Service Dog-Related Expenses Count as Medical Expenses

At least, they do according to many government agencies, including the Social Security Administration, the Internal Revenue Service, the Department of Housing and Urban Development, and the Ohio Department of Job and Family Services (the current name for the state welfare agency in Ohio, which seems a bit of misnomer to me, since I have neither a family nor a job but still require services from that agency).  This means you can deduct service dog-related expenses from your taxes along with any other medical expenses (if you itemize when you do your taxes, and if your medical expenses total more than a certain percent of your income; talk to an accountant or your tax preparer, though, don't take tax advice from me!).  It means you get lower rent if you qualify for subsidized housing with the Department of Housing and Urban Development and you may get more in food stamps and your Medicaid spend down may be lower.  Those agencies adjust your income by deducting certain expenses, like medical expenses, when determining how much assistance you qualify for.  So does the Social Security Administration, if you receive SSI and return to work under the Ticket to Work plan.

When I moved a couple months ago, I moved from one county to another withing the same state.  I guess because efficiency is not something valued by my state government, I had to reapply for Medicaid in the new county.  This meant I ended up having no Medicaid coverage at all for almost two months and that a caseworker had to spent time handling my application and reviewing all my documentation, even though my income had not changed and I had only moved 30 miles from where I used to live.  There are your tax dollars at work.

Since I had to reapply, I decided to provide verification of all my service-dog related expenses because I had not done so where I previously lived (because it was a pain in the butt to do so and I am lazy) and I expected that by doing so, I would qualify for some food stamps and that my Medicaid spend down would go down.  A Medicaid spend down, if you're not familiar with the concept, is like a deductible that must be met each month before your Medicaid kicks in.  My spend down was$538.  Yes, that meant the state of Ohio felt it was reasonable for me to spend $538 out of my pocket each month on medical bills, and then the state would cover the rest.

So I provided all the paperwork I could gather up, including:

• copies of receipts for dog food, dog treats, and dog toys
• copies of receipts from veterinary care, including the monthly flea prevention stuff I buy from the vet and then apply myself
• copies of cancelled checks from payments I've made myself to the program I got Isaac from (money that's been donated to help pay for Isaac doesn't count, of course)
• copies of cancelled checks for Isaac's dog walker
• an itemized list breaking down the average expense for each service-dog related item per month
• a copy of the certificate from Isaac's program, stating he is a trained service dog

Based on my medical expenses, which do include some other expenses but are mostly related to Isaac at the moment, my spend down dropped from $538 a month to just $158.  That was worth the paperwork hassle, I'd say.

Waking to Pain

To put this in perspective, keep in mind that my back hurts every day.  The last time I had an full day with no pain was sometime back in the winter, so four or five months ago, and that seemed like a miracle to me because it was the first full day with  no pain I'd had in probably over a year.  It has been months since I've slept through the night without the pain waking me at least once during the night.  It's not unusual to have pain so bad it makes me feel nauseous.  It's not unusual to move a certain way and actually cry out because it hurts so much.  That's my normal.

This morning Isaac woke me up about 5:45, insisting he had to pee.  It usually takes me a few minutes to get out of bed in the morning.  I'm stiff and sore when I wake up.  This morning, though, the pain was so bad, I could barely make it out of bed.  I had to pee myself, so I went to the bathroom, and had a terrible time getting up off the toilet.  I decided  not to brush my teeth because it hurt too much to bend over the sink like that.  I took Isaac out, held on to the side of the building while he peed because my back hurt so much I felt like I could barely stand, and came back inside.

I took a pain pill and fed Isaac.  I fed him from the plastic container of food I keep on the kitchen counter for occasions like this.  Most of his food is kept in a big plastic bin on the floor, but I have to bend over to scoop out the food.  Bending over to do that always causes some pain, sometimes more than others, but it's usually bearable.  This morning, there was no way I was going to try to bend over like that.  The food supply on the counter is for times like these.  I measured out his food, and dumped it into the dish on the floor without bending over.  Hopefully he'll eat all the little pieces that bounced out of the dish onto the kitchen floor.

I went back to bed, hoping the pain pill would kick in and I'd feel better when I next woke.  Isaac woke me up two hours later, and unfortunately, I didn't feel any better.  I took him out again, and by the time I got outside, I was in so much pain I was sweating heavily.  Then I threw up a couple times.  That causes my back muscles to spasm horribly.  I made it back upstairs to my apartment, where I considered taking more pain meds but decided against it because of the nausea.  I went back to bed.

