Oh. That's Why I'm So Tired. Duh.

I saw my rheumatologist Friday and she increased my gabapentin to 300 mg twice a day.  I'd been on 200 mg twice a day.  We discussed it and decided to increase it because I think the pain is going to get worse with the cold weather.  Actually, it has already started getting worse.  It's still quite tolerable, quite manageable, but I remember how horrible and nearly unbearable it was last winter.  So, hoping to head that off, we decided to try increasing the gabapentin.

I think I forgot to mention the med increase when I posted about the visit because I was too busy talking about how I dealt with the issue of her being scared of my service dog.

And today, I was struggling with this overwhelming fatigue and thinking it was just part of the fibromyalgia, which, you know, it is a symptom of that, but then suddenly as I was lying on the couch, too tired to sit up, it occurred to me.  Maybe fatigue is a side effect of gabapentin.  I couldn't remember if it was or not, though, and I was too tired to sit up and reach for my laptop and Google it.  A couple hours later, after Isaac convinced me to get up and take him out to pee, I did look it up and sure enough, it's a very common side effect. 

Did it make me this tired when I first started taking it?  Or when she increased it from 100 mg to 200 mg?  I can't remember.

She prescribed the higher dose Friday but I didn't actually start taking it until last night, after I picked it up at the pharmacy and put the new pills in my medi-set.  So I guess that explains why I am so exhausted.  And hopefully in a couple days I will adjust to the increase and this fatigue will pass.

Does Medicaid Pay for a Service Dog?

Someone recently found my blog searching for "Does Ohio Medicaid Pay for a Service Dog?"  It doesn't.  Neither does Medicaid in any other state.  Neither does Medicare.  I don't think the VA does, but they might under certain limited circumstances.  No regular insurance companies do, not Blue Cross Blue Shield, not Anthem, not Cigna, not Aetna, etc.

Currently, if you want a service dog, you have to pay for it yourself.  You can ask for donations.  I got help from some local churches to pay for my service dog.  But insurance won't cover it, and Medicare won't cover it, and Medicaid won't cover it.  I think they should, or should at least help with the cost, but they don't at this time.

Fatigue Is Not a Character Flaw

Said a good friend to me a while back.  And I keep reminding myself of that on days like today, when I am exhausted and all I want to do is sleep.

I actually went to bed relatively early last night.  And slept OK, I think.  I had some weird dream and being in a house that was flooding.  It wasn't a scary dream, though.  It was like, oh, there are a few feet of water in the house.  Oh well.  Which was weird, for sure.  But no nightmares or anything like that.

I forget what time Isaac woke me up.  I think it was around 7:00 am.  I took him out, fed him and went right back to sleep.  And slept, or dozed, until about 11:00 am.  And I only got up then because the maintenance guy showed up to fix my shower.

I took Isaac for a walk.  A slight shorter walk than usual, because I felt so tired.  My limbs felt heavy.  We came back home and he needed a bath because he'd had a swim in the pond on our walk.  So I gave him a bath.

Now I'm back on the couch.  I wish I had more energy.  It's hard not to be frustrated, hard not to be upset with myself.  It's a beautiful day outside and I'd love to have the energy to be out there.  There are so many things that need done around the house and I'd love to have the energy to do them.

And I don't.  I'm tired.

Saw the Rheumatologist Today

Remember last time I saw her, when she was afraid of Isaac?

I was thinking of taking a portable crate and crating him during the appointment, but decided that was too much trouble.  Plus the portable crate is really flimsy and I have better control over him when he is not crated.  Plus how is he supposed to perform tasks from inside a crate?  So I decided against the portable crate.

What I did was pull the chair beside the doctor's desk forward so that Isaac could go behind the chair.  I had him between the chair and the wall, with the desk blocking him in on the third side.  I put him in a down stay and had him stay there.

He was really good, too.  He didn't even start to get up when the doctor came into the room.

She seemed comfortable.  She didn't say anything about the dog.  Didn't act nervous.  Since she didn't bring it up, I didn't either.

Headwaters Outdoor Education Center

This is currently our favorite nearby park.  We probably like East Harbor State Park more, but it's 90 minutes away.  Headwaters is great, though, because it has miles of trails, reasonably flat and easy to hike, and because we are almost always the only ones there.  That means Isaac can run off leash without bothering anyone.

And it's beautiful.  Look at this place.

