This is the first real guild on how to do this since I can’t afford to have my dog trained professionally, I have been searching for weeks thank you for this
Me too It is all very well buying a “ pretrained” alert dog but most disabled people are on low paid jobs or on benefits so we must self train. I am getting a new puppy on Saturday to train as my new assistance alert dog.
This was helpful. I started this with my dog a year ago and did what all the other videos were doing but my health wasn’t the best so it was difficult to keep up with it. Your video is a lot better and more concise than the ones I watched a year ago. I feel confident starting back up with my service Saint berdoodle. So thank you! 😊
Wesley the Service Doodle, This was really great! I know this is an older video, but I am just going through them all. Thanks for sharing this. I will have to check to. see if my cardiac issues would apply to this method. Really lovely to see how well Wes did! High five to both of you!! :)
OMG this was helpful. I'm training a doodle puppy for a young girl with POTS. We will def be using this technique. I am looking for more from you now. Thanks a million.
Emily- this is super helpful! I am looking at training my sdit for medical alert for vestibular migraines in hopes that before the vertigo sets in I can take my preventative meds and get to a place to sit down before an episode happens. This was awesome!!
Thank you for making this! I have always wondered how people train medical alert dogs! Hope you have a wonderful day and rest of the week! Ps Wes is so cute!
That was an excellent way of showing or training your dog for cardio and I think I'll do that myself because I do have heart disease myself but I need to know how I can do a training with diabetes and COPD and PTSD
Others say the sample is good for a month in the freezer but I don’t know if you can use it then return it to the freezer to use it again for the whole time. They are saying the sample is only good for 2-3 day if only refrigerated. Thank you for showing how to teach to paw. I hadn’t seen anything about that yet. I am doing the regular obedience training right now but I am going to start the alert training very soon since this dog is so fast a learner.
This is sooooo helpful thank you so much. I’m looking into getting a PSD and until now I couldn’t find the steps for medical alert anywhere and was very overwhelmed.
Hello! I am a dog breeder and mobility service animal trainer for veterans. I recently had a client who has asked me to train their dog to do medical alerts. We found that your video was incredibly helpful. However i want to say that what really sold me on you as a trainer was the ecollar. People are completely wrong about this tool. What I tell all my clients is that it allows super gentle dog training and is a very effective tool for teaching the dog "that is not the command im asking for". Anyways... i can tell just by watching this video that you know how to use the ecollar properly and my only wish is that you would use your public high profile to help fight the stereotype that is associated with the ecollar. Caesar Millan uses them too, and never has them in his show. Then every time i pull it out people assume its a shock collar. I have to put it on them to show them how gentle it is. Please Please Please do a video on the ecollar for people so they can see the benefits! again top notch video, and top notch dog trainer here yall! PS Im a man who can admit when im wrong. I found your ecollar vids! Sub'd!
Von Bear K9 This honestly just made my day! Thank you so so so much for your kind words and support💛. I’m not a professional by any means, I have just learned from an array of amazing trainers! I will certainly keep fighting the stigmas!
Well i speak the blunt honest truth, so im not buttering you up. Since earlier i dove into alot of your videos. So much of what you say in your videos is exactly how i train/live. I mean its almost like we have the same philosophy, or the trainer who helped you does. Which means he/she is very good at what they do, which also means that you took the time to find a good trainer. In another video you mentioned that you get tired of people approaching you and saying what a pretty dog.Oh boy... I am a disabled veteran with a spinal injury. So i can relate. Its gotten so bad, that my wife will just walk away when strangers approach in a store because she knows ill be held up for 10 mins while the stranger chats me up. The way i got involved in service dog training was very organic. My service dog is named Mountain. I had a very hard time standing up, and have very bad muscle spasms. My Mountain was essentially charity, and he changed my life so much that i paid the trainer to shadow him, so i could help other veterans. I mean now, I can walk around the block, am off pain meds, and I never got the second surgery the surgeon was pushing on me. Service dogs are so amazing when they work, and its getting worse and worse out there. I dont know if you have noticed the movement on tv news(mainly the airport cases), but i feel that has directly made it noticeably worse. I just love it when the hostess of a restaurant asks to see my "certification". Like even if certifications where actually a thing, would i really have to show it to the restaurant hostess? Seems a bit much.
