Jeepers, Creepers, Where'd You Get Those Sneakers?

As if a service dog doesn't generate enough attention, Murphy has recently begun sporting dog boots. Common among service dogs but not dogs in general, I'm often asked about them.

Why? Have you tried walking across asphalt in July in Kentucky? I dare you to do it barefoot! It can cause blisters on dog pads.

Where? Ruffwear.com sells them as a set of four. Caution: Make sure the back feet are the same size as the front - they aren't always and you can buy them in pairs if necessary. If you are training a service dog, you can sign up for their pro account.

How? Don't get all excited when your box arrives, pop them on, and expect to go on a long walk. We trained a few weeks with rewards for just touching them with her paw and not chewing them. Then, we clicked and rewarded for putting one on with no walking. Then, she stood up on two and I threw treats continuously to make her forget them. By the time we put on all four, she didn't mind but her walk reminded me of the Ministry of Silly Walks.

"I can tell she doesn't like them!" said a judgmental bystander, arms crossed. Well, neither do horses like saddles right away. Again, take off your shoes and walk out to your car, THEN you can comment.

She now walks pretty well with them and only occasionally will, if bored, decide to chew on one. And, she does look rather cute.

Water Training

"She's in training?" the pool manager and lifeguard asked, looking down at Murphy. Murphy sported her "In Training" red vest. I casually knew this woman for some years from our Church and from the YMCA pool, and she was a reasonable person. Still, this was a private pool I knew that legally they could deny me permission to bring Murphy to sit by the pool while William swims. (A DAD is particularly useful in a water situation where the CGM (continuous glucose monitor) won't work as Bluetooth signals don't work in water. 

I affirmed she was in training. "You're doing water training?" she asked. Oh, no, I know she's not allowed in the water. Then, the woman told me that indeed Murph was allowed in this pool and that she would help us train her. If William should need her while he was in the pool, she needed to be comfortable entering the water. Murphy loves, loves water, ponds, lakes, gradual entry, but not swimming pools. So, we began showing Murphy the steps and seeing if she would just jump in. Murphy is cautious, but really wanted the tennis balls we threw in. 

Ultimately, we got her relaxed by playing in the kiddie pool which was unoccupied. 

This whole day was such a gift. In general, dogs are not allowed in public or private pools, though it varies by local ordinances. This pool manager not only allowed it, but offered to continue to help us train her for water access at an indoor facility in the off-season. The people around the pool, watching what was going on, clapped for Murphy when she finally jumped in on her own. It also was an opportunity for William to see the joy in training her himself.

Murphy's presence brings so much openness. I talk to so many people that I might otherwise throw a smile but keep walking instead of stopping, hearing their story, and answering their questions about T1D.

First Time for Everything

Enjoying a trip on the fishing boat with the boy.

First time on a boat (and yes, we are getting a flotation vest;

she outgrew the one I bought before it was ever used.)

First time on an escalator.
Shopping for the boy.

Bath Time

Scary Pig

Our local farm store had odd ceramic pig planters. Murphy was sure they were real hogs. Shopping often provides us with training opportunities.

Believe First

Murphy brought William a pillowcase she found in the laundry and sat in front of him. William told me that she was behaving a bit strangely. She brought the same pillowcase to me. Dexcom CGM said he was 107 flat, a nice, steady flat blood glucose. Was this an alert? 

I told William to test, just in case. He was 78 actual finger stick. Within the half hour, the CGM read 48 mg/dL, although William contends he was not that low based on symptoms. He had, however, already treated with carbs because of Murphy's alert. Likely, he would have been 48 had he not had the jump on it. 

At this stage, it is sometimes hard to believe or be sure she is alerting. The alerts are not consistent or clear. I think what we've come to realize is that William is often lower - in the 70s or 80s - and this doesn't concern Murphy. She is used to it. She does, however, clearly pick up on highs and rapid decreases. 

We have to believe first, followed up by a reality check. She just alerted again today - he was 77 and dropping, not flat. Good girl!

Even the Best Service Dogs Start Out as Puppies

Blame the cat?