Isaac enjoyed a quick dip in the pond today.

And much to my delight, though probably not his, he did not manage to roll in any poop.  Even so, it was a great day.

Hiking the Kokosing Gap Trail

Well, part of the Kokosing Gap Trail.  About three miles altogether.  The whole trail is about 14 miles long and that's far more than I'm up for hiking.

It was a beautiful morning and Isaac and I had a lovely time.

He also got to take a quick dip in the Kokosing River to cool off and get a drink of water.  He does love river water!

You know, Isaac and I have been doing a lot of hiking this summer.  Or maybe walking is a more accurate word.  Mostly on fairly flat, easy trails.  I like walking in the woods, on the rugged, hilly trails, but those are harder for me.  A small stumble can send my back into horrific muscle spasms that sometimes last for hours and hours.  But on flat, easy trails, I can walk a long way.  Three or four miles is easy for me.  I have stamina.  I have some strength.  It feels good.

I hope Isaac and I can keep hiking some this winter.  My fibro is getting worse as the weather is getting colder, I can already feel it happening.  But I'm hoping if I dress warmly, we can still do some hikes even when it's cold.  Maybe shorter hikes, if I'm in a lot of pain.  But I hope I don't have to stop hiking for the winter.  I think the exercise has been good for me, both physically and psychologically.  And of course, Isaac loves it.

Plastic Poop Bag Holder

OK, you don't have to use it for plastic poop bags.  It can be for plastic bags of any type, whatever you use them for.

Here's mine, hanging on the wall next to my front door.  So it's easy to grab a poop bag when I'm on the way out the door with my dog.

It works for holding mail, too.  In fact, that's originally what it was supposed to be.

You can get one here if you're interested.

Happy Mabon! And Giving Thanks.

Today is Mabon.  It's the first day of fall and a pagan holiday, sometimes referred to as the pagan Thanksgiving.  It's about being thankful for the harvest and for all our blessings.

I had this plan for a small feast I was gonna prepare for myself and then I was going to light some candles and chant and make a long list of all the things for which I am thankful.  But the day didn't quite go as planned due to my terrible, horrible, no good, very bad day yesterday.

But I am still thankful.  So here's a somewhat abbreviated list.

1.  I am thankful for this day.

Is this not the most gorgeous day ever?  Perfect for a long walk with Isaac at our favorite local park.  How could anyone see this beautiful blue sky and not feel thankful?

2.  I am thankful for Isaac.

3.  I'm thankful that, despite a difficult day yesterday, I was able to go for a long walk with Isaac today and do my tutoring and finish two articles I needed to get done.  I'm thankful I knew how to take care of myself and how to move on with what I needed to do.

4.  I'm thankful for my tutoring job.  It's a lot of fun.

5.  I'm thankful for my friends.   All of them.

6.  I'm thankful for all the time I had with Cayenne and I'm thankful that her passing was peaceful.

7.  I'm thankful for my home.

8.  I'm thankful for my car.

9.  I'm thankful for my health, such as it is.  It could be better, sure.  But it could also be worse.  I'm thankful that it's not.

10.  I'm thankful that my dental problems are much, much better.  My gums are still a bit sore but it's so much better than it was, and I didn't have to lose any teeth, either!

11.  I'm thankful for the new printer a good friend got for me recently.

12.  I'm thankful for the new winter coat I recently found at my favorite thrift store.

13.  I'm thankful that Isaac and I have been able to volunteer at the nursing home.  It's fun and it's meaningful and it's work that is real.

14.  I'm thankful for all the food I have stored up in my kitchen for winter, including a few dozen jars of sweet corn and applesauce that I canned myself.

15.  I'm thankful for my electric blanket, which I need to drag out again now that the nights are getting colder.

16.  I'm thankful for the trip I get to take in a couple weeks to visit several friends in a city a few hours drive from where I live, some of whom I haven't seen in many years.

17.  I'm thankful my rent went down recently.

18.  I'm thankful for my bathtub and long hot baths on chilly mornings when my body is stiff and sore.

What are you thankful for?

Eucalyptus Rosemary Bath Salts

Eucalyptus rosemary bath salts are my favorite way of dealing with stiff, achy muscles and joints during cold weather.  I make them myself and offer them for sale on  Etsy, if anyone is interested in trying them.  I have other aromatherapy bath salts as well, but these are the best for those cold mornings when I wake up stiff and sore.

