In a nation who has been at war for more than a decade, the rate of service members diagnosed with Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), and the frequency of suicide, has radically risen. The backlog of veterans waiting to receive benefits has also dramatically increased. This is leading to longer waiting times for diagnosis and treatment. To date, no authority seems able to find a viable and expedient solution to any of these problems. Yet, nationwide, some veterans are finding a solution. They have discovered the healing power of a service dog. While this is not a cure for PTSD or TBI, it is extremely beneficial to those who have chosen to utilize this tool in their recovery.
Since the attacks on the World Trade Center and the Pentagon on September 11th, 2001, the United States has been at war. To date, approximately 1.64 million (Rand) U.S. service members have deployed in support of Operations Enduring Freedom (OEF, Afghanistan) and Iraqi Freedom (OIF, Iraq), many have deployed multiple times. Of the nearly 60,000 U.S. casualties, 6,778 have lost their lives (iCasualties.org). This means approximately 50,000 have returned home with injuries from minor to catastrophic. Many of these casualties would not have survived in previous wars but thanks to better protective equipment, medical advances, and the ability to rapidly evacuate the injured to medical facilities both in country as well as in Europe and the United States, service members are routinely surviving wounds that would have formerly been fatal. This decrease in fatalities is leading to an increase in veterans returning with traumatic amputations of one or more limbs, TBI’s, and PTSD seeking compensation and treatment through the Veterans Administration.
PTSD and Traumatic Brain Injury (TBI) have been called the signature wound of the War on Terror. “Although these invisible wounds would appear less severe than the amputations inflicted by the IEDs, they affect many more service members and can have as much impact on the casualty’s future as the loss of limbs” (Kreisher). According to a recent report, nearly 30% of OEF and OIF veterans are being diagnosed with PTSD (Reno). Compare this number to The National Center for PTSD which has “estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%” (Gradus). Part of this massive difference is likely due in part to many service members serving multiple combat tours in their careers.
PTSD is a condition that has been around since the invention of war. It has been called many names: Nostalgia, Homesickness, Soldier’s Heart, Neurasthenia, Shell Shock, Combat Stress, and finally in 1980 the American Psychiatric Association called it Post-Traumatic Stress Disorder and added it to the Diagnostic and Statistical Manual of Mental Disorders. PTSD is comprised of a set of symptoms which include re-experiencing the traumatic event, avoiding places, events, or objects that remind one of the trauma, and hyperarousal. Most people feel many of the symptoms of PTSD after a traumatic event, but those symptoms fade with time. To be diagnosed with PTSD, the symptoms must last longer than 6 months.
PTSD can be extremely debilitating, leaving veterans homebound and isolated, suffering from co-occurring mental health issues and addictions (generally caused by self-medicating their symptoms). Add to these issues a Traumatic Brain Injury and you have a recipe for disaster. TBI’s can range from mild to severe, even resulting in death. The symptoms include loss of consciousness, memory or concentration problems, headache, dizziness, sensory problems, fatigue, convulsions, and emotional disturbances. “According to a Rand study, about 19 percent of troops surveyed report a probable TBI during deployment” (Williamson). Many symptoms of PTSD and TBI mimic each other, making definitive diagnosis difficult for some patients. How much of the patients symptoms are related to PTSD and how much to TBI? Patients and doctors are often left in a guessing game as to whether the symptoms require therapy, medication, or both.
The great influx of veterans returning home from the current conflicts has caused a massive backlog for the Veterans Administration. Currently, “401,000 claims remain officially backlogged, meaning the applicants have been waiting at least four months” (Glantz). Many of these are waiting a year or more for appeals related to service connected disabilities. This means veterans, who are too injured to continue their military service and unable to achieve successful and meaningful employment in the civilian work force are waiting for their disability compensation for a year or more, putting them and their families in financial peril. The stress of dealing with gathering the enormous amount of information required to fill the claim, the aggravation of having your claim misplaced, delayed, or denied only adds to the problems already being endured by the veteran.
The stress of dealing with PTSD and fighting the VA’s red tape backlog is lending itself to the suicide epidemic plaguing our veterans. Senator Bernie Sanders said, “Without being overly dramatic, let me state that we are losing 22 veterans every day from suicide. This is a tragedy that we must address. I know that no one in the VA, no one on this committee, wants to add to that tragedy, because of unnecessary delays that could extenuate the problems that veterans express” (Johnson). In 2012, the suicide rate of active duty personnel outpaced combat fatalities. “Access to care appears to be a key factor, […] once a veteran is inside the VA care program, screening programs are in place to identify those with problems and special efforts are made to track those considered at high risk” (Maze). The veteran suicide rates are outpacing that of the civilian population. In reports from 48 states, the suicide rate among veterans is 30:100,000 compared to civilian rates of 14:100,000. This is more than twice the rate of the average American citizen and is increasing at double the rate (Hargarten). Traumatic Brain Injuries can increase the propensity toward suicide, as can the overwhelming symptoms of Post-Traumatic Stress Disorder. According to Hargarten, “concussions also are a chronic risk factor leading to suicidal thoughts, […] because head trauma makes people more vulnerable to suicidal thoughts” (Hargarten).