Caught red-handed

People Watching at StuffMart

High Alert

One day, K and I went up to walk around the local antique mall just to browse and brought Murphy along for an outing and training. We had no specific goal in mind other than walking around and looking. I found a cool lamp for $3 and K found a vise grip because you can never have enough vise grips. While he checked out, two women made over Murphy who is growing out of her fear-of-strangers phase.

Another woman and her husband were in line behind K. The very large woman was in a wheel chair. She asked to see Murphy, and so we walked over to her, a good experience for Murphy who'd not yet seen a person in a wheelchair. Well, the chair itself held no interest for her but she began sniffing at the woman and was getting harder to control. The woman's legs were swollen to the point of tight, something I'd seen in my dad with COPD and Type 2 Diabetes. Not yet paired with an alert for a high, I still could tell that Murphy was detecting this in this woman. The woman seems a bit surprised at Murphy's interest in her. Finished with our purchase, I was glad to leave before Murphy did an all out freak out "you're high and smell!".

Aroma

The farrier came today. There is probably nothing nastier than the smell of clipped horse hooves. My dogs, however, relish these as if they were the finest escargot in a Parisian restaurant on the Seine. Murphy got her first taste of them this morning. Equally tasty, I found dried cod twists at Tractor Supply. They were on clearance but not expired. I'm thinking they didn't sell because they smell strongly of fish. Not exactly a great smell in the house. But then, a happy dog is a happy dog.  

Crawl

Learning "crawl" at Planet Fitness while William works out

When The Dog's Opinion Carries More Weight

Murphy came up over the seat to bite at William sitting in the front passenger seat. She was insistent even after he loudly said, "NO!". Quickly, I told him that he could not react that way. He turned and changed his tone, thanking her and saying he was going to fix it. She didn't settle down until he pulled out his meter and tested. He was 48 mg/dL. Granted, her technique needs a little fine tuning but her message was received: "You, Boy, are low!"

The fitness bug has bitten my teenager and he has increased his working out routine while lowering his carbohydrate intake. Good for him, you might say! Each small change has the potential to completely change daily management of this beast of a disease. Basal programs written for a boy that likes pizza and video games don't work for a boy with a daily 1.5 to 2 hour work out and much fewer carbs. I've had little sleep this week and lots of lows.

Dexcom? Oh, yes, the Dexcom was working. Doing training with Murphy in the lobby of the gym, I texted boy when I saw he was dropping like a rock. "I'm fine." Repeating the message got me no where. While dropping from his high of 270 due to a ran-out-of-insulin pod change is a good thing, you have to stop it around 150 for this boy and in our experience. Turning off basal isn't enough. It seems cell phone vibrations from frantic text messages from your mom can't be felt while lifting weights. 

So back in the car, the dog got across the message that mom was unable to. She is a puppy that sometimes wreaks havoc. She annoys the cats and my old dog. She tore up my one year old bonsai tree project. She saved my boy. 

Almost a Dog

This world, I think, is very much in need of more puppies. People, when we are out, still recognize the puppy in Murphy, even if at thirty-eight pounds, she is starting to look more like a dog. They take a step, hesitate with a silly grin. I can tell, they want so much to pet her. The red service vest stops them. When I tell them she is "in training" and touching her would actually help us in training, I can only say it is a relief that seems to wash over them and they come forward. When you have a puppy with you, there are no strangers.

The ownership of a dog connects us, and I hear about their favorite dogs. They start slowly asking questions. And it is then that I realize that even if Murphy never alerts consistently, she has already performed a service to the diabetic community. Her presence gives me a platform to discuss Type 1 Diabetes and how a dog like Murphy can help. I spend many hours (usually waiting for William as he works out at the gym) educating people about T1D. She is an ambassador in her own right.

Layers

It was near the end of his endocrinologist visit when Murphy stirred, asleep under my chair. The doctor frowned and said, "Oh, there's a dog under there!" This is probably the best compliment  a (Diabetic Alert Dog) DAD trainer could receive. He then began telling us that in his (unsolicited) opinion, a DAD was unnecessary with continuous glucose monitoring (CGM) technology.