The Terrible, Horrible, No Good, Very Bad Day

That was my day yesterday.

Now, I have to say, I've had worse days in the past.  If this was as bad as it ever got, well, I'd be doing OK.

But it was still a bad day.  The worst I've had in a while.

It started at 6:00 am, when Isaac woke me, wanting to go out to pee.

It had turned cold overnight and my fibro had kicked up a few notches.  It was not the most fibro pain I'd ever felt, not even close.  But it was more than I've felt in quite a while.  If the worst ever is a 10, and last winter I was frequently at an 8 or 9, well, yesterday was maybe a 6.  But for most of the summer, it's been maybe a 2 at most.  So it was a bit of a shock.

The bottom of my left foot hurt, a lot.  How weird is that?  Other places hurt, too, but especially the bottom of my left foot.  Fibro is like that.  Hurts in weird places.

Isaac and I were supposed to go to the nursing home and then this guy I've been seeing for a little while was supposed to come over.  I thought about cancelling everything.  Staying home instead.  But I wanted to go to the nursing home and I wanted the guy to come over.  So I pushed myself to get up.  I took a long hot bath, which always helps.

And Isaac and I went to the nursing home.  It was a good visit.

I was feeling a little anxious.  I thought it was because of the fibro.  I took some anxiety meds and tried to ignore it.

The guy I've been seeing came over.  We were, let's say, making out a bit.  And something got triggered.  I had a flashback.  This has happened to me before but not in a long, long time.  I'd figured it could still happen again some time but I guess I was hoping it wouldn't.

I wanted to be alone.  I told the guy to leave.  I took a double dose of my anxiety meds and went to sleep.  And I slept off and on the rest of the day, and all night, only waking up to take Isaac out and sometimes to eat something.

I finally pulled myself out of bed this morning.  I took a hot bath and went to the grocery store to pick up a few things and now I'm trying to finish an article I meant to finish yesterday but ended up not even working on at all.

I'm disappointed it was such a bad day yesterday.  I'm kind of pissed about the flashback.  Not at myself and not at the guy, just at the circumstances.  At the same time, I feel I'm handling it pretty well, as well as I can, and that has to count for something.

I hope to take Isaac for a long walk later today before I have to go tutor.  He's antsy after being kept inside all day yesterday.  And hopefully today will end up being a better day.

Flying with an Emotional Support Animal

Emotional support animals are pets belonging to people with mental disabilities, such as depression or post-traumatic stress disorder, which are recommended as part of their treatment plan by their mental health professionals. Emotional support animals can be any type of pet, including cats, dogs, hamsters, guinea pigs, ferrets, birds, rabbits and reptiles.

Air Carriers Access Act

The Air Carriers Access Act allows people with mental disabilities to fly with their emotional support animals in the cabin of a plane, as long as the emotional support animal doesn’t present a danger to other passengers. Most emotional support animals do not have to be kept in a carrier during the flight. The airline cannot charge an extra fee for people flying with emotional support animals. Emotional support animals should be kept on a leash during the flight. They must be housebroken (unless they are animals that typically live in a cage, like hamsters or guinea pigs) and well-behaved.  

Letter from Your Health Care Provider

In order to fly with an emotional support animal, you must provide to the airline a letter from your health care provider. The letter from your health care provider must say three things. It must say that you have a disability that is included in the DSM-V, the Diagnostic and Statistical Manual used to diagnosis psychiatric conditions; it must say that your disability substantially limits you with regard to at least one major life activity (major life activities include basic things like walking, talking, breathing, seeing, hearing and thinking); and it must say that he or she recommends an emotional support animal as a component of your treatment. The letter does not need to state what disability you have or how it limits you with regard to major life activities. The letter should include the name of the health care professional writing it, the type of license she holds and her license number. It must be written on letterhead within the past year.

Communicating with the Airline

You must notify the airline at least 48 hours before your flight that you plan to fly with an emotional support animal. You must provide the letter by your health care provider at that time. If you don’t give the airline 48 hours notice, they do not have to let you fly with your emotional support animal.

Making the Trip

Limit the amount of food and water you give your emotional support animal for several hours before your flight. Offer only small amounts of water during that time. Give your emotional support animal a chance to go potty before entering the airport.  Keep your emotional support animal on a leash while in the airport. You will be able to board the plane early if you want. Your emotional support animal must sit in your lap or on the floor at your feet. Make sure your emotional support animal does not block the aisle.

