Samhain Eve

What is everyone doing this Samhain Eve?

I just finished cleaning and decorating my altar and I am listening to Blackmore's Night and getting ready to bake some pumpkin bread. I need to clean the litter box and vacuum my floor, too.

Later I will be communing with Cayenne, my soul cat Eileen who died nine years ago, and perhaps my grandparents and a few departed friends. Or whoever else chooses to show up.

I am also going to decorate the urn Eileen and Cayenne share.  Last Samhain, I put Cayenne's ashes in the urn with Eileen's.  It is a plain wooden box and I have wanted to do something to decorate it for a long time but wasn't sure what.  And I guess just wasn't ready to do it.  Now I am.

Trip to the ER

Last night I went to the ER.  I didn't intend to.  I intended to go to Urgent  Care.  My local hospital has both an ER and an Urgent Care and I didn't consider my condition life-threatening or emergent, so I drove over there intending to be seen in Urgent Care.  However, they informed me I needed to be seen in Emergency instead.

I was feeling dizzy.  I've been feeling dizzy a lot lately and haven't posted much about it because, well, I figure people get bored hearing me complain about not feeling well, and I just didn't feel like talking about it.  I have seen my primary care doctor twice for it, though, and we still don't know what's causing it.  He is supposed to be referring me to an ENT but I haven't heard from him yet.

Anyway.  I was super dizzy and repeatedly felt like I was close to passing out.  I felt vaguely nauseous and, I don't know, just not right.  Something was wrong, I just didn't know what.

So I went to the hospital, intending to be seen in Urgent Care and ended up in the ER instead.

Isaac went with me, of course.  They wanted to take me from the registration desk back to an ER bed by wheelchair since I was dizzy.  They didn't want me to faint or fall or anything.  Isaac had never walked beside me before while I was in a wheelchair.  It never occurred to me to train him to do that, because it's not something he's ever needed to do before.  He handled it just fine, though.  He kept looking at me like he was not quite sure what he was supposed to do, and I was a little bit worried he'd get too close to the chair and get his toes run over, but I told him to heel and he did great.  It might not seem like a hard thing for a dog to do, but heeling with a wheelchair is different than heeling beside someone that is walking.

They took me back right away.  I didn't have to sit in the waiting room at all.

They seemed pretty concerned and got me hooked up to a heart monitor right away and then did an EKG.  My heart appeared to be just fine.  Although at one point the EKG tech said something like, "Oh, that's not good," and I thought, "Crap, there is something wrong with my heart."  Turns out she was talking about the  machine.  A cord was not working right.

I took a towel for Isaac to lie on.  He was snoozing away on the floor on one side of the gurney and at one point I had two nurses and the EKG tech on the other side of the bed, all doing things to me.  Or trying to.  I kept saying, "If you need to get on the other side of the bed, I can tell Isaac to move."  They kept saying, "Oh, no, we don't want to bother the puppy!  He's fine.  We're fine."

At one point I invited Isaac up on the bed with me.  He thought it was too high and too small and he did not want up there.  He preferred his towel on the floor.

The staff was all really good about Isaac.  No one distracted him, no one questioned my right to have him there.  One of the nurses asked me about what Isaac did for me, and when I told her some of the things he does, she said something like, "It's just amazing what they can do" and that was it.  The doctor didn't ask what Isaac did for me.  I'm honestly not even sure he realized Isaac was there.

It was overall a really good ER experience, and I'm glad because I have avoided the ER since my bad experience nearly three years ago.  I really like my local hospital.  I felt like they treated me with a lot of respect.  Of course, I wasn't there for anything mental health-related. 

You know how in the ER, you can often kind of hear what's going on with other patients?  Emergency rooms are not always the most private of places.  Well, a little while after I got there, a young woman was brought in by ambulance.  I couldn't see her but I could hear her some.  I could hear nurses talking to her some.  She was in a lot of pain, I think abdominal pain, and was crying and moaning some.  I'm not sure how old she was, not a teenager, but a young woman, I think.