Murphy dozing on bleachers at

William's basketball game

This dog, I explained, was being trained in time to be at her peak when William will go of to college. In addition, I was hoping that she will help him learn to awake at night when low. Well, the doctor continued, we could not rely upon the dog! The dog may not wake up!

This I know. I also know that William regularly sleeps through Dexcom CGM alarms, pod alarms, and fire alarms. Perhaps this will improve with age, but a persistent dog may be able to wake him when away at college. The doctor continued, "Well, can't you just call him on the phone if he is low?" Well, yes, but if he can't hear the CGM alarm what would be different enough to hear a phone ringtone?

I stopped him from all the "put a receiver in a metal bowl with pennies" advice because I've heard it. And, I get it - he doesn't see the need for the dog. He also, three years ago, saw little use for a CGM and detested Omnipod (insulin pumps). Now, he's advising that we rely on it, and only it. For us, it's all about layers of security. I totally get that this dog is not a guarantee. Life doesn't come with guarantees.

BOOM!

The storms were just letting up when I took Murphy out to "do her business" this morning. It was lightly raining and I could hear thunder in the distance. After going #1, it is her routine to find the perfect spot for #2 but she pulled me towards the door. I was surprised because she knows the routine and hasn't before shown an aversion to a bit of rain.

Reluctantly, knowing I'd have to take her again, I shut the door after taking her inside. The moment the door shut, lightning hit somewhere in my front yard. KA-BOOM!!  I could see various colors through the door window, but being shorter than the window, not where it hit. So now, she is also a "you are about to get struck by lightning" alert dog.

The power had been out when I woke up. Despite a feeble attempt by William to say he could not now do his (Internet-based) homework, he and I headed with Murphy to the library. Well, first, we needed to eat, so despite the "ick" factor for me, we headed to William's choice of restaurant, Aw-ful House. Let's just say that under the table at Aw-ful House is not the best place for a SDiT (service dog in training) due to the difficulty in ignoring the bounty of droppings. Still, she did okay.

The library was the perfect spot to relax. She was socialized some, soothing a crying toddler who wanted very badly to go to McDonald's for an ice cream and to play instead of sit by her studying mama. Murphy mostly slept a great deal of the time, and I got to read my Smithsonian magazine and find out what happened to all those people years ago on Greenland! (Fascinating - you should read it here.)

Tuck

One of the things Murphy needs to learn is to "tuck". She must learn to lie down in a small, out of the way place. Yesterday at Church and three string cheese sticks later, she finally tucked and fell asleep under the pew just as all the kneeling, sitting, kneeling, standing began for which Catholics are famous.

Then, it was time for Communion. My husband asked what we were going to do about the people who would need to get past her to go to Communion? Before noticing this, he was going to stay with her while I went up. Now, I was going to have to get her up and out of the pew. And then, they left! I looked and they were gone. I know them casually, and remembered that their custom was to leave early. Problem solved for now.

There are loads of little things that don't occur to you with a dog in public until you are there. We normally sit in a location that is more visible to the congregation, but also away from other people. Honestly, we usually do this to avoid shaking hands with people that are coughing and sneezing into those hands right before shaking ours, but the spot was so visible if Murphy wasn't on her best behavior. (Did you know that churches are one of the few places that can refuse to let you bring in a service dog? Hence, the desire to be under the radar and very well behaved.) I guess it is back to the more visible, but out of the way, place to sit.

You Stink

One of the most interesting things I got out of the "Dog Emotion and Cognition" taught by Duke University on Coursera is that dogs are time travelers. Perhaps it is not the traditional way we think of time travel, but a dog, whose sense of smell is on the order of tens of thousands of times better than humans, can tell time from smell. 

From a simple smell, they can tell who has been here in the past. Often, they leave their own calling card for others to find. My mom always called it "pee-mail". They can tell something about where you've been and who you've been with. It seems common knowledge, as I often hear, "She can smell my dogs (or cats or horses)." They can "visit" what has already happened.

