Thoughts and a request

Thoughts

The last two days have been interesting and very disappointing!  It is interesting that very few type 2 bloggers have made little or no comments about the Oprah and OZ show.  Not only did they go for ratings and the sensational aspects, but missed an opportunity to do something positive for people with diabetes.

I have never been a fan of the Oprah show, but she has done some good things, but when combined with a doctor of medicine who apparently can not make a living in medical practice, we get knifed in the back and have to put up with more misinformation for several years.


Request

If you are a person with diabetes (type 2) that is blogging about diabetes - if you are interested in being listed on David Mendosa's web site in the list of Type 2 bloggers (about 1/3 the way down the page) between item 52 and item 53, please send me an email and I will forward your request to him.

I have been encouraging type 2 people that are blogging and have let several months pass, to continue blogging.  There are many more type 1 people blogging and we need to continue being represented.  There are many good Type 2 bloggers and I want them to succeed.

My email is on my profile page.

Thank you.

Which is More Important?

Which is indeed more important - the news about a group uniting resources to develop a product which is potentially more than five years in the future and more likely 20 years from success, if then, or what is being foisted on us by a group of surgeons and the American Diabetes Association without proper studies and proof that the procedure will not do more damage than good.

I would normally like to step back and let the dust settle some, but since some bloggers have chosen to go ga-ga and make sure we know everything there is to know about a product that does not exist yet, I have to wonder why we get so wrapped up in the hype.  That a lack of common sense and proof that a product is possible are forgotten to hype an idea that is more than five years in the future makes me wonder why we even read this.   Something like this is possibly worth mention, but not on page one.   I am so tired of hype from this study and that study that are poorly conceived and more poorly constructed and developed that I will wait until something is approved by FDA or other government agency and possibly due to be on the market before getting excited.  Yes, I will watch to see if the efforts are still going forward to develop it, but beyond that I do not intend to spend more time than this.

What I am not understanding is how we have something going on today that is being overlooked and being encouraged to go forward without proper scientific backing and with the blessing of the ADA.  NOTE:  Copy the following into the search box to be taken to the article - doi: 10.1097/SLA.0b013e3181be34e7.   We are lucky that Janet Ruhl has chosen to write about this. No one else seems to be even aware that a group of doctors are being given a nod to charge high fees for an unproven surgery.

I am concerned that many people who are easily persuaded by doctors and their own fear of diabetes, plus the fear of giving up their "good" life will have this bariatric surgery which at this point has to be risky at best.   I have seen several persons posting on several forums who have had the surgery, but do not tell us what is happening to them now.  After a month of how good they feel, I am not aware of any that are participating any longer to make us aware of the successes or pitfalls of having the surgery.   That is not to say that I may have missed a post or two, but I do feel that many just disappear and never come back to let us know how good or how bad the decision was.

Depression and Other Thoughts

Sorry this has been a while since posting anything.  After doing my volunteer work, I was having a difficult time getting all the information together for another post and am still waiting for some additional information.  Yes, I may have had a little writer's block and a good dose of the following. 

Depression for people with diabetes is a factor to deal with.  David Mendosa has written about it describing five strategies for conquering depression.  I agree that the five strategies are good for many people, I am a little disappointed that two of them do nothing for me.  The five are

• Exercise - this is the best one for me.  I have to get my repetitions up, but it is helping better than anything.
• Music - may help many, but leaves me cold.  Probably because it is difficult to get much on the local radio stations that is relaxing.  That plus being in a poor reception area and a lot of electrical interference makes it nerve racking.
• Meditation - I have never been taught how to meditate and thus cannot say what this would do for me.
• Vitamin D - This has helped, and my last test was 64 which is not at the bottom.  The vitamin D that I have been taking must be helping.
• Omega-3 - This may help, but I need to do more research here.

Now understand this is for minor depression and that severe depression requires medication.   Mr. Mendosa states in this article that 19 percent of people with diabetes suffer from major depression and an additional two thirds of us have some symptoms of depression.  This means that it can be a constant companion that we need to deal with on a daily basis.  I think for me, this winter is probably more difficult for me.  I have always enjoyed living here, but after breaking my tail bone last winter on ice,  this winter has taken a lot out of me

In the limited research about this, every source is willing to go into detail about symptoms and causes, and most make the assumption that the depression is major and the only treatment is medication and psychotherapy.   Very few even mention minor depression and variations on this theme.  The National Institute of Mental Health seems to have the more balanced approach to depression.   They list many of the symptoms, but do little to enlighten us on the various causes.

Of course, I may also be talking about something that is not depression, but related.  At least most of the sources listed illness as a contributing factor.  The one statement many made, that I have to agree with is "Most people with depression never seek help".  Most refer to common treatments of medication and psychotherapy, which means severe or major depression and not minor depression.