Anyway, I overheard them asking her about her medical history and stuff, and heard that she was on the spectrum.  They were referring to it as Asperger's, although that diagnosis no longer exists, technically.  All forms of autism are now referred to as autistic spectrum disorder, or ASD.  Anyway, even though she had autism, they were treating her the way I image they'd treat someone without a neurological disability.  They were talking to her like an adult, like she was capable of answering questions about her medical condition (and it seemed that she was indeed capable of doing so).  Her boyfriend was there at first and later I think a family member was there, but the ER staff all talked to her, not to the other person.  That may seem obvious or common, but it's really not.  It is common for medical people to ignore a person with a disability and talk to their companion instead, like the disabled person is not capable of peaking for his- or herself.

Back to me.  They did some blood work, and it was all normal except my blood sugar was a teeny bit low.  So I got some orange juice and graham crackers.  My blood pressure was low, so they gave me some IV fluids.  After a full bag of fluids, my blood pressure was even lower than it had been when I arrived there!  So they gave me more fluids.

They also wanted to do a urinalysis.  I didn't think I had a UTI, there was no reason to think I did, but whatever.  They wanted me to pee in a cup so I peed in the cup.  And guess what?  I have a UTI.  Apparently a pretty bad one.  I have no idea how I could have a really bad UIT and not know it.  I have no pain, am not peeing any more than usual, have no fever, my pee seems normal to me... I don't know.  But it was bad enough that they wanted to give me some IV antibiotics while I was there.  And they sent me home with a script.

I don't think the UTI is causing my dizziness, though.  So that has not been resolved.  At least I found out I have a UTI, though.  At least I'm being treated for it.  I just don't get how I didn't know I had one.

Isaac at the Halloween Store

I just realized I forgot to post about our trip to the Halloween store!

I took Isaac to the Halloween store so he could experience something new and to practice working in a challenging, distracting environment.  Isaac did great!  I expected he would; if I thought he wasn't ready for something like this, we would not have gone.

When we first arrived, we paused right inside the door so Isaac could get used to the lights and sounds.  Then we slowly approached a display of large decorations.  It was set up so that when you stepped on a certain spot, which was clearly marked, a display item would turn on.  The witch would cackle, the eyes of the monster would light up, whatever.  A friend was with me, so I asked him to step on the spot to turn on the decorations while Isaac and I stood back a bit.  That way we could see what was going to happen without being too close.  That way Isaac was less likely to be startled.

I then allowed Isaac to approach the displays, gently encouraging him but not making too big a deal about it, and offering yummy treats.  Isaac did not seem concerned about the decorations or displays.  He was interested in treats, though!  One easy way to see if a dog is getting too stressed is to offer a treat.  A dog that is stressed out will not want to have a treat.

This three-headed dog or wolf or whatever it was had eyes and mouths that lit up and smoke also came out of the mouths.  Isaac wasn't worried about that at all.  He was happy to take a treat that I held right beside its foot.

This witch cackled and talked.  Isaac was happy to take a treat that I held right beside her hand.  He was very happy that I allowed him to sniff her hand.

Picture Time!

First, Whiskers.  Today was Laundry Day, which is probably her favorite day of the week.  She loves to sleep on the clean, warm laundry as I fold it and stack it on the couch.

And here is Isaac on a recent hike in Mohican State Forest.

More on Service Dogs in Ambulances

I recently wrote about an online discussion with an EMT in which she stated that she didn't care what the law says, she could and would decide whether or not to allow a service dog in an ambulance with their handler.

Here is what the U.S. Department of Justice says about it in their recent document entitled Frequently Asked Questions and Service Animals and the ADA:

Q16. Must a service animal be allowed to ride in an ambulance with its handler?

 

A. Generally, yes.  However, if the space in the ambulance is crowded and the dog's presence would interfere with the emergency medical staff's ability to treat the patient, staff should make other arrangements to have the dog transported to the hospital.

There are two things to note here.  Well, actually, three things.

1.  The federal law says she is generally supposed to allow service dogs to ride an ambulance with their handlers.

2.  If the dog cannot ride in the ambulance, arrangements should be made to have the dog transported to the hospital.  One person joining that online discussion mentioned that when she had to be transported by ambulance, police officers drove her service dog to the hospital.  But the EMT that said she did not have to follow the law made no mention of making such arrangements.