When I was little, my dog, "Banjo" would sit at the end of the driveway waiting for the bus to come just minutes before it did. In this course, they discussed that dogs can also tell time because evening smells differently from morning. They know the future as well as the smell of a thing arrives before the thing itself. 

And of course, they can smell what is going on all around them. Enter the Diabetic Alert Dog (DAD). The most frequent question I am asked is how a dog is trained to detect low scent or high scent of a person with diabetes. The quick answer is you don't. Dogs can detect some odors in parts per trillion. It is thought that DADs can detect the chemical isoprene in hypoglycemic people (low blood glucose) and perhaps ketones in hyperglycemic diabetics. They smell it without our need to train them to. The goal is to teach the dog that this particular smell is one you are interested in and to teach the dog to tell you when they smell it.

So, DAD training is really about teaching communication from the dog to you that they detect a low or high smell. Murphy is being trained to alert behaviors which is rewarded. Those alert behaviors are being tied to low scent samples we made. Dental cotton rolls are chewed on by William when he is low and frozen for use with training Murphy that this is the smell we want her to detect. Why focus on the "low"? High is easier for dogs and I'm told it will come naturally; we need only to teach a better alert than eating William's computer cord and emptying the trash can in agitation. (I am told a dog does not like the high smell and they think it "stinks", surprising given my dogs would eat deer poop and opossum carcasses if I let them.)

So, in a nutshell, the dog, already smelling these low and high smells from any body fluid (blood, saliva, sweat) is taught to communicate that it detects that smell and communicates it in some trained alert to a human. The dog must sometimes be persistent and perhaps exhibit "civil disobedience" if the human ignores the alert. Probably all dogs, (although our old brachiocephalic dog, Paris, is probably an exception) can detect these smells. Then, it comes down to whether the dog has the drive and temperament to be a service dog.

Hopeful

Happy birthday to my big boy-man! Time goes by so very quickly and now he towers over me and hugs envelop me. My little boy is gone and replaced by a teen. I miss that little boy but look forward to seeing his future unfold. 

This morning after breakfast. Murphy nudged me hard in the thigh. This is not something she does to ask for treats or anything else. William said he felt fine and a finger stick said his BG was 110 and Dex said he was steady. I reminded him that the dog will likely be 15 minutes ahead of finger sticks and Dex if he is dropping. 

William and Murphy retreated to their bedroom to work on homework. Ten minutes later, William was back. "I'm dropping." Dex still held steady. Finger stick was 117 mg/dL. William decided to trust Murphy and drank some juice. He had himself felt he was dropping after paying attention because of the alert.

Two hours later, he's 124 flat. Two hours postprandial is usually when he will be the highest because of the meal. This means that he will go down from this 124 and could have been low if he had not taken the juice. 

The dog outperformed the Dex this time. It's not that we wouldn't have caught the low or drop eventually, but if she tells us he is dropping, we can treat it before it becomes a low. That's pretty awesome.

Note: Dex here refers to the Dexom G5 continuous glucose monitor, which is also pretty awesome but not nearly as cute and loving as Murphy

Peek-a-boo

Yesterday evening, we went to a youth group outing at an entertainment center. It was quite a sensory overload for a young pup, but she did well the first hour. Lights, noises, tons of people, bowling alley, you name it. She did very well, but I took her to the car with me to wait after the hour was up. It was a lot to ask of her to stay any longer. Her cue was that she barked, which she has never done before in public.

While there, however, I encountered an interesting dilemma. I had to go to the bathroom and William was bowling. I'll take the dog with me, I thought to myself, and use the family restroom. Of course, that was "occupied". Heading into the ladies' room, my next stroke of brilliance is that I would use a handicapped stall which has more room. What I didn't anticipate is that Murphy would try to look under the stall to the next stall to to visit with the person next door! Next time, I think I'll wait for the family bathroom until she is more fully trained.

