Bo's First Basketball Tournament

This nose knows.

Last Saturday we were at a basketball tournament with Austin and Bo from 5:30 to 10:30 pm. While Austin sat and played with his teammates on the court, we watched the games from the balcony with Bo. He alerted to a high while Austin was playing.

It was a busy, loud and crowded environment with lots of distractions. Food on the floor was one of the biggest and most difficult distractions for Bo, although he responded promptly to my commands to 'leave.' All the training we've done at basketball games helped prepare him for a tournament atmosphere.

Watching the games from the balcony.

Bo tucked between my legs and the balcony glass.

Generalizing the Alert Behavior

Bo waiting for me after an alert.

One of the many key concepts in scent training involves teaching your dog when you ask him to perform a behavior it means the same thing regardless of the environment or scenario. This is called generalization; teaching a dog to generalize a behavior involves training the behavior in different locations and under different distractions. It also involves changing up the position of your body when you ask for the behavior. Once a dog is able to generalize a behavior, he is able to give the behavior on cue despite the scenario. 

During a recent extended stay at a vacation home, Bo demonstrated his ability to generalize his night time alert behavior. The vacation home was larger than our home and the floor plan was much different. I wondered if Bo would alert at night given the new space. Would he find his way from the room where he slept with Austin to the room where I slept. Would he come to the side of the bed to wake me? Would he lead me back to Austin? 

The first night he demonstrated his ability to generalize night alerting. Despite being in new surroundings, he alerted to a low of 69. Just like he does at home, he left Austin's bed and came to the side of the bed where I slept to wake me. When I stood up, he bowed at my feet and then he led me to Austin. 

Bo with reward toy after a game of getcha.

What really impressed me was his ability to also generalize his reward behaviors. Just like at home, he went to the refrigerator to get his food reward, then he followed me to the bin where his reward toy was and waited for me to initiate a game of 'getcha.' After a few laps of me pretending to get him, I cued him to return to the kitchen with the toy. He dropped the toy and waited for his last treat before returning to bed with Austin.  

Night after night in this new space he worked just like he works at home. He alerted to lows in the 80s and highs ranging from 173 to 220. His alerts were not limited to at night, he alerted during the day catching post skiing lows in the 70s and 80s, as well as highs related to temp basal decreases that were a bit too aggressive. 

Settled 'under' after being rewarded for a high alert.

At the ski lodge, he broke place from under the table to alert but Austin's blood sugar was 157, so we told him we would 'watch.' Within 12 minutes he re-alerted by paw swiping my leg from under the table; this time Austin's blood sugar was 187 and in Bo's high reward range. After being treated for his alert, he settled back under the table where he remained until we left. 

Being away on vacation has provided Bo the opportunity to demonstrate his ability to generalize his alert behavior. Seeing him work successfully in new environments and under different distractions fills my heart with pride and gratitude. We've come so far on our journey. 

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! 

Reward Range Thresholds

When it comes to Bo's nosework, I expect alerts within his low and high reward range thresholds. For a high it's 170 to 220 and for a low it's 70 to 89.* An alert that allows us to treat Austin's blood sugar before it gets dangerously high or low, is one that meets my standard of a successful alert.

Dangerous highs may result in ketones and may put Austin at risk for long term complications associated with high blood sugar. Dangerous lows may put Austin at risk for short term conditions such as seizures, coma, or in the worse possible case, death. In general, if Bo alerts on a blood sugar above 220 or below 70 I consider the alerts helpful but not successful. 

There are two scenarios when I make an exception to this standard. They are: 

1. When Bo alerts on a low below 70 or a high above 220 upon Austin arriving home after being separated from Bo. For example, when Austin sleeps at a friend's house and Bo stays home. Bo has alerted outside his reward thresholds  (higher than 220 or lower than 70) upon Austin arriving home. I consider this a successful alert because Bo was not with Austin to smell his blood sugar when it was in the 170-220 range.
2. When Bo is re-alerting on a low that's dropping or a high that's rising. He may give his first alert within his reward thresholds but continue to alert well beyond the 220 or below the 70 until Austin's blood sugar is in non-reward range (above 90 and below 169.) I consider this acceptable because these alerts serve to let us know there is either an issue with treating the low and it's still dropping below 70 or still rising above 220. 