3.  Even though the law says your service dog can ride with you in most cases, and that staff should make arrangements for your dog to be transported if he can't ride with you, some EMT's don't care about the law and will violate your rights anyway.  This is really scary to me.

Pine Cones, Anyone?

For all my crafty readers, I now have pine cones available for sale in my Etsy store.  They are great for crafts and decorating, especially at this time of year.  I want to make some wreaths by gluing them together in a circle and adding a green or gold bow.  I need to get a hot glue gun, though, I think, to do it right.

If you want a different amount than is available in the Etsy store, feel free to contact me at poet_kelly at yahoo dot come or through Etsy.

Isaac went with me to collect pine cones, although I must say he was not much help.  He raced around and then rolled in the pine needled, getting pine sap in his fur. Talk about hard to get out!

No! It Wasn't Me!

Yesterday when I was getting groceries at the food pantry, a woman said she thought she'd seen me in a local restaurant about a month ago with my SD and asked if I'd been there. I said I go there once in a while but didn't know if I'd been there when she was there or not.

Then she said, as if to jog my memory, I'd been feeding my service dog bites of my steak under the table.

I was horrified. I said, "Oh no! No, no, no! I NEVER feed him in a restaurant! Service dogs are NEVER supposed to be fed in a restaurant! That was not me, I would never do that."

I wonder if that means there is another service dog team in my area now? One with a handler that thinks it is OK to feed her SD in a restaurant?

The woman didn't seem to understand why I was so emphatic about it not being me, but I wanted to be really clear that I would never do that and that it would be very inappropriate for anyone to do it.

Today at the Medicaid Office

Isaac and I spent a rather long and unpleasant hour at the Medicaid office today, getting a gas voucher.  In my county, they give gas vouchers to Medicaid patients for travel to medical appointments that are reimbursed by Medicaid.  There is a long list of rules and a bunch of hoops to jump through (like with most benefits for low income and disabled people) but the amount they give for gas vouchers is actually pretty good and helpful.  So I do it.

Today there was a long line and it was moving slow.  You don't actually have to stand in line, you take a number and then wait for your number to be called.  There are chairs, although there are often not enough chairs and people have to stand and wait.  There were several mothers there with very small children and it occurred to me how well-behaved the children often are that I see in places like this.  It is a very long wait and they are bored, as am I.  There are no books or toys in the welfare office waiting room for kids.  I think they are used to waiting for long periods of time in places like this - at the welfare office, at the food pantry, at the free clinic.  Sometimes I try to imagine a childhood like that and I can't.

Anyway, Isaac and I had been at a park earlier and he ran around a whole lot and he was content to lie down by my feet and go to sleep. 

A little girl about two came up and started to pet him, so I bent down and gave her my little speech about "It's not OK to touch a doggie you don't know without asking.  You always need to ask first."  I don't think she really understood me. 

Her mom came over then and led her away, chastising her.  I spoke to the mom and tried to explain that I was not upset with the child, but that I always want to explain to kids that they need to ask before petting a strange dog.  I don't think mom got it, either.

Another little boy was asking his mom if he could pet the dog and she told him he had to ask me.  So he asked and I said yes and thanked him for asking.  Then two other little boys came over and asked if they could pet him, too, and I said yes and thanked them for asking.

Later, the little girl came back and I asked her if she wanted to pet the doggie and of course I could tell that she did.  I asked her if she could ask me to pet him and then I realized her verbal language skills didn't seem to be too good.  She ended up  just pointing at Isaac and looking at me.  I understand she was asking permission to pet him, so I said she could and thanked her for asking.

She didn't know how to pet a dog nicely, though.  I had to keep reminding her to be gentle.  Poor Isaac, he was very patient with her, but she kept wanting to touch his toes, which he does not like, or to poke her fingers up his nose, which he also does not like, or to unzip the pocket on his vest, which I did not like.

I was getting really annoyed with her mother, who was not providing adequate supervision.  Mom should have been right there with her, helping her to pet the doggie gently and teaching her how to interact with a dog. 