Other Thoughts -----

Since January began, I have been pleasantly surprised at the number of blogs that have really said something to me.  I read a lot, but most I read and go on to the next.  So the following people need my thanks -

1. Tom Ross - two blogs - one on 01/08/10 and 01/09/10.  The first deals with diabetes and smoking and then with the alarming fact that many doctors are not properly treating or seeing that their patients are given proper instruction to handle their diabetes.  We are seeing more and more of this on the forums when people come asking what to do when the doctor have left them wondering how to take care of themselves.  The second covers the middle ground and the lack of clear defining definitions for the meanings of diabetes.  An example is the poor definition of prediabetes.  Thanks Tom for blogs to make you think about what some of us take for granted and misuse when talking about diabetes.
2. Bennet Dunlay - blog of 01/07/10.  His discussion is about our misleading food labels.  This is a topic that needs investigation and more exposure.  
3. Will Ryan - blog of 01/04/10.  Shows how we need to be alert 24/7.  Covers how a small incident resulted in a meter reading over 400.   Will - we all need reminding.
4. Scott Strumello - blog of 01/08/10.   This is a well written article about the new insulins that may be coming on the market and that may help bring overall costs to a more reasonable level.  This is a much needed improvement and may make insulin more available world-wide.
5. Robert Scheinman - blogs of 01/04/10 and 01/11/10.  Two articles about fat and how the different types affect those of us with diabetes.   I normally do not read articles like these, but for once I am very happy I did.  

These are the ones that really meant something to me.  There were a few others that were interesting, but had no lasting impact.

I am on a mission to encourage bloggers with type 2 diabetes that have not blogged for a while to get back to blogging.  One has and I hope others will renew their blogging.

Lesson to be learned

Before doing this, I had to do some hard thinking and get back to my positive side.  If you are interested, please read a post by Dr. Bill Quick at My Diabetes Central.  He did an excellent post correcting information put in the public domain by the American Diabetes Association.  This information was, to say the least, poorly thought out and not the full truth.

I must thank Tom Ross for his blog of Nov 9, 09.  I agree with his analysis of a common concern of newly diagnosed people with diabetes.  Most do seem to want the "rules" that they can follow to be able to be compliant with their doctors' orders (if indeed the doctor ordered anything).

I belong to a couple of forums about diabetes and this repeats itself very often.  All are searching for some simple rules to get their blood glucose under control so they can return to living.  They do not realize that diabetes is a 24/7 problem they must deal with.  Many, but not all, do not want to hear what they are told and never post again.  Others take a different tack and reposition their question to elicit a response more in their favor.  Failing with this, they post the same or similar questions on several forums.  A few wake up, pay attention, and proceed to ask the real questions.  They are receptive to the variables and the idea that the "rules" are the ones they discover about their own situation and body chemistry.

We can tell people that "what works for me, may not work for you", but many do not listen.  When something does not work, they blame the forum and its' members and do not return.  They keep looking on other forums for answers, but do not find them and never post again. 

I may be wrong, but "rules" and "quick fixes" seem to be at the top of a list of what these people are looking to find.  Few are type 1's, but the majority are type 2's.  Many, unfortunately, do not have insurance and are unable to do everything they should to test as frequently as they need to for determining what foods their body is capable of handling.  Controlling their blood glucose now becomes a problem which the doctor often can not help.

Since November is diabetes awareness month, there are many bloggers putting out some excellent blogs for diabetes awareness.  Hopefully they are reaching more than just fellow bloggers.  I am listing several that have something to say.  Amy Tenderich has an excellent blog on Nov 13 about some interesting technologies on the horizon (and in the near future I hope).

The over commercialization of diabetes and the attempt to take advantage of people with diabetes is the subject of posts by Janet Rulh on Nov 8 and Scott Strumello on Nov 13.  They both make valid points that must be considered and expose some of the shortcomings of diabetes awareness month and diabetes day (Nov 14).  I admit that I was unaware of what happened during diabetes awareness month other than it was a month on the calendar.  I had never heard of diabetes day.  Some bloggers are doing a lot within the diabetes community, and a few are actually channeling their efforts outward to the public to make them more aware of the truth of diabetes.  This is where I hope to make some effort next year. 

I appreciate Scott Strumello's blog about dogs for the hypoglycemicly unaware.  He listed one supplier that is being sued by the State of Missouri for violations, but otherwise the blog was good to put in front of the people.  This is a repeat for a previous post.

George Simmons took a different view of veterans's day.  Since he is unable to serve his country in the military, he has chosen to view himself as a veteran in his war on diabetes.  Good interpretation and a worthy cause George.

Notice on Diabetes Alert Dogs

For all future blogs about diabetes alert dogs, service dogs, and related blogs, these will be found at the following link.   Thank you, Bob

I feel that separating the two topics will allow more concentrated effort for each.