Bo is not perfect. He is a living, breathing animal and his ability to work can be influenced by many factors including but not limited to: 

• How full or empty his stomach is;
• How energetic or fatigued he is physically or mentally;
• The number and strength of distractions that are present in his work environment.

Alerts outside of his reward thresholds don't happen frequently but they do occur and when they do, they provide me the opportunity to evaluate the influences at play and modify his scent training to address them.

I'm interested in hearing from you. What are your experiences with regards to out of reward range threshold alerts? What are your expectations around your DAD's alerts? What exceptions, if any, do you have to your expectations? What other thoughts do you have on the topic of alert reward ranges and thresholds?


* Reward thresholds vary among DAD teams.

Prerequisite to Having a DAD

Fellow T1 parent, blogger and Diabetes Alert Dog (DAD) owner, Frank Wisneski of A Guardian Angel for Stella recently published a Facebook post highlighting the importance of understanding diabetes management if you are going to have a DAD. It got me thinking of all the prerequisites a family should have before adding a DAD to its diabetes management tool box. Frank wrote the following:

"Don't believe the hype. All situations are different, but the posts that start off with "our puppy saved our child's life, he alerted and little Johnny was 120 (a perfect #) and had 2 units of insulin on board (IOB) that would have dropped him 160 points and he'd be dead" are at best exaggerating and at worst treating dogs for false alerts. The dog would be alerting CONSTANTLY, at which point is not an alert, you've become a treat dispenser. 

Many questions need to be asked. If a 6 year old has 2 units of IOB, that isn't basal insulin working in the background, that is a bolus that was given by the parent for a reason. High blood sugar, food consumption, etc. that insulin is serving a purpose. Most likely if left alone, the blood sugar would settle and the insulin would be working against the food like it's supposed to. The insulin on board example is not a great way to judge how well a dog alerts. Could the child drop? Of course. And the child could have been blouses and forgotten to eat. There could be delayed exercise burn off. But just saying that 2 units of IOB on board could have killed little Johnny is disingenuous. Why was it there? And how did it get there. If your dog consistently saves your child's life because they have IOB, you don't need a dog, you need a better understanding of diabetes management."

I echo Frank's sentiment and firmly believe a strong understanding of diabetes management is a prerequisite for having a DAD. I believe this because it's my experience that in order to truly benefit from the nose of a DAD you have to be certain you are reinforcing and rewarding only accurate alerts based on the thresholds you set. 

I share the following alert to demonstrate why an alert with insulin on board is not necessarily indicative of imminent danger and how understanding diabetes management allowed me to handle the alert for what it was. and nothing more.   

A few weeks ago, Bo stopped playing a game of tug with Austin to alert to me. Austin checked and he was 140 with insulin on board for the lunch carbs he just ate. This alert is not in Bo's reward threshold, so we told Bo we would watch. Exactly 15 minutes later, Bo alerted to me again. This time Austin's blood sugar dropped to 106. This is a quick drop but 106 is a safe number, so we left it alone knowing there was insulin on board but realizing that insulin was working on the carbs he had eaten for lunch. Bo settled again and didn't show any precursors to an alert. Twelve minutes after his second alert Bo was still settled and showing no signs of smelling a low. I re-checked Austin and his blood sugar was up to 114.   

I share this as an example of how important it is to understand Type 1 management when you have a DAD. The dogs smell fast drops and to a novice it may seem like with insulin on board a crash is imminent when blood sugar is dropping at two or three points a minute. It's important to understand how insulin works on carbs that are consumed. In this case, Bo smelled the fast drop but the lunch carbs countered it. If I would have given Austin 15 g of fast acting sugar, he would have likely ended up going above his target of 120.

So, in the scenario described above, Bo did not get rewarded for his alert. While it's evident he was smelling a fast drop in blood sugar, he did not alert within his reward range. He only gets a reward when he alerts within his reward threshold. Had I not understood how insulin works on carbs or how DADs may alerts on a fast drop or rise in blood sugar, I may have falsely concluded Austin was in immediate danger of going low. Had I come to this conclusion, I would have ended up sending him high by treating him with sugar when it wasn't necessary. 