On a brighter note, another mom asked me about how to get a service dog.  Her little girl is blind and mom said she doesn't need one now, she's too young, but she was wondering how you get a guide dog.  She wanted to know for when her daughter gets older.  She was under the impression it would be very expensive and I said oh no, not with guide dogs.  The main guide dog programs place dogs free of charge and even cover your travel expenses to go get your dog and be trained to use a guide dog.  I was glad to be able to let her know that and also glad she wasn't trying to get a service dog for her toddler but planning for the future.

Doggie at the Doctor's Office

I had an appointment with my primary care physician today. Isaac loves him and he really likes dogs.

We were chatting while he examined me and I mentioned that my rheumatologist is afraid of dogs. I explained how I put Isaac in a down stay behind my chair and keep him there the whole time she is in the room so she feels less anxious about him being there.

He looked surprised and said "Really? If Isaac was any more laid back, I'd want to check his vital signs!"

In other news, he ordered some blood work because I've been feeling dizzy a lot and my blood pressure has been running low.  He also prescribed something for migraines, because I've had three of them in the last month

Nice Day for a Swim

Today, Isaac thought it was a nice day for a swim.

We are trying to spend as much time outside as we can while the weather is nice.  Today it was especially nice.  I was perfectly comfortable hiking in jeans and a tee shirt.

I considered wading in the pond with Isaac but quickly discovered the bottom was slimy mud and changed my mind.

After hiking about an hour, we came to an observation tower.  Isaac insisted we go up all the steps.

He was not tired at all, of course.

Nice Day for a Walk in the Woods

Yesterday was a beautiful day for a walk in the woods.  Or a run.

And after a run, it's time for a rest.

Do Ambulances Have to Transport Service Dogs with Patients?

Most of the time, they do.

This evening on Facebook I saw a discussion about this and an EMT posted something along the lines of "Most of the time there is not going to be room for Fido in the ambulance and Fido will be in the way if we have to do CPR or something.  I know the law but even so, I am going to make a judgement call.  I know service dogs are medical equipment but on an ambulance, I am the only medical equipment you need."

Well, this scares the crap out of me.

I expect EMT's to know and comply with the law. But I also realize some may not.  And in an emergency, I would be at their mercy.  Just like in the ER.

If there is really not room for my SD in the ambulance, then it would be perfectly legal for them to decide not to transport him. If he would really be in their way and prevent them from doing their jobs, then that would be considered a "fundamental alteration of services" and the US Dept of Justice says that is a legal reason for denying access. 

However, simply deciding that the EMT is all the medical equipment I need is not a legal reason for denying access. I am not aware of any cases involving paramedics but there was a case not that long ago where a hospital denied access and refused to allow a patient's SD while she was an inpatient, saying the staff could do everything her SD would do for her, and the court disagreed. She won her case and the court said a hospital could not have a blanket policy like that and that they would need a specific reason to deny a SD and that hospital staff cannot necessarily do everything a SD does for a handler. I'm betting a court would say the same about EMT's, and EMT's don't know a handler well enough to make that judgement.

For a Little Perspective

Today I drove an acquaintance to this church that has a free clothes closet. She was looking for a winter coat for her 14 year old son. His coat from last winter doesn't fit anymore. It was 34 degrees when he went out to catch the school bus this morning and he was cold because he didn't have a coat to wear.

Well, the church did not have any kids' coats at all. So then we stopped at a Salvation Army thrift store. She hoped she would find a coat to fit him and that she could afford it. They had exactly one coat in his size. It cost $3.85. She only had $3. I had exactly 81 cents in cash on me. A woman in line behind us gave her a nickle so she could buy the coat for her son.

The whole time, I was wishing I wasn't broke because I would have loved to have been able to drive her to Walmart and buy her a nice coat for her son. I can't imagine what it must be like as a mother to have to send your child out to catch the school bus with no coat when it's this cold because you cannot afford to spend more than $3 on one.

Stuff like this just makes my problems seem small.

Whiskers Pictures

Just 'cause she's cute.

Saw My Psychiatrist a Couple Days Ago

I saw my psychiatrist a couple days ago.  I called and was able to get in sooner than scheduled, which was fortunate because I'd been feeling pretty bad.