Over the years, countless studies have been published promoting the health benefits of owning a pet. Pets can, lower blood pressure, encourage exercise and socialization, improve mood and reduce stress. Is it any wonder they are being trained to assist disabled veterans struggling with the effects of PTSD and TBI? Training dogs to assist with disabilities is not a new concept. Most people are quite familiar with service dogs for blind or wheelchair bound individuals. However, those with invisible disabilities can also benefit from a service dog.
Psychiatric Service Dogs can be trained to assist their handlers in many ways. They can be trained to retrieve assistance during a disabling episode, either a nearby person or by using a special K-9 rescue phone to dial 911. They can be trained to answer the door and lead first responders to their handler. They can provide balance during episodes that potentially cause dizziness and help their handlers up off the floor. These dogs can be trained to alert to increasing anxiety levels so their handler can more effectively handle the symptoms before they become overwhelming and disabling. They can pull their handlers from dissociative episodes, or flashbacks, wake their handlers from nightmares, provide deep pressure therapy during panic attacks, and give their handlers a sense of ‘crowd control’. In short, these animals are giving back to veterans something they lost when they left the service…a battle buddy – someone who has their back twenty-four hours a day.
The legal definition of a service dog, according to the Americans with Disabilities Act, is a dog that is “individually trained to do work or perform tasks for people with disabilities” (ADA). These dogs and their handlers are granted public access by federal law, meaning they must be allowed wherever the handler would normally be allowed without the presence of their dog. There are some restrictions such as sterile environments, such as operating rooms or burn units, and private property. They are allowed in stores, restaurants, hospitals, and anywhere else the general public goes. This protection enables veterans who had previously been home bound to return to the world without the crushing effects of PTSD plaguing their every movement.
United States Marine Corps Captain Jason Haag, credits his service dog Axel with saving his life. “I’ve led 150 Marines into combat three times. I couldn’t walk out of my […] house to buy a pack of gum. I couldn’t go to sleep without a gun underneath my pillow. That’s how bad my PTSD was” (HLN). Captain Haag states that after returning from Afghanistan he began drinking heavily, having angry outbursts at his family, unable to leave his basement and on 32 different medications. “Axel hit the reset button for me” (HLN). Since graduating from K9s for Warriors more than a year ago, Captain Haag has radically decreased his medications – to 2 per day, he now regularly participates in family activities, and has even been to Capitol Hill, advocating for service dogs for veterans with PTSD (Haag).
Captain Haag’s story is not an anomaly. Most graduates have returned to a new ‘normal’ of doing the everyday things that most take for granted, such as walking through the grocery store or visiting their children’s school.
K9s for Warriors is just one of many non-profit organizations who are training service dogs for veterans with PTSD and TBI. These organizations train and place service dogs with disabled veterans, often at little to no cost. They are filling a gap left by the Veterans Administration, when they discontinued a congressionally mandated study on the efficacy of service dogs for veterans with PTSD.
There is still reason for optimism, though. Two bills have been introduced into the House of Representatives this year with the intent of expanding the availability of service dogs for disabled veterans. H.R. 183 – “Veterans Dog Training Therapy Act”, introduced on January 4th, 2013 directs the VA to begin a pilot program to research the efficacy of service dog training and handling in the treatment of PTSD. H.R. 2847 – “Wounded Warrior Service Dog Act” would direct the “Department of Defense and the Veterans Affairs to jointly establish the K-9s Companion Corps program for the awarding of grants to assist nonprofit organizations in establishing, planning, designing and/or operating programs to provide assistance dogs” (govtrack.us). Should these bills pass, perhaps in time the studies will confirm what those veterans who already have service dogs know.
According to Sandi Capra, the Director of Development for K9s for Warriors, of their more than 100 graduated teams, 92% of graduates had reduced or eliminated their need for medications, and 94% have reported reduced symptoms of PTSD (according to the Harvard PTSD standards). At one year from graduation, 95% of teams recertify successfully. These achievements are not an isolated occurrence. A simple online search of service dogs for PTSD returns more than 286,000 results. You will find countless news stories about homegrown veterans reclaiming their lives thanks to their new ‘battle-buddy’, veterans attesting to the lifesaving partnerships they’ve found in a service dog and web pages for scores of organizations who train these dogs for our disabled veterans.