This video was so helpful to me, especially the part where you described increasing Wesley’s sensitivity to the smell. My SDiT is learning behavior interruption (legs shaking) right now and doing well with it, but I would love it if she was able to alert to increasing cortisol levels. I will use your tips! Thank you!
I know this is an old video but if you see this - is the unscented sample a sample from you when you weren't having an episode or is it just a plain cotton ball? If the latter then how does he know to pick out the scent from the specific episode rather than just constantly alerting? Sorry if you mentioned this and I missed it. Thanks!
The unscented sample is a plain cotton ball, reward when your dog alerts the scented sample and don’t do anything when your dog rewards your unscented sample. Hope this helps! 😁👍🏼
This video is Auctly very helpful for me i plan on getting a medical alert dog for my anxiety and heart since my heart has ben acting up lately .. really glad i came across this
Hi....I am chronically ill and I am thinking about getting a service dog especially due to the fact that my DH is getting older and we both feel that getting a service dog for me. Would you mind giving me some advice, such as what is the best type of dog to get for a service dog? Also, my DH has a friend that asked him to take his service dog when he passes away (the man is blind)....Could a dog that's been trained for someone else be retrained to help me? I have severe headaches, I vomit (alot every day) I am diabetic, I also suffer from Vertigo. Thanks for any help you might be able to give me. Thank you.
If I am training my dog for cardiac alert for my POTS, should I only take samples when my HR is high due to the POTS, or could I take samples when I'm exercising and my HR is up naturally? So far I have only taken samples when there's no other reason for my HR to be high. I feel like those are very different scents to a dog.
I have a West Highland White Terrier that will is training to be my psychiatric service dog and after the psychiatric service tasks I want to also train him for medical alert for my asthma
I never trained my dog he just started allerting and then my ekg results came back abnormal and then i understood why my dog would tap my chest repeatedly with his paw and then place his wait on my chest
Does the cotton ball work for any scent detection. I am only using actual wheat? But she has an auto immune so get body attacks itself when she accidentally eats certain foods. Just thought I would ask and see if you knew. My trainer only has done diabetic dogs and not this type of service dog.
I am sorry, I am not sure if it will work with that! I know there are allergy detection dogs and I am assuming they are trained using the scents but I do not know enough to be sure. I am sorry!
Do you think I should get a golden retriever puppy and train it to be a medical alert dog? Heres why. I have anxiety and my leg shakes all day :/ i also get panic attacks i had one a few days ago also when i had one i was saying lies that i thought where true and i was bitting my nails but i didnt notice that i was doing that untill a few mins after when there was the pain. I want the dog because i think it would help me with stop shaking and have less attacks and i think it will help me have less anxiety. Btw i have had therapy and it didn't work...
Thank you so much for this video! I'm getting my prospect soon and your channel is really helpful. Does anyone know if you can teach a dog to alert for seizures using this method? Or how to time the swabbing with petit mal seizures? Thanks!!
shelby j I think this works for seizures too, I know they use this method for company training diabetic alert dogs so I think it’s a solid all around method.
Hi Emily. I have narcolepsy and I read that our sweat is different from non narcoleptics but not sure how to shape that into a medical alert since it’s not as readily available as saliva. But i guess I could try saliva too? I also just want to clarify something. So you made the sample when, not before, you were having an episode? Because while I do get a feeling most the time before sleep attacks, I could have the attack hours later or sometimes not at all. So I wouldn’t be sure when to get a sample.
Only difference for me is I sweat profusely which has a sweet smell different from normal sweating Can I use sweat samples not saliva? Apart from general house/ puppy manners training how soon can he start this training?
So I’m not sure if you have any advice for this but let me know: I have extremely severe epilepsy to the point where it is life-threatening. Because of this, I have to have my seizures under strict control or else I will die. This means that I’m not able to have seizures all the time. The problem with this means that I can’t really get scent samples easily from my seizures. Do you know what I could do? I am trying to look into synthetic samples and I can’t find any that would work for seizures. Do you know where you could find them? Do you know if there is anyway to get seizure samples from other people? I am desperate. I tried loosening my treatment in order to have more seizures to train my dog about a year ago and because of it I almost died, so I can’t try that again. Please let me know if you have any ideas
Saliva is one of the best ways to do it. You can soak a cotton ball with it or swab your gums really thoroughly. For elevated heart rate get to a point you want them to alert (a bit before you get extremely elevated so that you get warning, but not too low that you are getting false alerts). You can get several samples depending on how long your episodes last.