The appointment went all right.  He recommended increasing my Cymbalta.  I'd been on 90 mg and it was my understanding that 90 mg is the highest dose studies have found to be effective.  While  higher doses are safe, studies haven't found them to be beneficial.  So I had though increasing it wouldn't help.  However, what I wasn't thinking of is that sometimes higher doses might be helpful for someone, even if statistically studies haven't found that to be the case usually. 

I was on a very high dose of Effexor for several years, 450 mg, when most people are on 300 mg or less of that.  And it caused me to develop super high blood pressure, but it did help my depression, when a lower dose hadn't.

While I'm not sure a higher dose of Cymbalta will help, it does seem reasonable to try that before switching to a new antidepressant.  Plus it might help my pain, too.  I mean, Cymbalta does help my pain, that's one reason I am hesitant to switch to a different antidepressant.  I just mean maybe the higher dose might help even more.  I was worried that changing to a different med would cause a significant increase in pain.

He also prescribed Trazadone for sleep, which I've been on before.  Trazadone is actually an antidepressant, but for it to help much with depression, you need a big dose.  But it's very sedating, so it's seldom used for that purpose these days.  We have better antidepressants now that have fewer side effects.  But it's often used for sleep in smaller doses because it is so sedating.

Well, when I took it before, it seemed like if I was on a high enough dose to make me sleep, it made me really groggy and hung over the next day, which I did not like.  But at this point I'm willing to try it.  He prescribed 100 mg but I plan to start with 25 mg (I will chop the pill into quarters) and increase it after a few days.  I am desperate enough for some relief that I'm willing to deal with some grogginess in the morning if I have to, but I want to minimize the side effects as much as I can.

My psychiatrist also recommended I find a therapist for CBT, or cognitive behavioral therapy.  I've done CBT before and I know it works for most people but I really did not find it helpful.  If I wanted to do therapy, that's not what I would want to do.  But I don't really want to do therapy.  I reminded him I have not been in therapy for almost three years, not since my horrible experience at the ER and in the psych ward.  I pointed out that I don't trust mental health care providers anymore.

He sort of laughed at that.  I sort of laughed, too.  I was like, "I don't really trust you very much, either."  I trust him enough to see him, but if I didn't have to see him in order to get my meds, I wouldn't.  But my PCP won't prescribe my psych meds.  And I wouldn't feel very comfortable having my PCP adjust my psych meds, either.  I believe my psychiatrist is more knowledgeable and better able to do that safely and well.  But that doesn't mean I trust him a whole lot.

He tried to talk me into CBT.  I don't think he understood what I was saying about it not being helpful for me.

I did think about it afterward.  I did a little DBT, or dialectical behavioral therapy, when I was in the hospital up in Michigan many years ago, the hospital that specializes in treating PTSD and trauma-related disorders.  I'd be willing to consider doing that again, if I could find someone that does it nearby.  It's often done in a group therapy setting and I might feel safer in that setting than one-on-one.  But I have no intention of doing CBT.

* The hospital I was at in Michigan is Forest View Hospital in Grand Rapids.  I highly recommend it for anyone needing inpatient care for PTSD or DID.

Review of Omron Electro-Therapy Device

This review is not service dog-related, but it does have to do with fibromyalgia and chronic pain.

My readers probably all know I have chronic pain. I have back pain due to degenerative disk disease and a couple of herniated disks. I also have osteoarthritis in my knees and hands. And I have fibromyalgia, which causes pain in all sorts of places. 

I can’t take non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen because I had gastric bypass surgery. I take used to have prescription pain medication but no one wants to prescribe it anymore. I’ve tried some other treatments, like chiropractic adjustments, physical therapy and steroid injections, which provided a little relief. Acupuncture helps. I am also on meds for the fibro. I still have pain on a daily basis, though.

I was at a local drugstore, looking at warming ointments like Bengay, when I spotted the Omron electro-therapy device. It is similar to a TENS unit, if you're familiar with those. I was curious about it but not certain it would really help with my pain. But it was on sale, marked down from $59.99 to just $39.99. So I decided to give it a try.

The device comes with two sticky pads, which are actually electrodes. These are placed on the body, on either side of the area where one has pain. For instance, to relieve pain in my elbow, I place one pad on my arm just above my elbow and the other on my arm just below my elbow. The pads are connected to the device with wires. It kind of resembles a CD player with earphones that are connected by wires.