What other prerequisites do you think a person should have before having a DAD?

Bittersweet

There have been times on this journey when I've questioned Bo's ability to work in public. The time he barked at a woman as she entered the gym where we were training during a basketball practice. The time he reacted to a cardboard box display in the aisle of the hardware store. The time he reacted to a rolling cart in the market. The time he went running and barking at a gum wrapper on the ground. The time he was whining in the hair salon and gave a false alert. I could go on naming moments on our journey when I had to resort to getting out of Dodge and trying again the next day. Those moments caused me angst and I often reached out to our trainer, Helen, seeking advice and support. Helen always reminded me that Bo was an adolescent dog and that he still had a lot of growing up and maturing to do. Give him time to grow up before you write him off as not being able to work in public was the message I would hear from her. 

How could I have ever imagined then that a day would come when he worked in public with such confidence and ease that instead of feeling all joy, I would also feel sadness. The sadness that comes with realizing your sweet pup is growing up and growing older. That day was today and it was bittersweet.

I was at the outlet mall with Bo. I had just dropped Austin off at the movies; he didn't want to keep Bo with him at the theater, so I took Bo with me to make a return. Bo had worked like a pro in the theater lobby as Austin purchased his ticket and waited for his friends to arrive. Upon leaving the theater he navigated the parking lot in a close heel and loaded into the car just as we have trained. 

When we got to the outlet mall one of the first distractions we encountered was a small child running up to us. I used my body to put space between the child and Bo and Bo kept moving without a second look at the child. We then entered the store where I was making my return. Bo waited on cue at the doorway until I gave him the command to walk with me through it. He stayed in a close heel as I walked through the store to the check-out line. As I waited in line, he made the choice to go down. When we were called to the register, he went down between the counter and my feet. He stayed there until I cued him with my body to stand and walk with me. 

We left the store and window shopped. We passed strollers, wheelchairs, a cleaning cart and even a large German Shepard who had his eyes locked on Bo. Despite these distractions Bo walked at my side with a loose leash and remained focused on me the entire time. I stopped and he stopped. I stopped and lingered and he stopped and sat at my side. I sat at a cafe table; he went under it and stayed down at my feet. I sat on a mall bench and he laid under it. We encountered a family with young children exiting a storefront and upon hearing my command to wait he stopped immediately -- allowing me to put space between them and us. (If the children were inclined to approach Bo, the space would provide me time to move away.) 

He worked calmly and with confidence the entire time we were out. When we returned to the movie theater to pick-up Austin, as we were waiting in the car, a woman getting out of her car began looking and talking to Bo through the car window. Bo just sat and looked at her with no angst or excitement -- just a calm observation. 

There is no question our pup is maturing and as exciting as it is to see him do the work we've been training him to do, it's also sad to see him grow up. Like Helen says, "They aren't puppies for long. The nipping and potty training and chewing will pass and they need training and guidance but in the end, you will miss the craziness." 

Video: Bo's First Time Flying

Pre-boarding the plane.

This week  Austin, Helen and I took Bo on his first commercial airline flights. The two flights we took were non stop and nearly four hours in duration. We spent three weeks before our trip training for the experience. We practiced working in an airport, passing through a metal detector and loading up and riding in small spaces. Our overall goal with this highly focused training was to set Bo up for a successful first flight.

Our whirlwind trip began in the early morning hours of May 18.  I awoke at 2 am to shower and get myself ready. At 3 am I woke Bo and exercised him for 50 minutes. We walked/jogged up and down our street and played games of chase (and tug) with our lunge whip. The idea was to exercise him enough to tire him but not make him hot, thirsty or hungry.

Walking to the gate.

At 4 am we departed for the airport and by 5 am we met Helen in the terminal. Our plan was for Austin to handle Bo, for Helen to support Austin and monitor Bo for signs of stress, and for me to carry the bags and document the trip. We each knew our roles and carried them out just as planned.