Diabetes Resources on the Web

The number of web sites devoted to diabetes continues to grow. This should be a good thing, but I am wondering if we are getting the advantage. It seems that many of the sites do nothing but promote more studies about nothing and create more misinformation.

I had hopes when Amy Tenderich covered a new site "TheDiabetesResource.com" that had been sending out emails to announce it arrival on the scene. Its mission was to be a resource for all that is about diabetes. Amy's coverage was on October 5, 2009.

So to see what Amy was talking about I did some investigation. I discovered that it had a listing of blogs about diabetes; however, when I looked further, many of the blogs are misclassified, listings are duplicated, and in some cases are dead sites still on the web (anything with no activity for more than two years is a dead site to me). There is a lot of work for this site to correct the errors it has created for itself in the rush to go public.

I commend the site for what it wants to accomplish, but it did not do its homework before exposing its flaws to the public. Many of the errors will probably remain uncorrected while the site tries to get the latest information on line. Yes, we all make mistakes and live to regret proper prior planning and this site will have a lot of work to do to become the source for all that is diabetes.

Until some of the misinformation and errors are corrected, I will sit on the sidelines and wait before joining. I like the concept, but not the product that is now available for public consumption.

Here's hoping that this site is able to fulfill it mission and be the one source for diabetes - there is a need for this.

Types of Service Dogs

This is off the topic of diabetes, but necessary to be grounded in the subject of assistance/service dogs of which diabetes service dogs are an integral part.

Assistance Dogs International Inc. (ADI) uses a simplified definition, listing guide dogs for the sight impaired, hearing dogs for the hearing impaired and service dogs for other disabilities.  While guide dogs have a 70-year history and hearing dogs a shorter history, other service dogs are a recent development and have not gained the recognition in numbers to be in a class by themselves.

Please take time to browse their complete site.  It has much valuable information for determining whether you are being given the correct guidelines for training and the essentials for measuring the training your dog needs to be an excellent assistance/service dog.

Now, service dogs for other disabilities will take up the rest of the discussion.  There needs to be a list of these service dog types for medical or health related disabilities.  Standards may be developed for all these types or for each type of service dog.  Service dogs for disabilities are covered by Americans with Disabilities Act (ADA).

Please note that Therapy Dogs, Search & Rescue Dogs, Forensic Dogs, Police K-9's, Military Working Dogs and other types of working dogs are NOT Service Dogs.  This may be what ADI is referring to for facility and therapy dogs for which currently do not have standards established.  

Liz Norris of Pawsabilities Unleased has a list of eight types and some of the tasks they can be trained to accomplish.  The US Service Dog Registry lists 13 types of service dogs in addition to guide and hearing.  Not mentioned in either list is service dogs trained for cancer, strokes, and migraines.  More types are being added regularly and many service dogs are trained for multiple disorders in their human partners.

The latest type of service dogs added is for soldiers suffering from post-traumatic stress disorder (PTSD).  This project is part of a study funded entirely but the Department of Defense and put service dogs with 10 soldiers.  The other type recently added is a service dog for autonomic neuropathy.  Autonomic neuropathy is a disease that damages the autonomic nervous system, a branch of the central nervous that helps people adapt to changes in their environment, according to the American Heart Association. 

Today only 0.9% of persons with disabilities have service dog partners.  This means that there are approximately 15,000 service dogs across the U.S.  These dogs have a significant influence on their human partners' lives and are able to function more independently with the help of their canine partners.

Diabetes Alert Dogs - Part 2

Getting Prepared

Think you want a diabetes alert dog?  Are you prepared and do you know where to find one?  Chances are you are pretty much in the dark.  You are looking for information - any scrap of information that may lead you to where you can obtain more.

The information is out there in the internet, the difficulty is finding reliable information and knowing what you need.  Learning is the most important part.  This is the step you do not want to rush.

There are two terms that you should know.  Service dogs is a common term and diabetes alert dogs is one of several types of medical service dogs.  Americans with Disabilities Act (ADA) is the law that makes it possible to take the service dogs into places they would not otherwise be allowed.

The following is from "Clickin' Canines" website of Rita Martinez, used with her permission.

Quote

LIVING WITH A SERVICE DOG

So you want a service dog!!!