The control has three settings: one designed to relieve arm pain, one designed to relieve back pain and one designed to relieve leg pain. It sends out little tingly zaps of electricity to the sticky pads, which vary in pattern somewhat depending on which setting you choose. It feels like tingling and tapping. You can see the muscle jumping a bit under the skin, which is rather odd-looking.

You can adjust the intensity level of the stimulation from one to five. When I put the pads above and below my elbow and selected the setting for relieving arm pain, I couldn’t feel a thing on the lowest setting. When I increased it to two, I could feel it, but barely. When I increased it again to three, I could feel it well. I suspect it would have been uncomfortable on a higher setting, but I wasn’t brave enough to actually try it. Every time you turn on the device, it starts out at level one. That way you’re never surprised by a greater level of intensity than you want or expect.

The device shuts off automatically after 15 minutes. The instructions say not to use it for more than 30 minutes at a time and not more than three times a day, though I didn’t find an explanation of why it was recommended not to use it more than that. After 15 to 30 minutes, I feel ready to turn it off anyway, though. It’s a kind of strange sensation and I wouldn’t like having it on all the time.

The one thing I don't like is that the sticky pads get un-sticky after a while and need to be replaced and that gets expensive. The package says they are supposed to last for 150 uses, but if I use the device daily, that means they just last a month or two. Then they don't stick well.

I love this device, though. When I use it on my elbow, I have no pain at all while I’m using the device. When I stop using it, the pain returns, but it’s so nice to have a break from the pain which has been constant for the last few months. When I use it on my back, I have no pain while using the device and my back feels better, though not completely pain-free, for a while after using it. I know it’s not a cure for the problems that are causing my pain, but it’s absolutely marvelous to experience some relief and to be able to get relief regularly and reliably, even if just for a short time. I highly recommend trying this if you have ongoing muscular-skeletal pain.

What's the Deal with the Dog?

Old man at McDonald's: Say, what's the deal with the dog?

Me: He's a service dog.

Old man (gesturing at Isaac's vest, which clearly says Service Dog on it): Yes, I see that, but I don't know what it means.
 

Me: It means he helps me with my disability.

Old man: Oh. I thought maybe it meant he was in the Armed Services.

One More Reason We Don't Need New Laws about Certification for Service Dogs

There are already laws in place about what qualifies a dog as a service dog and where they are allowed to go.  We don't need new laws because we already have laws.  They are just not being enforced very often.

Under the Americans with Disabilities Act, a business is allowed to ask two questions when someone comes in with a dog.  Is that a service dog?  What tasks is the dog trained to perform?  If the handler answers yes, it is a service dog, and is able to say what tasks the dog is trained to perform, the business is supposed to take them at their work and allow the dog in.

Sure, people could lie and say there pet is a service dog.  They might make up something when asked about tasks, but I think that question would stump many fakers.  So simply asking the two questions allowed by law would screen out some fakers.   Not all, but some.

Now, under the ADA, businesses are allowed to ask a handler to remove a dog that is not housebroken or that is disruptive or behaves aggressively.  But often they don't. 

If they did, though, I think people with poorly trained dogs would soon stop taking them places.  I mean, why drag your pet dog to the store every time you go if every time you were asked to remove him?  That would be a big hassle.  You'd start leaving Fido at home, right?

Some states also have laws making it illegal to misrepresent a pet as a service dog.  I don't think those laws are enforced much, if ever, though.  But they could be.

Wouldn't it be easier to enforce existing laws than to pass and enforce new ones?

More on Why I am Opposed to Certification for Service Dogs

A while back I wrote about how I am opposed to certification for service dogs because I believe it would create barriers for people with disabilities.  It would cost money and I believe service dog handlers would have to bear at least some of that cost.  Lack of accessible transportation would also create a barrier if a handler had to go somewhere to get their dog certified. 

But here's more.  And this is possibly the most important thing, I think.

Most people do not need a special ID card or certification to go to Walmart or McDonald's or wherever.  I don't believe I should have to have a special ID just because I am disabled and need a service dog.  