Will the dog be able to tell when it will happen no matter what or is you need to know will you have to lick something and have them sniff it to something like that or will they alert without it.(not the sample to train with but saliva in the moment)
I have a question on what dog food you use for Wesley? I have a doodle that seems to have stomach issues and I use grain free food but she still seems to not tolerate it very well. You also said something in a video about a probiotic you give him. What is that?
Bridget Mineck I don’t know what she gives Wes, but I have a goldendoodle who used to have really bad stomach issues and we now feed him performatrin ultra grain free. We also give him a spoonful of pumpkin to settle him.
I absolutely love your video and will look for more. I am planning to buy a puppy and train it myself as a Diabetic Alert Dog because I cannot afford one that is already trained. I have type 1 diabetes and get no warning of hypoglycemia. I pass out regularly and sometimes I will sustain an injury. Can you give me an idea of what is a good age range to start the training? If I get a very young dog then I will have to potty train, basic command train, and scent train. This will be very time-consuming. What do you suggest?@@wesleytheservicedoodle1047
How did you find a good trainer to help you train Wes? Im chronically ill and wanting to owner train, I just don’t know where to start when it comes to picking out a puppy from a breeder & finding a good trainer to help!
Hi! my name’s Delaila and i have type 2 diabetes but i’ve been on insulin since they first diagnosed me with diabetes and i’ve been thinking about getting a diabetes service dog since it’s really hard for me to control my sugars since i’m a minor, but i haven’t been able to find any information on type 2 diabetics having service dogs so i was wondering if you knew anything about type 2 diabetics being able to have a service dog? I’m not sure if you can answer this question but it’ll be really helpful if you can, thank you!
Katie s if he were to alert to the unscented that means he is confused and you need to take a few steps back and correct him. Try breaking your steps down a bit more, try switching up the containers so he isn’t alerting to shape. If that doesn’t work it means he doesn’t under stand your training. To fix this you can retry training the alert as well as retraining the sniffing and treating for just sniffing and then apply the alert after a few sessions.
Austin Lee thanks for your opinion on what I need, but it didn’t actually pertain to my statement in a helpful way. Your comment was based on an assumption that I only get samples once every six months. Please try not to tell people what they need and don’t need.
My SD alerts to a breathing change. It is not a behavior it is a part of a medical episode. Does that count or does it have to be scent trained? She uses her ears instead of her nose to alert that's the only difference.
So well done Emily ❤️ V v v proud of u and Wes
Service Angel Percie You are the best person ever💖
luv u both 💕 hope u are doing well🌿
This is the first real guild on how to do this since I can’t afford to have my dog trained professionally, I have been searching for weeks thank you for this
Me too It is all very well buying a “ pretrained” alert dog but most disabled people are on low paid jobs or on benefits so we must self train. I am getting a new puppy on Saturday to train as my new assistance alert dog.
that is amazing training , easy and nice something you as a person can remember to do fast step by step to train. thank you!!!
Thank you for watching! I hope it helps you in your journey :)
This was helpful. I started this with my dog a year ago and did what all the other videos were doing but my health wasn’t the best so it was difficult to keep up with it. Your video is a lot better and more concise than the ones I watched a year ago. I feel confident starting back up with my service Saint berdoodle. So thank you! 😊
Wesley the Service Doodle, This was really great! I know this is an older video, but I am just going through them all. Thanks for sharing this. I will have to check to. see if my cardiac issues would apply to this method. Really lovely to see how well Wes did! High five to both of you!! :)
Thank you so much for watching my videos, I hope you enjoy them! And if your issues do, I hope this works out for you!
OMG this was helpful. I'm training a doodle puppy for a young girl with POTS. We will def be using this technique. I am looking for more from you now. Thanks a million.
Emily- this is super helpful! I am looking at training my sdit for medical alert for vestibular migraines in hopes that before the vertigo sets in I can take my preventative meds and get to a place to sit down before an episode happens. This was awesome!!
Thank you for making this! I have always wondered how people train medical alert dogs! Hope you have a wonderful day and rest of the week! Ps Wes is so cute!
