the entry to the store and then walked with me through the door when I gave him the 'with me' command. He performed sits, downs, and down stays. He remained down while I dropped the leash and walked away from him. He came to me when I called him. He held his down position when I handed the leash over to another person and walked out of his sight where I remained for a short time before coming back to him. He maintained a heel position while I let go of his leash and draped it over his back. He navigated tight spaces between shopping carts. He ignored adults and children. He behaved politely in the cafe where people were eating and food was being prepared.
Bo heeling without me holding his leash.

The test didn't take long and to my surprise it felt anticlimactic once it was finished. In my mind I built the test up to be a Herculean feat. In reality, it was no different from our typical public outings. Bo did the work we've trained him to do and I did the work Helen trained me to do.

With this milestone on our journey met, I'm looking toward the next -- for Bo to take the PACT with Austin at school. There is still more training to do in school, as well as conversations to be had with school representatives before this happens but I'm confident we will get there. For now, I'm enjoying the pride of accomplishment that comes from hard work and grit.

Saturday, August 29, 2015

Book Review of Elle and Coach

Elle and Coach by Stefany Shaheen with Mark Dagostino is a heartfelt, authentic, engaging, inspiring, empowering and myth breaking story of life with Type 1 (Autoimmune) Diabetes and a Diabetes Alert Dog. Stefany's gift for writing and storytelling makes for powerful prose that captures your heart and mind.

As the mother of a child with Type 1 Diabetes and the owner of a Diabetic Alert Dog, I was able to relate to the story on a deeply personal level. Throughout the book there were parts where I found myself thinking: 'wow, I feel that way too' or 'I do that also.'

The chapters flow into each other making for an easy and quick read, while the imagery and detailed descriptions bring the story to life -- allowing you to experience a range of emotions including happiness, sadness, heartbreak, disappointment and even mama bear anger.

In telling her story, Stefany tells the story of thousands of Type 1 families across the nation. Reading it will touch your heart and open your mind. I promise you will be talking about it and sharing it with family, friends and co-workers.

Video: Training at School

We brought Bo to our meeting with the school nurse the other day and took the opportunity to do training in the empty corridors. We experienced a few bumps but overall the boy and pup did well. Austin walked Bo up and down the corridors and up and down the stairs. He stopped to talk with a former teacher and he pretended to get things from a locker. Our plan is to gradually increase the intensity of distractions and duration of exposures in the school environment. This day only teachers and administrative staff were in the building. The distractions were what I consider low: new smells, new but quiet spaces, low traffic and calm interactions with people.