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

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.