Alerts: Last night, William had a pod (pump) change right before bed. They sometimes cause BGs to rise if the pump site was going bad (not delivering insulin well). He added a bucket of insulin and went to sleep. I stayed up, making sure not too much. When I went in to check, Murphs practically cried! "Finally," she whined. She was alerting to the high, but because the door was shut, could not come get me. (This is to keep her from wandering in the night.) I showed her that I was fixing it, gave her a taste of peanut butter, and she went back to sleep. Note that normally, she sleeps through the night and only lifts her head when I come in to check him. Good alert, Murphy!

First Alert

At first, we though Murphy's agitation was due to the intense skunk smell coming into the car on our way to William's basketball game. Because we had a full car, she was sitting in the wheel well at my feet. (We are working on getting her a harness seatbelt.) She, however, climbed on my lap, up on my shoulder, and was desperately trying to get into the backseat with William. 

The Dexcom CGM showed he was 159 and climbing, but I asked him to test. He was 189 and climbing. She would not settle. I assured her that we were working on it, had William thank her, and she watched him use the PDM to bolus insulin. I gave her treats and finally, she started settling down, though clearly still agitated.

"How do you train them to do that?" is probably the most common question I get while in public after told that Murphy is to be a Diabetic Alert Dog. My answer is that these dogs can detect these changes without training. The key is training them to communicate (alert) what they already know and to train ourselves to pick up their alert. It is easy to doubt ourselves that we are experiencing her alert. Even in this case, we wondered if the skunk smell, unfortunately simultaneously encountered with a rising BG, was the cause of her distress. It certainly distressed me.

The high alert, I'm told, is easier for dogs to detect. Likely, they smell ketones in the breath. For lows, the chemical isoprene is likely what the dog detects. This first alert is encouraging. Maybe we'll figure all this out after all.

While at the game, we got two of the best compliments you can get for a service dog. The first was that a woman finally noticed Murphy, exclaiming, "Oh, there is a dog here! I hadn't even noticed her." (She was sleeping in the bleachers.) Later, she turned to me (as Murphy continued to behave) and said, "That is not a normal puppy." 

Weight this week: 28.5 pounds at 15 weeks

Socialization

Murphy was so wildly popular at the YMCA yesterday, there ought to be a business where puppies are taken out into public to socialize people. People I never would have spoken to or who wouldn't have spoken to me sat with me in the lobby, asked about Murphy's intended service dog purpose, were educated about Type 1 Diabetes or told me their own stories, talked about dogs they have/had, and so on. The staff there are very welcoming and it is a good place to train.

She was cuddled and petted by dozens of people, including the entire 10 year old girls swim team, leaving her rather soggy. Other highlights of the week were meeting her doggy cousin, from whom she commandeered this ball left behind, going to two classes with William, and Tae Kwon Do.

Noisy environments like the pool at the YMCA and a do-jang are both challenging for her. She shook when we first got to Tae Kwon Do just because of a new place with new people. When they started kiap shouting and kicking each other, she became very concerned.

Soon, however, she accepted the input and watched her boy.

Murphy learning Spanish:

This stage of her life is critical for experiencing new situations and socialization. It is hard, hard work and one comes to realize why diabetic alert dogs cost $20,000.

One staff member asked what treats I was giving Murphy and I told her about our "work to eat program" whereby Murphy gets no food free in her bowl. All food must be earned. "I should have done that with my son," she replied.

Three's a Crowd

A diabetic alert dog was on my radar right away, back in 2013. There were many reasons to table the idea for awhile. We already had so much on our plates: the learning curve for T1D is steep. We already had two aged dogs, both just over 10 years old and complicating the social scene. Perhaps in several years, they would have lived their natural lives, making bringing a puppy into our home easier. And lastly, timing for William. He needed to be old enough to participate, but more importantly, the dog's age needed to be such that it would still (God willing) be young enough to be a DAD as William goes off to college.

For over a year, I studied the type of dog, the type of training, researched kennels and breeds, and yet, our two old dogs were the energizer bunnies. Now over thirteen years old, neither shows any sign of slowing down. Paris, the Japanese Chin on the right, she is blind, deaf, and stupid (no, really) and Daisy, she patrols our perimeters daily, cornering opossums in the barn and other intruders. Her eyes remain clear.