Thank you for watching, I'm glad it was interesting!! And thank you :)
That was an excellent way of showing or training your dog for cardio and I think I'll do that myself because I do have heart disease myself but I need to know how I can do a training with diabetes and COPD and PTSD
so helpful!! thank you for this!! you and wes are amazing ❤️
Oh thank you so much! I am really happy this helped. :)
Others say the sample is good for a month in the freezer but I don’t know if you can use it then return it to the freezer to use it again for the whole time. They are saying the sample is only good for 2-3 day if only refrigerated. Thank you for showing how to teach to paw. I hadn’t seen anything about that yet. I am doing the regular obedience training right now but I am going to start the alert training very soon since this dog is so fast a learner.
Romeo is a mobility dog w-some alertness- we need to improve it but your tips r AWESOME
This is sooooo helpful thank you so much. I’m looking into getting a PSD and until now I couldn’t find the steps for medical alert anywhere and was very overwhelmed.
Hello! I am a dog breeder and mobility service animal trainer for veterans. I recently had a client who has asked me to train their dog to do medical alerts. We found that your video was incredibly helpful. However i want to say that what really sold me on you as a trainer was the ecollar. People are completely wrong about this tool. What I tell all my clients is that it allows super gentle dog training and is a very effective tool for teaching the dog "that is not the command im asking for".
Anyways... i can tell just by watching this video that you know how to use the ecollar properly and my only wish is that you would use your public high profile to help fight the stereotype that is associated with the ecollar.
Caesar Millan uses them too, and never has them in his show. Then every time i pull it out people assume its a shock collar. I have to put it on them to show them how gentle it is. Please Please Please do a video on the ecollar for people so they can see the benefits!
again top notch video, and top notch dog trainer here yall!
PS Im a man who can admit when im wrong. I found your ecollar vids! Sub'd!
Von Bear K9 This honestly just made my day! Thank you so so so much for your kind words and support💛. I’m not a professional by any means, I have just learned from an array of amazing trainers! I will certainly keep fighting the stigmas!
Well i speak the blunt honest truth, so im not buttering you up. Since earlier i dove into alot of your videos. So much of what you say in your videos is exactly how i train/live. I mean its almost like we have the same philosophy, or the trainer who helped you does. Which means he/she is very good at what they do, which also means that you took the time to find a good trainer.
In another video you mentioned that you get tired of people approaching you and saying what a pretty dog.Oh boy... I am a disabled veteran with a spinal injury. So i can relate. Its gotten so bad, that my wife will just walk away when strangers approach in a store because she knows ill be held up for 10 mins while the stranger chats me up. The way i got involved in service dog training was very organic. My service dog is named Mountain. I had a very hard time standing up, and have very bad muscle spasms. My Mountain was essentially charity, and he changed my life so much that i paid the trainer to shadow him, so i could help other veterans. I mean now, I can walk around the block, am off pain meds, and I never got the second surgery the surgeon was pushing on me. Service dogs are so amazing when they work, and its getting worse and worse out there. I dont know if you have noticed the movement on tv news(mainly the airport cases), but i feel that has directly made it noticeably worse.
I just love it when the hostess of a restaurant asks to see my "certification". Like even if certifications where actually a thing, would i really have to show it to the restaurant hostess? Seems a bit much.
This video was so helpful to me, especially the part where you described increasing Wesley’s sensitivity to the smell. My SDiT is learning behavior interruption (legs shaking) right now and doing well with it, but I would love it if she was able to alert to increasing cortisol levels. I will use your tips! Thank you!
Totally AMAZING!!! This helped me so much- we r going to do this ASAP! Thank u. Wes is awesome
I know this is an old video but if you see this - is the unscented sample a sample from you when you weren't having an episode or is it just a plain cotton ball? If the latter then how does he know to pick out the scent from the specific episode rather than just constantly alerting? Sorry if you mentioned this and I missed it. Thanks!
The unscented sample is a plain cotton ball, reward when your dog alerts the scented sample and don’t do anything when your dog rewards your unscented sample. Hope this helps! 😁👍🏼
This is so helpful! Thank you so much!