How to Handle Access Disputes with Your Service Dog

If you have a service dog, at some point you will find yourself faced with an access dispute. You’ll attempt to enter a place of business with your dog and an employee, manager or owner will tell you that you can’t bring your dog inside. Are you prepared?

Make sure you know the law before taking your service dog somewhere.

 

Occasionally I hear stories about someone attempting to take a service dog somewhere and having an access dispute and getting angry because the business wasn’t complying with the Americans with Disabilities Act, when the particular place they wanted to take the dog isn’t subject to the ADA. For instance, churches aren’t subject to the ADA, so if you want to take your service dog to church, you must first get permission from someone in charge at the church.  Legally, the church can refuse to allow you to bring your dog. If you accuse someone of violating the ADA when the ADA doesn’t even apply to them, you appear uneducated and you are unlikely to gain access in that way.

Tell the person questioning you or attempting to deny you access that your dog is a service dog.

 

Sometimes that’s all it takes. Legally, you are not required to provide proof that your dog is a service dog, such as a certification card or letter from your doctor. Business owners and employees are not permitted to ask for such proof, either.

Tell the person questioning you that the Americans with Disabilities Act gives you permission to bring your service dog into the establishment.  

If they seem unfamiliar with the Americans with Disabilities Act, explain that it is a federal law.

Offer to show them a copy of the business brief issued by the U.S. Department of Justice.

This business brief clearly explains the rights of people with disabilities as well as the rights and responsibilities of businesses. I carry a couple copies in the pockets of my service dog’s vest so I always have them available when needed.

Point out the fact that business owners are permitted to ask only two questions.

They can ask, “Is that a service dog required because of a disability?” and “What task is the dog trained to perform?” Answer those two questions.

Suggest the business owner or employee call the ADA information line at 800-514-0301.  

Note that the information line is only answered on weekdays.

Remove your dog if the business owner or employee still insists you cannot bring your service dog in.  

Yes, they are violating a federal law if they deny you access, but if you refuse to remove your dog when asked to do so, you could end up being charged with trespassing. If you become loud and argumentative and cause a scene, you could also be charged with disorderly conduct. Stay calm, get the name of the person denying you access if you can, and leave.

Contact the manager or owner of the business to describe what happened. 

Be polite and stay calm when discussing the situation. Be prepared to tell the manager or owner what you would like to be done about the problem. For instance, you might ask them to provide training to their employees about the rights of people with service dogs and to post a sign on the door to their business stating that service dogs are welcome.

If the business is part of a larger company, contact the corporate office if the manager or owner does not resolve the problem to your satisfaction.  

Explained what happened, let them know with whom you’ve already spoken about the problem, and let them know what you would like to be done about it.

If all else fails, contact the U.S. Department of Justice to file a complaint against the business.  

Download of copy of the form used to file a complaint from the ADA website. Mail the completed form to the U.S. Department of Justice at 950 Pennsylvania Avenue NW, Civil Rights Division Disability Rights Section – 1425 NYAV, Washington, D.C. 20530. You can fax the form to 202-307-1197 or file it via email if you prefer. Contact the ADA information line at 800-514-0301if you have questions or need assistance filing a complaint.

Prayers in Boxes

My hands,
once supple and strong,
now aged and aching,
lift dusty books from their shelves,
fit them carefully into boxes,
tape them closed,
label them with a black Sharpie,
the smell of which slices through
the smell of dust and mold
and love grown old.

There are cobwebs in my hair
and tears in my throat.

On one shelf,
alongside books about writing,
I find the prayer journal I made him
I-don’t-remember-how-many years ago.
I flip through its yellowed pages,
touched that he kept it all this while,
and at the same time so aware
he never wrote a word
on those carefully crafted pages.

That was the problem all along,
of course,
I realize
as I tuck the journal into a box
with other books
and seal the top with tape.

Today's Trip to the Nursing Home

Today was our regular day to visit the nursing home.  It was a good visit.  Isaac has a routine down there now.

First we got to visit his friend Sue.  We go there first because she has treats for him.  She was especially excited to see him today because she had seen her sister over the weekend and gotten some treats from her sister to give Isaac.  Until now, she's been giving him the treats I brought her for that purpose.  But today, she had some milk bones and she had one "special treat," which was shaped like a little steak and supposed to be steak-flavored.  Before we got to her room, one of the nurses stopped me to tell me to make sure we stopped in to see her.  I guess she'd been telling the staff about how she had special treats for Isaac.  So we went there first, like we always do, and Isaac got quite a few treats.