Service dogs can be a wonderful asset for someone with a disability, but it is always good to go into anything with your eyes open from the beginning.  Many factors come into play with the use of a service dog.  These dogs can be a life saving partner, but they come with needs and can change every aspect of your life.  Below are some things to think about:

1. Do you like dogs?  Enough to share your life with them 24/7?  These dogs are not simply a tool, they are individual intelligent creatures with their own set of needs.  They become a part of your everyday life.  Are you ready for this kind of sharing?
2. Are there other animals in the home?  Do you have family support for a dog?  Keep in mind that bringing in a working partner while there are other animals in the house will change the dynamics.  Are the current animals likely to adapt easily?  Does the rest of the family want an addition to the household?
3. Having a service dog is like growing an appendage.  You are no longer just you - you are a 'we'.  That means there are frequent times that it will be inconvenient.  You have to make sure the dog has a place to be comfortable with you yet safe from heat or cold or tight quarters etc.  Yes, that means even in public restrooms...
4. Are you ready and able to care for your dog's physical requirements?  Dogs need proper exercise, grooming, bathing, feeding and off-duty outlets.  There also needs to be a provision for the financial responsibility of regular healthcare and preventative medicine.
5. Are you ready and able to participate in continued training to keep the skills from degrading?  Training is never finished - Maintenance is forever.
6. Are you aware that there are licenses, equipment, and miscellaneous costs associated with having a working dog?
7. A service dog is on call 24/7 for you.  Are you ready to be equally dedicated to your dog?  They aren't machines with a off switch, they are living partners.
8. Are you aware of the public issues you will come across?  You will forever be answering the same questions, educating the general public about service dogs, never be simply un-noticed, and will have to deal with the individual fears that people have of dogs!  You will have to consider where you can walk, sit or stand and be safely out of harms way.  You will have to seek appropriate places for your dog to relieve itself.  You will be responsible for all your dogs needs at all times.
9. And lastly, are you comfortable with the liability of having your dog with you in all situations in the public?

These questions are not meant to discourage you from having a service dog.  But, it is wise to approach  something this important with real thought.  Having a dog as a working partner is a commitment that lasts many years.  It is a decision that needs to be well thought out.  End of quote.

I would like to expand on Rita's number 2 above.  If there is family support and there are other pets in the house, will the family members be willing to give up those animals for your service dog if it becomes necessary?  If there are cats in the household, how difficult will this be for the service dog?  While some pets do get along well together, is the family willing to part with those pets that do not get along with the service dog?

And I would include some specifics not mentioned -

• Do you have the patience required to have a service dog?  They cannot be mistreated or neglected.
• Under financial and miscellaneous fees, there will be vet bills and the need to have emergency vet care available.  Have you located or know where to locate this service?  To keep a service dog requires weekly expenses for dog food.
• And, as the service dog ages, will you be ready to take on a replacement dog and retire the current service dog?  Most people writing about service dogs do not bring up this issue, but it needs to be thought about.  All dogs age and lose their usefulness in 10 to 14 years and need to be retired.

All are questions that need to be answered before the search begins.

If you have answered all of the above questions and are comfortable with the answers, what is next?  There are several ways to proceed.  You will have to decide what is best for you and your own circumstances.

1. It is my belief that you need to locate a trainer before thinking about getting a dog.  Both the trainer and the dog will require much research, but having the trainer first gives you an advantage because the trainer will while assessing your needs, be able to make recommendations for a possible dog and have suggestions on finding a good fit for you.  You still will have to make the final decision.  The links provide a place to start in locating a trainer.  Rita Martinez lays out some excellent frequently asked questions (the first three are very important), how to choose a trainer, and choosing the trained dog.  Please read this carefully.
2. For those persons who know they desire a certain breed of dog, check with the American Kennel Club for locations of breeders.  You will need to then follow the same steps under choosing a dog, but apply this to the breeder and you will need to check out their trainers as well.  Do not bypass any of the steps as this could cost you many dollars being misspent.  How do I get this point across - Do not make decisions based on emotions!!!  There are breeders out there that are counting on your emotions taking over once you see the dogs.  Never make a visit until you have completed your homework.  Yes, visiting the breeder's facilities is the next to last step, but be prepared to leave if you don't like your first impression.  Make them show you the entire facility before they show you the dogs.
3. Then there are those of you who will want to go to the local SPCA or animal shelter.  Now I would strongly urge you to have a trainer first.  You will want to have discussed this with them and they will have prepared you for the questions to ask.  You will want to make sure that the recent history of potential dogs is known.  I may cost more to retrain out bad habits and past abuses that the animal may have suffered.

For both the trainer and the breeder, check the Office of the State Attorney General in the state where they are located for complaints or actions on file against them.  Once you have the references, do not put them in a drawer and think you have completed you due diligence.  Call or correspond and get the information!  It just may prevent future disappointment.

There are dog breeders, trainers, and others that are reputable.  The above is to help make your experience a pleasant and positive one - not one of regret.  Always remember, they should put your needs first and fully answer your questions.

Now comes the big decision - getting the dog!

Note:  I have used Rita Martinez as a resource person for much of this because her philosophy is close to my own and while we may differ sometimes, she offers many pointers that I might have missed otherwise.  Both of us want to make the experience of getting and having a service dog a pleasant and satisfying experience.  Rita has and is working with about 40 dogs for diabetes alert dogs.