This video is Auctly very helpful for me i plan on getting a medical alert dog for my anxiety and heart since my heart has ben acting up lately .. really glad i came across this
I'm so glad it was helpful! Let me know if you have any questions :)
Wesley the Service Doodle i will💞
you guys are awesome! i have a sdit, a 5 month old aussiedoodle! your videos are super helpful thanks :)
This is so sweet of you! Thank you! And good luck with your sdit. :)
Hi....I am chronically ill and I am thinking about getting a service dog especially due to the fact that my DH is getting older and we both feel that getting a service dog for me.
Would you mind giving me some advice, such as what is the best type of dog to get for a service dog?
Also, my DH has a friend that asked him to take his service dog when he passes away (the man is blind)....Could a dog that's been trained for someone else be retrained to help me? I have severe headaches, I vomit (alot every day) I am diabetic, I also suffer from Vertigo.
Thanks for any help you might be able to give me. Thank you.
If I am training my dog for cardiac alert for my POTS, should I only take samples when my HR is high due to the POTS, or could I take samples when I'm exercising and my HR is up naturally? So far I have only taken samples when there's no other reason for my HR to be high. I feel like those are very different scents to a dog.
Wow thank you!
I have a West Highland White Terrier that will is training to be my psychiatric service dog and after the psychiatric service tasks I want to also train him for medical alert for my asthma
Awesome!!! Good job both of you! Very helpful video!!!
Thank you so much! I'm glad it was helpful! :)
I never trained my dog he just started allerting and then my ekg results came back abnormal and then i understood why my dog would tap my chest repeatedly with his paw and then place his wait on my chest
Does the cotton ball work for any scent detection. I am only using actual wheat? But she has an auto immune so get body attacks itself when she accidentally eats certain foods. Just thought I would ask and see if you knew. My trainer only has done diabetic dogs and not this type of service dog.
I am sorry, I am not sure if it will work with that! I know there are allergy detection dogs and I am assuming they are trained using the scents but I do not know enough to be sure. I am sorry!
How long do you keep each training session before putting the scents back in the freezer?
So after you freeze the cotton balls are you supposed to let them thaw out or keep it frozen?
Do you think I should get a golden retriever puppy and train it to be a medical alert dog? Heres why. I have anxiety and my leg shakes all day :/ i also get panic attacks i had one a few days ago also when i had one i was saying lies that i thought where true and i was bitting my nails but i didnt notice that i was doing that untill a few mins after when there was the pain. I want the dog because i think it would help me with stop shaking and have less attacks and i think it will help me have less anxiety. Btw i have had therapy and it didn't work...
Thank you so much for this video! I'm getting my prospect soon and your channel is really helpful. Does anyone know if you can teach a dog to alert for seizures using this method? Or how to time the swabbing with petit mal seizures? Thanks!!
shelby j I think this works for seizures too, I know they use this method for company training diabetic alert dogs so I think it’s a solid all around method.
Omg thank you. Is it hard to train two different alerts? Is it mostly just repetition and sometimes some steps back?
This was so helpful! Thank you!
Of course! Thanks for watching!
Hi Emily. I have narcolepsy and I read that our sweat is different from non narcoleptics but not sure how to shape that into a medical alert since it’s not as readily available as saliva. But i guess I could try saliva too?
I also just want to clarify something. So you made the sample when, not before, you were having an episode?
Because while I do get a feeling most the time before sleep attacks, I could have the attack hours later or sometimes not at all. So I wouldn’t be sure when to get a sample.
Thank you very much, really!!!
Only difference for me is I sweat profusely which has a sweet smell different from normal sweating Can I use sweat samples not saliva? Apart from general house/ puppy manners training how soon can he start this training?
Question
Would it confuse the dog to train for cardiac and sugar alert?
So I’m not sure if you have any advice for this but let me know: I have extremely severe epilepsy to the point where it is life-threatening. Because of this, I have to have my seizures under strict control or else I will die. This means that I’m not able to have seizures all the time. The problem with this means that I can’t really get scent samples easily from my seizures. Do you know what I could do? I am trying to look into synthetic samples and I can’t find any that would work for seizures. Do you know where you could find them? Do you know if there is anyway to get seizure samples from other people? I am desperate. I tried loosening my treatment in order to have more seizures to train my dog about a year ago and because of it I almost died, so I can’t try that again. Please let me know if you have any ideas
I don’t know your full situation and how possible it could be but when you have a seizure could someone else possibly swab the inside of your cheek?
What is the scent used here? If I wanted a dog too alert for an elevating heart rate, how would I collect the scent of that for training?