Then we went on to visit other residents.  We saw his friend Edith, who usually sings to him and loves to feed him treats.  She was having a bad day today, though.  She was crying.  She was the saddest I've seen her since the first time we saw her.  I don't know why she was crying, because she doesn't really communicate.  She doesn't talk, anyway.  She was able to communicate the fact that she was very sad just fine, but not able to communicate why.  She was eager to pet Isaac, though.  She didn't sing to him and didn't cheer up at all when I let her feed him some treats, but she did seem to be comforted, at least a little, by petting him.  She pet him for a long time.

We were visiting another resident in the dementia unit and he said, "Hi, Doggie," several times.  A couple nurses were standing nearby watching and were surprised that he spoke to Isaac and that he made sense.  Apparently he rarely talks and even more rarely says things that make sense.

It was a good therapy dog day.

Isaac's Top Toy Recommendations

I've frequently said that Isaac is a champion chewer.  He is quite skilled at chewing toys of all types to bits.  Still, we've found a few toys that last a long time and are nearly impossible to destroy.

Kong

One of the first toys I bought my dog, before I even brought him home, was a Kong. A Kong Classic, to be exact. Bright red, firm rubber, shaped sort of like a cone. They have a hollow center, perfect for filling with peanut butter or stuffing with treats.  

Isaac now has two Kongs, the classic one and another that looks just like it except it’s made of ever sturdier black rubber. The black one is known as a Kong Extreme, designed for the most powerful chewers. The reason I bought a second Kong is because in the summer when it’s hot out, I fill his Kongs with a mixture of plain Greek yogurt and peanut butter and then freeze them for a cold treat. I bought the second one so he can enjoy one while the other is being frozen for later.

The first Kong I bought now has some tooth marks in it, but he’s yet to chew off a bite, and he’s had that toy for more than a year. I think I spent about $15 on it and that may have been the best $15 I’ve ever spent. Isaac loves his Kong. He loves both of them, really. Sometimes he takes them to bed with him. He’ll gnaw on one for a while before dropping off to sleep and later I’ll see him snuggling up to it while he sleeps.

They are also great for playing fetch with because they bounce in crazy ways. I throw it in one direction but Isaac never knows where it’s going to go. He likes it best when I put some sort of treat in it. Well, I’d have to say he likes it best when I put part of a hotdog in it. It is one of his favorite toys, though.

Nylabone DuraChew Hollow Stick

Nylabone makes a number of toys that are supposed to stand up to powerful chewers. I bought the DuraChew Hollow Stick toy at the same time I bought Isaac’s first Kong, and like that Kong, Isaac still has his Hollow Stick. It’s designed so that tiny bristles are raised during chewing and those bristles are supposed to help clean dogs’ teeth. Both ends of Isaac’s Hollow Stick are sort of squashed from many hours of gnawing, but he still has the Hollow Stick more than a year after I bought it and still likes it.

The Hollow Stick was supposed to be bacon-flavored when I bought it. I imagine some of the flavor must be gone by now. Since it is a hollow toy, treats can be stuffed inside it. This morning I stuck a piece of hotdog in Isaac’s and he spent the whole morning chewing on the stick, trying to get the hotdog out.

Treat Dispensing Pickle Pocket

I know the thought of a toy pickle for a dog seems ridiculously silly. I was at Petco one day, looking for a specific type of treat dispensing ball for Isaac, but I couldn’t find what I was looking for. I did, however, come across a treat dispensing pickle. It’s made of green rubber and has little pockets in which you can stuff treats or kibble. Isaac likes it best with tiny bits of hotdog in it, but then, Isaac thinks hotdogs are the most wonderful food in the world.

Isaac adores his pickle. I think it is his favorite toy, with his Kong coming in as a close second. When I bought it, I had no idea how much he would love it. He’s had it for several months now and gnaws on it frequently and it doesn’t even have any tooth marks on it. I think it’s truly indestructible.

My only complaint about the pickle is that little bits of food get stuck in the pockets and it’s not real easy to clean the pockets out. I wash the pickle when I’m doing dishes and use a cotton swab to get down inside the pockets. It’s worth the hassle, though, because Isaac loves it so much.