Yes, I realize most people do not get to take a dog to Walmart or McDonald's, so there is something different about  me.  But then, most people don't have PTSD and fibromyalgia, either.  Most people are not disabled.

It's a civil rights issue, really.  The Americans with Disabilities Act is a civil rights law.  Requiring someone to have a special ID just because they are disabled would be a violation of their civil rights.  And yes, some might say the ID is not because I am disabled, it is because I have a service dog.  But I have a service dog, I need a service dog, because I am disabled.

I don't believe I should have to show ID to go to Walmart unless everyone is going to be required to do so.  It's about civil rights.  It's about equality. 

Coordination of Care

My readers with multiple health issues will probably understand this. Those without multiple health issues or complex conditions may not have experienced this personally.

People with multiple health issues or complex conditions typically have multiple physicians.  Health care is so specialized these days.

I personally have a primary care physician, a rheumatologist, a psychiatrist and an acupuncturist (yes, she is a physician) that I see regularly.  Each treat different things.  None communicate much, if at all (my PCP referred me to the rheumatologist, so I think there was a little communication there in the beginning, at least a few records faxed back and forth).  Three of them prescribe medications and they are only aware of what the other prescribes because I tell them.  My pharmacist and I look out for possible medication interactions. I also take lab reports about blood work or other labs ordered by one physician to the others so they all have copies.

So I've been feeling lousy lately, feeling like something is off and maybe I need some meds changed for something. But here is when having multiple doctors is a problem.

If I'm feeling more anxious and depressed, I should probably see my psychiatrist, right? But depression can sometimes, though apparently not often, be a side effect of the medication I take for fibromyalgia. Which was just increased recently. So should I see my rheumatologist instead? And if my psychiatrist wants to try a different antidepressant, that will probably mean stopping the one I'm on first, but in addition to being an antidepressant it is used to treat pain, so if I stop taking it my fibro pain may get worse, so should I discuss that with my rheumatologist first? 

Ideally my psychiatrist and rheumatologist would have a discussion about these things, but do you know how hard it is to get two doctors that do not work for the same practice to have a conversation? Sigh.

Review of Starmark Treat Dispensing Pickle Pocket for Dogs

This is Mr. Pickle, also known as the ickle pickle.

It is one of Isaac's favorite toys.  I don't know who came up with the idea of a toy pickle for a dog, but he really likes it.

You may recall that we lost Mr. Pickle at one point and I couldn't find it anywhere so finally had to order another. When the new one arrived, Isaac was absolutely delighted to see it. He licked it for a long time, then when he needed to go out to go potty, he insisted on carrying his pickle outside with him. 

If you can't tell by looking at it, there are grooves in the pickle where you can put treats.  The only thing I don't like about Mr. Pickle is that it is hard to clean those groves.  Isaac gets it all slobbery and there are little bits of treats in there and it's gross.

But Isaac loves it.

 It is also really durable.  Isaac is a champion chewer, after all, and Mr. Pickle does not even have any tooth marks.

The Cat in the Cupboard

I left the kitchen cabinet open for about a minute and look who had to get in.

The Service Dog at the Library

The other day, Isaac and I stopped at the library in the nearby town where we used to live.  I still have a library card there but haven't been there in a while.

This is the library at which Isaac and I ran into out first service dog team, about 2.5 years ago, shortly after I got him.  He barked at that other service dog.  Like he wanted to eat him.  I mean, it was awful.  I was so embarrassed.  I got Isaac out of there as fast as possible.

If you want to read up on our limited history meeting other service dog teams in public, here's a brief rundown.  It rarely happens.  We live in an area where there are not a lot of service dogs, I guess.

Well, what stood out to me is that this time, Isaac just glanced at the other dog.  He was curious, but not too distracted.  He kept walking, in a nice heel.

I love it when things like this happen and I can see so much progress.

I Want That Job

Yesterday while I was sitting in the waiting room of the periodontist, Isaac was stretched out on his side, sleeping soundly, looking very relaxed.  An older man and woman sat down across from us and the man looked at Isaac and read the patch on his vest out loud: "Please don't pet me, I'm working." 

I knew right away what he was thinking.  Isaac really looked like he was hard at work.