Two hours later, I got up again.  I was finally able to bend over the sink to brush my teeth.  I guess that's progress.  I got out the heating pad, which usually helps but I have to bend over to plug it in, which is extremely difficult when I'm in this much pain.  I'm sitting on the heating pad now, though, and it feels a little better.

I have stuff I need to do today.  I have an appointment with  my psychiatrist later, which I really, really need to keep.  I have to drive 45 minutes to get there, then get out of the car (which is really difficult and really painful when my back is this bad), then I'll sit in the waiting room and have to get up out of that chair to walk back to his office, then sit in another chair, which I'll have to get out of a few minutes later, then drive 45 minutes back home.  I know that doesn't sound that strenuous but I'm dreading it.  I was planning to take a shower before my appointment, but I'm not sure I can stand up that long.  I had a couple errands I needed to run before my appointment, too, but right now I'm thinking I'm not getting in and out of the car anymore than I have to.

Right now I'm dreading having to get up again to take Isaac out.  I wish there was someone I could ask to take him out for me.  The dog walker is coming at 4:30 to take him for a run, but he'll need to go out before then.

Some Thoughts on Abortion

I know, this has nothing to do with service dogs.  It is somewhat related to my disability, though.  And I see so much discussion on this topic on Facebook and in the news and everywhere these days.  I just wanted to take the opportunity to put some of my own thoughts into words.

I guess I should start by saying I am pro-choice.  That doesn’t mean that I think abortion is something that should be chosen lightly, and I don’t think many women do make the choice lightly.  I can think of three women I’ve personally known that had abortions (there are probably more but it’s something most people don’t share with everyone they know) and I know all three of them put a lot of thought into making that decision.  I know two of them considered themselves pro-life or at least never thought they would choose to have an abortion, until they found themselves in circumstances in which they could not see another solution.  I know one of them got pregnant while using condoms and one of them got pregnant while taking birth control pills; the third was not using any form of birth control because she was not sexually active when she was raped and became pregnant.  I know one of them would have loved to have another child but it just did not seem feasible at that time, in those circumstances.  None of them was relying on abortion as a form of birth control.

I’ll also say that while I am pro-choice, abortion is not necessarily the choice I would make if I found myself facing an unexpected pregnancy.  I actually got pregnant when I was 16, and both my parents and the father’s parents encouraged us to either place the child for adoption or have an abortion.  I chose not to have an abortion.  I gave birth at age 17; my daughter was mostly raised by her father.  I see abortion as a last resort type of thing.  It’s what I would choose if I felt I was unable to carry a pregnancy to term for some reason.  If I felt I could carry a pregnancy to term but not raise a child myself, then I would place the child for adoption.

So what does all this have to do with being disabled?  Well, to begin with, being disabled affects my access to contraception.  I’m on Medicare, and I would like to have a tubal ligation because I definitely do not want to become pregnant, ever again.  However, Medicare will  not pay for a tubal ligation.  My primary care provider recommends I avoid birth control pills because I have a family history of breast cancer and the pills increase one’s risk of breast cancer.  She and I agree that it is best that I avoid all hormonal forms of birth control, since side effects can include depression and I already have a history of very severe depression.  That doesn’t leave me with many options, but Medicare will not cover a tubal ligation.  Unfortunately, I don’t have the $5,000 the surgeon told me it would cost to pay for it myself.

So because I am disabled, I don’t have access to real effective birth control.  I can use condoms, and I do, but they are not nearly as effective as a tubal ligation.  Am I just supposed to be celibate to make sure I don’t become pregnant if I don’t want to be?  I’ve been on Medicare since I was in my mid-30’s.  Do our legislators just assume disabled people aren’t interested in having sex?  And none of the pro-life folks have offered to pay for my tubal ligation in order to prevent an unwanted pregnancy, either.

At this point in my life, if I did become pregnant, I believe I would have to abort.  I don’t want to have to do that, so I am super careful about birth control (which at this point means condoms and vaginal contraceptive film).  But what if my birth control failed?  Even a tubal ligation can fail, although it’s very rare.  I asked the surgeon I spoke to how that could possibly happen, and it said that in some cases the tubes simply grow back together, or grow around an obstruction.  How bizarre is that?  It’s kind of cool, too, if you think about it, the body’s remarkable ability to heal and repair itself.  But it wouldn’t be so cool for a woman that had a tubal ligation and then found herself pregnant.

And let’s not forget that fact that some women that are abstinent become pregnant after being raped.  And women with disabilities of any kind are more likely to be raped than women without disabilities, although of course it can happen to anyone.

Anyway, if I became pregnant at this point in my life, I think I would have no choice but to abort.  I don’t see how I could possibly get through a pregnancy.  And that’s because of my disability.