Bo and Austin worked through the security checkpoint, navigated the busy gate area, and boarded the aircraft with ease and confidence. On the plane Bo settled at our feet and slept for most of the flight. Early in our first flight, he alerted to a low of 82 and then later in the flight he alerted to a low of 78. On the flight home, he alerted to highs of 215 and 255. I was able to capture video of his alert on the 255.


I didn't expect him to alert on the plane because we had not done scent training on one, plus the environmental distractions were new and strong. The fact that he did alert demonstrated his ability to "generalize" or learn to perform a behavior in any given situation or environment. It also demonstrated his willingness to do the job we've trained him to do. 

Asleep during the flight.

I worried a lot about flying with Bo and it turned out none of the scenarios I worried about happened. Sure there were challenges but nothing we couldn't work our way through. For example, there were a few people who tried to pet Bo but Helen intercepted each of them. There were plenty of people who stared at and talked to Bo but Austin was able to re-gain Bo's focus by a simple call of his name. At the very end of our whirlwind trip, as the three of us stood alone waiting for an elevator to the parking garage, Bo got spooked by a man pulling luggage on wheels. The man came around a corner suddenly and Bo reacted with barking but Austin reset him and he recovered quickly. 

Settled at our feet.

While Bo was very visible as we walked through the airport terminal and as we waited at our gate, on the plane he was inconspicuous.  He settled at our feet and slept for the majority of the flight. In fact, he was so quiet and out of sight that he went completely unnoticed by a passenger sitting across from us. She only noticed him when we were getting off the plane. She came up to me and said, "I didn't even know you had a dog with you." I smiled at her knowing we had achieved success.




Waiting to board our flight.

In line to board.

Night Alerts

We are fortunate in that Bo alerts in the middle of the night. We've found our success in allowing Bo to get a couple of hours of sleep in our bed early in the evening, when Austin is still awake, and then placing boy and pup together when Austin goes to bed. At 3:13 am this morning, Bo hopped out of Austin's bed and came to mine to alert. Austin was 84 -- an ideal number to be alerted at for a low. Bo is not perfect by any means but he is one heck of a night alerter and for this I'm incredibly grateful!

Video: Discovering a New Food Puzzle

Today, I headed to Home Goods seeking inspiration for Austin's new bedroom design. I didn't find what I was looking for but I did find two new Busy Buddy treat dispensing toys for Bo -- the Rip 'N Tug Barbell and Octopus. It's a running joke in our family that when I go shopping, I always come home with something for Bo. The fact is, I'm always looking for new toys to keep Bo engaged and new food puzzles to keep him interested in working for his food. (Bo works for all his food.) 

When I got home, I didn't waste any time letting Bo give his new toys a try.  Bo immediately showed interest in the toys when I removed them from the bag. It might have been their bright green and purple color, smell, or fabric texture that captured his interest. Regardless, when I presented the barbell to him, he took it in his mouth and proudly carried it through the house for all of us to see. 

I captured this video of him figuring out how to release the kibble that I hid inside the food pockets located in each of the barbells. You see him work to open the fabric fasteners and release the kibble. He also picks up and drops the toy to try and release the kibble. Seconds after I stopped the video, Bo alerted to me. I was still sitting on the floor with my camera. Austin checked and he was 78. After a short session of live scent training, where Bo was reinforced for offering his low alert chain, we played 'getcha' his favorite game.

The Gem in the Journey

One of the most joyful discoveries on this journey has been the realization that I can help other D-moms who are on a parallel path to raise a DAD for their children. For much of our journey, I have been a recipient of other D-parents' gifts of guidance and encouragement. Recently, I have had the opportunity to share what's worked and what hasn't worked, and what we've learned from others, as well as what we've discovered on our own. Being in a position to share what I've learned on this journey for the simple sake of helping another D-mom has truly been the gem in the journey. 

One of the Most Useful Pieces of Training Advice I've Received

One of the most useful pieces of advice I received on my journey to raise and train Bo was to limit verbal cues to one or two word commands and to avoid adding the word it to the end of commands. The idea being the fewer number of words to discern within a command, the faster the dog will learn, recognize and interpret the command. I received this advice early in our journey and it has influenced how I choose the words for verbal cues. 