The man smiled and said, "Huh.  I want that job."

Sunshine

After a few days of rain, the sun finally came out yesterday afternoon. Isaac was delighted and took the opportunity to roll in a sunny patch of grass. Doesn't he look almost angelic there?

New Experiences

Isaac had not one but two new experiences today. He's a pretty seasoned service dog now, so he doesn't get new experiences that often. The last new experience was the Halloween store we did a couple weeks ago (I still need to write about that) and I planned that experience on purpose to give him a new experience.  I think the last before that was a spiral staircase.  No, maybe it was seeing farm animals up close when we went to Nebraska - he got to see chickens and horses up close. I think the spiral staircase was before that.

Anyway. He doesn't have new experiences very often these days. Maybe a walk on a new trail, but not something totally different that what he's used to.

The first new experience today was a glass elevator, which I hate, but he just seemed interested, not worried. He kind of stretched his neck out a little, like he does when he wants to get a good look at something, and just watched out the window.

The second new experience was a revolving door, which he did not like too much, and it took us forever to get through it because we had to inch along because he didn't quite get the concept. But he was willing to give it a try.

I think new experiences are good for him because, well, life is full of strange things. When Isaac gets to experience something new, he gets to practice how to handle new and strange things. We might never go through a revolving door again, certainly it's not something I think is important for him to get good at doing, but I am certain we will run into something new and unexpected again, something Isaac hasn't trained for, something surprising or confusing, and it is important that he is good at coping with those things. That's important for any service dog.

Review of SoFetch Natural Cleansing Wipes

I am going to start including some reviews of certain items on my blog.  There are a couple reasons for this.  One is that I have received some items at a discount, or even free, in exchange for providing an honest and unbiased review.  I promise not to tell you it's a good product unless I really like it!  The other reason is that there are some products I really, really like for dogs in general and/or for service dogs in particular.  I think these reviews can be helpful for people.

So, my first review here is of these SoFetch Natural Cleansing Wipes.  They are like baby wipes for doggies, but not only for use on their bottoms.

If you read this blog much at all, you know how Isaac loves to play in the woods, swim in creeks, roll in stink stuff, and just generally get dirty. Since Isaac is a service dog, I need him to be clean, to look and smell nice, when he accompanies me into public places. Sometimes I need to run errands after we've gone for a walk or played outside and I don't always have time to go home and bathe him first. I've been trying to clean him up with a spray bottle of water and a towel, but thought these wipes would come in really handy instead.

Please note, if he is too dirty or smells bad, he does not accompany me to public places. I make other arrangements. And I generally plan my day so that I don't take him places where he is likely to get really dirty before we have to go someplace else where he should be clean and presentable.  But, dirt happens.

So today we went to one of our favorite parks and he ran around and swam in a pond and rolled in something that smelled quite bad. Afterward, I used a couple of these wipes to clean him up. They are soft and pretty big and worked really well. Isaac not only looked clean but smelled good, too!

The environment is important to me and I do not generally use disposable paper products. At home, for instance, I don't use any disposable paper products. I use cloth napkins and cloth rags instead of paper towels. I use cloth wipes instead of toilet paper. I use cloth menstrual pads. I wouldn't use disposable wipes for my dog all the time, because it's just not ecologically friendly or sustainable.

However, there are times that these wipes will really make my life easier and I feel OK about using them occasionally. And I like that the box these come in is small and cardboard, so It can be recycled (inside the box, the wipes are in a small plastic bag). And I like the fact that these wipes use natural ingredients, so they are good for my dog as well as for the environment.

Disclaimer: I received these wipes at a discount in exchange for my honest and unbiased review, provided here.

You Don't Like Tomatoes

I was slicing grape tomatoes in the kitchen and Isaac came in acting like he wanted one. I told him he doesn't like tomatoes but he was pretty insistent. So I offered him one.

He took it, carried it into the living room, spit it on the rug and considered it. He licked it. Sniffed it. Picked it up, spit it back out. Picked it up again and carefully bit into it.

I think he got a squirt of tomato juice in his mouth and apparently did not like it because he quickly spit it out and backed away from the now-deflated tomato. Silly dog.