Perhaps, I unwisely reasoned, Daisy would teach the puppy manners. Murphy quickly checked (still does) Daisy's "equipment" for nursing possibilities. Daisy doesn't take too kindly to such familiarity. Paris is a squeak toy that never quits. She provided the opportunity to teach that we don't jump on the backs of geriatric dogs. All gather at my feet when it is training time, eager for treats.

Daisy was trained to alert for a low smell in a bottle (she doesn't give a rat's ass about William being low), but uses her paw. Murphy, ever observant, tried this alert, too. We are going to use a nose nudge, so I am now training her separately from Daisy on alerts. All in all, it would be better if we had only one dog for training and I highly recommend it. We've gotten around some of the difficulties with a routine that works. I'll write more on that tomorrow.

Update: Murphy now weighs 18 pounds and likes three cups of kibble a day (also used as treats)

In Training

Murphy got her "In Training" vest yesterday. We added another location to visit, the Friends & Fiber shop. The women there asked us to please stop by if we are in town.

Having a "baby" again is certainly challenging to this old woman who isn't sleeping well as it is. Although the "baby" will sleep from 11 p.m. to 6 a.m., if I get up to check William, she wakes up and often "says" that I might as well take her potty since I'm up. At 10 degrees F and in my bathrobe....The good news is that she is supposed to wake up if I check him, particularly if he is high or low BG.

She doesn't like the cold either and quickly relieved herself on our covered porch before I could get her down the stairs. I can't say as I blame her.

Feeding

While Murphy is waiting for her vaccine immunity to be complete, we are working at home on obedience, potty training and scent training. I've read a pile of books on general obedience, puppy rearing, and service/alert dog training. Actively, I am using the Dog's Way Podcast and Diabetic Alert Dog University for training at home.  Both seems to fit my own ideas and natural style. I'm sure I'll gather from other sources as well.

In her videos on the Diabetic Alert Dog University, Mary talks about dividing the dog's food for training purposes:

• One fourth for morning working breakfast (has to get it out of a toy)
• One fourth for scent training from nesting bowls containing low scent
• One fourth for general training from my or William's hand
• One fourth for evening working breakfast (has to get it out of toy)

Typical Lab, she inhales her food if given in a bowl. My husband calls it "hoovering" as in vacuums.

This bowl slows down her eating and makes her think. I ordered some of the suggested eating toys online, but improvised a few homemade ones while we wait for delivery.

This is just a tube from inside an empty aluminum foil package (they are stronger) sealed on both ends with paper and duct tape, with a hole cut on one end. I put kibble and one piece of smelly lunch meat inside. Keeps her very busy!

Personal All Time Low

Murphy at 9 weeks

William hit a number I'd hoped never to see last night: 38 mg/dL. You might wonder, "How in the world...? Don't you have that fancy CGM thing?" We do. It did work. It alerted that William was 70 mg/dL. I tested and he was and with two units on board. Two units, if in range, can drop him as much as 60 points. I suspended his pump and gave him juice, set my alarm to 20 minutes for a recheck and settled in to watch an episode of "Lost" on Netflix in the middle of the night to keep me awake.

I watched the CGM continuously. It dropped a bit to 59, waiting for that juice to kick in. It never went below 59, but when twenty minutes were up, a retest shocked me. 38! William had been too high earlier in the evening and perhaps had gotten a bit aggressive with lowering his BG. Sometimes being high and fighting it with insulin is followed by a low.

While we were treating, Murphy woke up and excitedly was licking his face. William tried to hold her at arms length but she would not quit. An alert? I took it as one and gave her lots of high pitched praise and a spoonful of peanut butter. Out to potty, and then she went back to his bed to sleep. I am hoping this is the beginning. 

The thing is this: the CGM is very good at reading what IS. If I'm awake, I can look at a graph and predict the trend. I don't do so well at predication while asleep.  An alerting dog can actually detect up to 15 minutes before a CGM. Here's to Murphy and her future.

Happy New Year!

Murphy at 9 weeks and 14.5 pounds