The following are the verbal cues we use with Bo and the behaviors they represent:

Take: Used to direct Bo to use his mouth to take an object from any number of places including out of our hands.
Get help: Used by Austin to send Bo to bring a person back to Austin.
Go sniff: Used to prompt Bo to use his nose and smell. 
Spin: Used to prompt a circle motion.
Back: Used to prompt two to three steps backwards.
Sit: Used to prompt Bo to have his tail-end on the ground or floor.
Down: Used to prompt Bo to have his underside on the ground or floor.
Stay: Used to prompt Bo to remain in one place.
Drop: Used to prompt the release of an object from Bo's mouth.
Bring it: Used to prompt bringing a retrieved object to us. (I do use the word it with this command)
Leave: Used to prompt Bo to turn his head away from an object, person or animal.
Wait: Used to prompt a temporary pause in action that's followed by eye contact.
Under: Used to prompt going under a table, bench or other object.
Touch: Used to prompt Bo to hold his nose on our hand.
Load up: Used to prompt the motion of jumping to get onto or into a higher surface. (i.e., into a car or onto a raised scale at the Veterinarian's office.)
Bump: Used to prompt Bo to bump his nose on our body or on an object.
Try again: Used as a non-reward marker to indicate a behavior given is not the desired behavior. (It's important to note 'try again' is not an aversive, it is never followed by a punitive act or reprimand. )
One: Used to prompt voiding urine.
Two: The opposite of one.
Come Bo: Used to call Bo to us. (I strive to reserve the come command as the only one that I couple with Bo's name.) 

Without making a conscious effort to use one or two word commands, it's easy to fall into a habit of adding additional words. For example:

• Take your Kong;
• Bo go get help;
• Spin around;
• Back-up;
• Sit down (the combination of two separate commands);
• Lay down;
• Stay there;
• Drop it;
• Bring it to me;
• Leave it;
• Wait a minute.

What's one of the most useful pieces of advice you've received related to training your dog?

Bo's Two Year Homecoming Anniversary

October 13, 2012

Today marks the two year anniversary of welcoming Bo into our hearts and home. In 24 months, we've made so much progress and come so far in our journey. We have raised a sweet pup who loves to learn and do the job we've trained him to do. Time and time again, he has demonstrated not only his ability to do his job, but also his willingness to choose working over other highly rewarding activities. He alerts around the distraction of other dogs, food-filled Kongs and chew bones and in strange/new places. He alerts at night and has alerted on car rides. He has alerted remotely -- when he is inside the house and Austin is outside.

October 13, 2014

While he primarily alerts to me, he does alert to Austin and other family members in my absence. His alerts are consistent and accurate, with the exceptions of alerts to fast drops or spikes. In those scenarios, he is alerting 15-20 minutes ahead of when the meter reads within his alert reward range. We continue to work to hone his alerts during fast drops or spikes. Being sure to highly reinforce alerts within his threshold ranges with high value reinforcements. (i.e., cheese and chicken, reward games and toys)

Bo alerts with a paw swipe

He has mastered the basic obedience commands (sit, down, stay, stand, come, back, wait) and has good stimulus control with many of them. He has also mastered more complex commands. For example, when Austin gives him the command to 'get help,' he will search out a person to bring to Austin. When given the command to 'find Austin' he will search out Austin. When asked 'what is he?' he will either bow or paw swipe to indicate a low or high.

We continue to teach him new, more complex behaviors to keep him stimulated and engaged in learning. He is currently learning how to retrieve a juice box on command and is learning to lie on his side on command.

He is vaccinated against resource guarding and aversions to basic grooming tasks including teeth brushing, nail clipping, ear cleaning and body bathing and combing.

At this point in our journey, a major focus is training a reliable leave while in public. While he has a reliable response to the leave command in our home, he doesn't in public. He has an especially difficult time leaving the scent of dog urine. We also continue to work on his focus when working in public. As his primary handlers, I am committed to building my confidence level when it comes to working him in public. I'm also trying to talk to him less while I'm handling in public. My goal is for him to learn to respond to my movements rather than relying on my verbal commands for direction.

