Not Just Pets: Service Dogs Enhancing Life with Chronic Illness
Written by Alexandria Yarborough, PharmD
I absolutely love dogs. If I happen to see one when I am out, I will almost always ask the owner if I can pet it….unless it happens to be a service dog. As much as I want to pet them, I realize that they are working and move on. Unfortunately, that is not always the case.
Last year, I had the pleasure of meeting my friend Yasemilit “Milit” and her service dog, Luna at a spoonie meetup. A spoonie meetup is for anyone with chronic health conditions such as POTS. We each talked about our various chronic health conditions, identified shared experiences (both good and bad), and understood each others’ unique, yet similar struggles. It was so nice to be around people who understood what it was like living with a chronic health condition. After the spoonie meetup, Milit and I stayed in touch. I have been honored to learn more about her story.
Milit's Journey with Chronic Illnesses
As a child, Milit battled different health conditions. The main ones are severe anaphylactic allergies, asthma, and chronic anemia. Her allergies were especially difficult to deal with. The most debilitating is an allergy to chocolate. I don’t know about you, but I can’t imagine being a child (or even an adult?!) and being denied chocolate.
As a result, Milit was a frequent flier at numerous emergency rooms. As a teenager, she battled with severe endometriosis and found herself often in unbearable pain. These conditions resulted in a lot of time away from social activities and school. In 2011, she developed her most serious symptoms to date.
She began battling severe gastrointestinal (GI) inflammation and eating made it worse. She found herself scared to eat because eating it almost certainly meant pain. Milit lost so much weight she got down to under 100 lbs. Being of Puerto Rican descent she found herself trying numerous homeopathic remedies, but nothing was working. She then visited numerous doctors who ignored her symptoms because her lab values were normal.
Finally, two years later she was referred to a gastroenterologist who diagnosed her with Crohn's disease. Although having a diagnosis was helpful, she found the disease state difficult to manage. Her GI symptoms, fatigue and inflammatory attacks were often unpredictable and painful. Even the medications prescribed to help were causing numerous side effects, especially dizziness.
In 2017, Hurricane Maria, a Category 5 hurricane, devastated Puerto Rico. Because of this, Milit and her family immigrated to the US, settling in the Orlando, FL, area. A few years later, in 2020, she started having more troublesome symptoms. Often, she would find herself about to faint (a medical condition called presyncope). Her blood pressure would drop significantly, her vision would go black, and her heart rate would skyrocket.
At this time, she had been a veterinary technician for 18 years so she just figured she wasn’t resting enough or was overworked. She saw her general practitioner and was referred to a cardiologist. Based on her history of medical gaslighting, she was thankful for the referral.
After being given multiple tests from EKGs to being required to wear a Holter monitor, she was finally diagnosed with POTS. Luckily, her job was able to accommodate her so she wasn’t standing on her feet all of the time. For example, she was no longer assisting in surgery but switched to dental cleanings or pharmacy where she had the option to sit while working.
Although accommodations were made, Milit was still battling severe symptoms such as presyncope, unpredictable blood pressure and heart rate changes, extreme fatigue, blood pooling in her feet, and nausea.
Luna attending to Milit during a POTS episode.
Luna: more than just a pet
Milit’s family never owned dogs but she always desired one of her own. One day at work, a litter of adoptable husky puppies came into the vet’s office and it was love at first sight. Despite living in tight quarters at the time, she immediately connected with Luna and had to have her. She was her dream dog.
She trained Luna as she would any dog, with basic commands such as sit/stay, and walked her on a leash. Yet, during the pandemic, Milit noticed that Luna was starting to act differently. Stay-at-home orders and reduced hours led to Milit noticing that Luna seemed to make herself known right before a flare-up would occur. It was a unique coincidence.
Luna would either lay her head down in Milit’s lap for 30-45 minutes before she would experience a Crohn's Episode, if Milit was sitting down, or nudge her if she was standing. This was life-changing. Luna’s signaling would help Milit plan to find a safe and or private place to deal with her symptoms. She mentioned this to the vet that she was working for at the time and they suggested that Luna be trained as a service dog.