For a moment, let’s just forget about my fear of doctors and hospitals.  I’d have to have a home birth, with a midwife, but that’s what I would have wanted before developing this fear, anyway.

I have severe depression, which is sort of stable at the moment, but the physical and emotional stress associated with pregnancy could wreak havoc on my psyche.  The hormonal upheaval scares the crap out of me.  Looking back on my life, I think I was depressed from a very young age, but it was not diagnosed until I was pregnant the first time.  And in the postpartum period, my depression was very severe; that’s when I attempted suicide for the first time.  Perhaps a second pregnancy would be easier than my first, but I don’t believe it would.  I believe there is a very good chance my depression would get significantly worse.  I believe I would be at risk for killing myself.

How does a severely depressed, suicidal person get through nine months of pregnancy?  Even if I  wanted to spend nine months on a locked psych ward (and I don’t), that wouldn’t happen.  Who would pay for it?  You’d be looking at about $1,000 a day, maybe more; that’s about $30,000 a month.  Medicare isn’t going to cover that; I think my co-pay for inpatient hospitalization is something like $450 per day right now, because I’ve already used up a lot of my inpatient days on my Medicare Part A plan.  As far as I’m aware, none of the prolife organizations offer to pay for inpatient psychiatric care for suicidal pregnant women, either.

Then there is the issue of quality of life.  Who would want to spend nine months on a locked psych ward, even if that was an option?  Who would want to spend nine months suffering from severe depression, from self-hatred, from feelings of guilt and hopelessness and despair?  

Medication wouldn’t be an option, since most psychotropic drugs have not been proven safe during pregnancy and many are now known to cause serious birth defects.  There are currently some class action lawsuits in the works for women that were given antidepressant drugs while pregnant and told the drugs were safe.

The bottom line is that I do not believe I would live through a pregnancy.  Now, many prolife folks, though not all, believe abortion is OK if a woman’s life is at risk.  Not all do, though.  And even if it is legal to have an abortion if my life is at risk, who gets to decide whether my life is at risk or if the risk is great enough?  Do I have to convince a doctor that my depression is that severe?  We all know how well doctors listen, right?  Who is in a better position to decide whether or not I really need to have an abortion than me?

All Worn Out

Poor tired doggie.

He says his stuffed tiger with the squeaky butt makes a good pillow.

If Everybody Spoke Sign Language...

I'm reading this book called "Talking Hands" by Margalit Fox, which is about the linguistics of sign language.  Before you decide that sounds really boring, check this out.

Among other things, the book talks about how, from the late 1700's to the mid 1900's, there was a very high percentage of deaf people living on Martha's Vineyard.  Most of the deafness was hereditary and it was so common that everyone there spoke sign language.  They spoke their own language, Martha's Vineyard Sign Language, a language which has mostly been lost now.  Apparently it resembled British Sign Language more than American Sign Language, but it was a unique language.

Did you know there are many different sign languages?  Many hearing people think there is one universal sign language, understood by deaf people around the world, but that is not true.  American Sign Language and British Sign Language are actually quite different.  American Sign Language is more like French Sign Language, because the first American teachers of the deaf went to France to study sign language and methods of teaching the deaf, then brought what they'd learned back to the States.

Anyway.  On Martha's Vineyard, everybody spoke sign language.  When deaf and hearing people gathered together, they spoke sign sign language, but groups of hearing people sometimes signed even when no deaf people were present.  Everyone on the Vineyard was bilingual.  It wasn't considered unusual or abnormal in any way.

Being deaf wasn't considered unusual or abnormal, either.  Deaf people on the Vineyard worked at all the same jobs their hearing neighbors worked at.  They got married, often to hearing people, and raised families.  In 1978, an anthropologist named Nora Ellen Groce was interviewing elderly people on the Vineyard about the deaf residents and what it was like for them (she later wrote a book about it called "Everyone Here Spoke Sign Language").  She asked a woman in her 80's what it was like for the children that grew up handicapped by deafness on the Vineyard, and he woman said, "Oh, those people weren't handicapped.  They were just deaf."

Do you get how cool that is?  The deaf people on the Vineyard didn't have to worry about interpreters, because everyone there signed.  The kids didn't have to go to special schools.  The adults could do all the same jobs hearing adults did.  The deaf and the hearing went to the same churches.  There was no discrimination, no prejudice. 

What if it was like that now, everywhere?  And what if everywhere you went, menus were printed in both print and Braille?  And what if all restaurants and stores and doctors' offices were wheelchair accessible?  (Do you have any idea how many doctors' offices are not wheelchair accessible?)