It's been a tremendous amount of work to get to where we are today. I owe so much of our success with Bo to the many people (some I've never met in person) who have guided me, advised me, taught me, supported me and most importantly believed in me. None of this would have been possible without each of you. 

Video: Training Juice Box Retrieval

I've been working with Bo to train him how to pick-up a juice box from a shelf and bring it to me on command. I started a few weeks ago. Yesterday when I was working with him, I took this video.

Ideally, he would release the juice box in my hand. We still have more work to do -- adding distance, getting the proper location for the release but overall he understands what I'm asking him to do.

Alerts on Ellen

This is Ellen. Ellen lives with Type 1 Diabetes and Bo works for her when she is at Syl's house.  Yesterday morning Bo alerted Ellen to a low of 76 when she walked into Syl's house. This afternoon he alerted her to a low of 78. One day we hope Bo and Austin will go to school together but in the meantime, he gets to do his job during the day by working for Ellen when she visits Syl.

Video: Bo Waiting for His Food Bin to Be Refilled

In this video, I'm in the garage refilling Bo's food bin and I've given Bo the commands to sit and stay. I take my time filling each bin in front of him. When I'm done, I reward him with pieces of kibble in fast succession. You see him air scent and tongue flick but he doesn't break his stay. Even when I go to him to reward him, he holds his sit stay. He moves out of his sit stay when I place the kibble on the ground in front of him.

Video: Brushing Bo's Teeth

I brush Bo's teeth as part of our nightly routine. I bring him into the kitchen and let him watch me prepare his toothbrush with toothpaste. I then squat down to his level, ask him to come and gently hold onto his collar before putting the toothbrush in his mouth. He likes the taste of the toothpaste but he doesn't get excited about the actual teeth brushing. I'd say he tolerates it. What's your assessment?

Video: Demonstrating the Command 'Close'

The close command is one I learned from one of my Guiding Eye for the Blind (GEB) puppy raiser friends. It's a command to prompt your dog to sit between your legs when you are either standing or sitting. It took a lot of patience and practice to teach Bo this command. I wish I would have taken video when I started teaching it, so I could show the progression of Bo's learning. Instead, I just have this video of the end product.

Video: Bo Working in Staples

These videos were taken a couple of weeks ago when I was training Bo at our local Staples office supply store. I'm using a hands-free leash and I'm rewarding Bo for eye contact.

The Lowest A1c Since Before Type 1 Diagnosis

Today we are grateful because Austin's A1c dropped from 7.9 in March to 7.2 today. This is the lowest average 90 day blood sugar we have seen in the eight years he has lived with Type 1. (The closest we've gotten to this number is 7.3 in 2011.) It's especially exciting because when his average 90 day blood sugar is segmented into 'within', 'above' and 'below' BG goal, the below goal represents 0%. A low A1c can be achieved by a lot of low blood sugars but as you can imagine that's not optimal. The goal is to achieve an A1c of 7.5 or lower by maintaining one's blood sugar in your target/goal range. Austin's goal range is between 80 and 140 mg/dl.

We attribute Austin's A1c today in part to Bo. Over the past six months, Bo's alerts have become more consistent and reliable. Additionally, he continues to demonstrate his willingness to work for us. He is not perfect but he is showing excellent and marked progress. We will continue to work to tighten Austin's blood sugar control with the goal of ensuring his long term health and well being. There is no question Bo will help us achieve tighter control sooner, rather than later.

Austin and Bo First Day of 7th Grade

Today I Turned Two

I walked in the meadow.

I ate grass.

I played fetch in the field.

I posed for pictures.

I found my family's brick in the school yard.

I practiced 'leave.'

I went exploring.

I found a tennis ball.

I rested in the sculpture garden.

I got brushed.

I brought Syl presents for my birthday.

I got a birthday gift from Syl and Gil.

I played football.

I got rubs from Syl.

I hung out with my boy.

I got a cupcake treat from my Mama.

I got a new toy.

Our two year old pup. August 23, 2014.