Unfortunately, finding a trainer was a difficult journey. Milit is bilingual and Luna’s commands were in Spanish. Because of this, she was dismissed by a lot of trainers who were not up for the task. Training in this case was particularly complex with having two languages and because to train Luna to act upon Milit’s different health challenges that impact her daily life, unfortunately, you must provoke symptoms. This is an unknown and often the most difficult part of training a service dog. Finally, one trainer accepted the request to work with Milit and Luna even with their bilingual abilities. That’s all it took to forever change both Milit and Luna’s lives.
At this time, Luna is bilingual and can respond to both English and Spanish commands. Not only that, she also responds to hand gestures. So, verbal commands are not always necessary. In addition to alerting a Crohn's flare-up, Luna is also able to alert Milit when her heart palpitations elevate and reach 120-125 beats per minute.
A Day in the Life with a Service Dog
I wondered what a normal day was like for Milit and Luna. Milit explained on regular days, Luna spends her free time like any dog, lounging around the house. However, she is always ready to alert Milit when she has an episode approaching.
Luna’s role as a service dog is defined as a medical alert/mobility service dog. This means she will alert Milit concerning Crohn's/POTS symptoms (fatigue, joint inflammation, GI upset and pain) but also counterbalance when blood pressure is low or dizziness is present. She will put deep pressure on top of Milit’s legs to help comfort her and help with blood flow when it starts to pool during a flare-up of POTS. These talents allow for the decreased length of time episodes of symptoms last.
Milit visiting NYC with Luna by her side.
In addition, Luna helps with dissociation interruption (the process of stimulating someone who is losing conscious awareness due to various medical conditions). If Milit is going in and out of consciousness, Luna will lick her hands. If she is able to pet her, Luna knows that she is okay and not to lick. When fatigue strikes, Luna is able to help with forward momentum. This is helpful when Milit is out and about, especially with long distances.
Luna is integral to Milit’s freedom and managing her chronic conditions. Nothing can compare to the peace of mind Luna can provide. When she hasn’t had Luna present there have been devastating consequences. Once, upon passing out, Milit fell down the stairs at her former apartment complex. This would have never happened if Luna had been around to assist.
Unfortunately, things don’t always go well when it comes to having a service dog. Luna is not one of the typical four types of service dogs; German shepherd, lab, poodle, or golden retriever. Huskies are not a usual choice. Because of this, people usually don't realize Luna is a service dog, and she draws a lot of unwanted attention. To raise awareness for how to act around a service dog, here are a few tips Milit has compiled.
5 Things to Remember with Service Dogs
1. Service dogs are working.
Please talk to the handler, not the dog; especially not in any distracting way such as baby voices. Do not approach, pet, scream, record, etc. without the permission of the handler. If Luna is distracted, she could miss alerting Milit of an upcoming episode.
2. It is never appropriate to ask why a service dog is needed.
Service dogs are used for those with health conditions. Oftentimes these conditions are invisible such as POTS or Crohn's. Even if the handler looks perfectly fine, it is not your business to know why they are needed. No one asks about your health conditions in public and those with service dogs should be offered the same privacy.
3. Never give a service dog food or treats.
If you have something for a service dog, offer it to the handler and they can decide if their dog can have it. Service dogs can have allergies or get sick too. If they are sick, they can’t work.
4. It’s okay to ask questions about the service dog, but please ask if it is a good time.
Give them space especially if you see someone on the floor. It’s hard to have a conversation when you are not fully conscious.
5. Realize it's okay for a handler to say, “No”.
They are not required to answer your questions, explain their health history to you, or allow you to take pictures of their service dog. Some handlers don’t mind photos but you should never follow them around and take them like a paparazzi.
Redefining Disability
In addition to tips about service dogs, Milit mentioned that she is also spreading awareness about the term disabled. She considers herself disabled because her health conditions require her to seek accommodations within her daily life.
However, she would like to change people’s perspective on what it means to be disabled. Disabled people are no different from "able-bodied" people. The term doesn't mean she can't do things, it just means she needs a different way to achieve it. This can be accomplished through accommodations.
Luckily for her, she has the doggone best one around, Luna.
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