Use your saliva scent, it’s connected to all types of blood parts, so your heart included! 😁👍🏼
Saliva is one of the best ways to do it. You can soak a cotton ball with it or swab your gums really thoroughly. For elevated heart rate get to a point you want them to alert (a bit before you get extremely elevated so that you get warning, but not too low that you are getting false alerts). You can get several samples depending on how long your episodes last.
Thank you guys. I'll give it a try some day
Will the dog be able to tell when it will happen no matter what or is you need to know will you have to lick something and have them sniff it to something like that or will they alert without it.(not the sample to train with but saliva in the moment)
I have a question on what dog food you use for Wesley? I have a doodle that seems to have stomach issues and I use grain free food but she still seems to not tolerate it very well. You also said something in a video about a probiotic you give him. What is that?
Bridget Mineck I don’t know what she gives Wes, but I have a goldendoodle who used to have really bad stomach issues and we now feed him performatrin ultra grain free. We also give him a spoonful of pumpkin to settle him.
Hold old was Wes when you started to scent train him? Great info!!
Thank you! He was about 6 months :)
I absolutely love your video and will look for more. I am planning to buy a puppy and train it myself as a Diabetic Alert Dog because I cannot afford one that is already trained. I have type 1 diabetes and get no warning of hypoglycemia. I pass out regularly and sometimes I will sustain an injury. Can you give me an idea of what is a good age range to start the training? If I get a very young dog then I will have to potty train, basic command train, and scent train. This will be very time-consuming. What do you suggest?@@wesleytheservicedoodle1047
How did you find a good trainer to help you train Wes? Im chronically ill and wanting to owner train, I just don’t know where to start when it comes to picking out a puppy from a breeder & finding a good trainer to help!
Hi! my name’s Delaila and i have type 2 diabetes but i’ve been on insulin since they first diagnosed me with diabetes and i’ve been thinking about getting a diabetes service dog since it’s really hard for me to control my sugars since i’m a minor, but i haven’t been able to find any information on type 2 diabetics having service dogs so i was wondering if you knew anything about type 2 diabetics being able to have a service dog? I’m not sure if you can answer this question but it’ll be really helpful if you can, thank you!
So of I need my dog to alert to when I am holding my breath
Do you think service dogs could alert to a medical "condition" called a Kidney Reflux? Just wondering
Thank u for this vid- I needed help
Which containers are you using?
This was so amazing! Love you and Wes. LB_and_me
AlwaysSleepy We love you too❤️
What do you do if he alerts to the unscented?
Katie s if he were to alert to the unscented that means he is confused and you need to take a few steps back and correct him. Try breaking your steps down a bit more, try switching up the containers so he isn’t alerting to shape. If that doesn’t work it means he doesn’t under stand your training. To fix this you can retry training the alert as well as retraining the sniffing and treating for just sniffing and then apply the alert after a few sessions.
Why do you train him to alert to the smell of saliva?
How do you train the paw so he does it when you point?
This is really helpful!
Thank you! And thank you for watching!
thank you for the info! also you are so gorgeous!!!
Where did you get your containers? What do you recommend I use that is freezer safe?
Dr Phil's Butthole rubbermaid, or anything from the dollar store really. ive never had any issues with my dollar store containers in the freezer :)
slidesandspoons thank you very much!
I heard saliva samples could last six months in the freezer from another training source
Austin Lee thanks for your opinion on what I need, but it didn’t actually pertain to my statement in a helpful way. Your comment was based on an assumption that I only get samples once every six months. Please try not to tell people what they need and don’t need.
My SD alerts to a breathing change. It is not a behavior it is a part of a medical episode. Does that count or does it have to be scent trained? She uses her ears instead of her nose to alert that's the only difference.
No that is an interruption because your breathing has already started and your SD interrupts it in attempt to stop it.
Thank you
Will this work for a panic attack? Like can they smell when your heart rate increases?
A med alert dog trained to do so, can sense a rise in cortisol levels (which indicate increased stress level).
does anyone use their doggos for alerting low cortisol for addisons?
Yes, I do. It‘s a little late for an answer but I watched the video just right now.
Does this scent sample training apply to seizure alert dog training as well?
Lily yes
What about an anxiety attack
My medical alert dog will jump in my lap and she will nudge me to pet her when she senses a anxiety attack