These stories are not the ‘too good to be true’ paid endorsements for the latest fly-by-night “cure” for PTSD. They are not random coincidences. They are the stories of recovery from a devastating and debilitating invisible injury. These dogs are not a cure. They are a tool in their handler’s arsenal for coping with and overcoming some of the obstacles associated with PTSD and TBI. There is a reason they are referred to as “man’s best friend”. They are the heroes on four legs and they are giving a new ‘leash’ on life to veterans who suffer from the invisible wounds of war.
Capra, Sandi. K9s for Warriors. Director of Development. Personal interview. 13 November 2013
Glantz, Aaron. “Overtime, New Computer System Put Sizable Dent in VA Benefits Backlog”. The Center for Investigative Reporting. 11 November 2013. Web.
Gradus, Jaimie L., “Epidemiology of PTSD.” National Center for PTSD. n.d. Web. 24 November 2013.
Haag, Jason. Personal Interview. 13 November 2013.
Hargarten, Jeff, et.al. “Suicide Rate for Veterans Far Exceeds That of Civilian Population”. Center for Public Integrity. Web. 30 August 2013.
“HLN Stories of Courage – K9s for Warriors”. Headline News. Television. 11 November 2013.
iCasualties.org, Coalition Casualties by Year, n.d. Web. 24 November 2013
Johnson, Bridget. “Sanders: VA’s Massive Claims Backlog Could be Contributing to Vet Suicides”. PJ Tatler. PJ Media. Web. 13 March 2013.
Kreisher, Otto. “Biding the ‘Invisible Wounds’.” Brainlinemilitary Brainline.org. n.d. Web. 24 November 2013.
Maze, Rick. “18 Veterans commit suicide each day” Army Times. Web. 22 April 2010.
Reno, Jamie. “Nearly 30% of Vets Treated by V.A. Have PTSD.” The Daily Beast Presents: The Hero Project. The Daily Beast. 10 October 2013. Web. 24 November 2013.
“Service Dogs.” ADA.gov. Web. 12 July 2011
Williamson, Vanessa and Mulhall, Erin. “Invisible Wounds – Psychological and Neurological Injuries Confront a New Generation of Veterans”. Iraq and Afghanistan Veterans of America. Issue Report, January 2009. Web.
This past week in treatment here at the hospital has been exceptionally difficult for me, I have really been letting the environment cloud my mind and hamper my recovery. It has severely constrained my thinking and ability to address my issues at hand. Instead of the facing the issues and problems, such as; taking someone’s life, that I have severely damaged my marriage through bad decisions, and that I live in constant pain from being shot. Rather, I have been focusing on the small things, the enviromental distractions, hell I was blaming Elizabeth for stuff and shes 1000 miles away. But I have realized that I choose to focus on little things: like the bathroom door being locked, not being able to throw a dip in, no hot water in the showers, crappy food, and even yelling at Elizabeth because she went to a concert.
So why did I do these things?…that is the sixty four thousand dollar question.
I will tell you why, I did those things because I didnt want to face my deamons, which ties directly to PTSD.
I started my inpatient treatment here with my doctors relatively light, but then ramped it up significantly in the very next session. I sat down with them and explained to them (seperately, i have a social worker and pychartrist) almost all of my problems, from having volatile outbursts, a shitty father, to a having killed other human beings, I told it all. I have never done that with anyone, never, and honestly, it was brutal, it felt like I was being stabbed in the heart with a rusty screwdriver. To sit there and listen to myself say all those things I had done was horrible, but whats worse, was knowing that my wife and kids were on the receiving end of that. But it was worth listening too, because I discoverd something, something I think is at the core of my PTSD. It is that I am using other things around me, kids fighting, bad dreams or whatever I can think of to not have to actually deal with my issues. Does that make sense?
Basically, it boils down to this, I’ll use my being shot and being in pain for an example. My pain level directly correlates to my behavior and attitude, so if my pain level is high so is my irratability, if the pain is low than so is the anger and so on an so forth. But when my anger is high I blame my behavior on something else, my kids being loud, fighting, they are running in the house, anything. When really thats not the issue, I’ve just made it that way because I can not control my pain and anger, which comes from being shot. But the crazy part is, is that it’s not actually about the physically pain, which I am able to control now through meds, it’s about that anger and hopelessness when I was actually shot.
I have learned that everytime I feel that pain in my leg, I go back to that horrible place, laying there in the street of a third world country,sweating, filthy, bleeding, in excruciating pain, wondering if I going to die, if I’m ever going to see my wife or my son again (Tristan was the only one at that point). It’s a horrific feeling, but one that I have never been able to let go of, hopefully, until now.
So every time my pain level goes up in my leg I associate that with the fear, anger and hopelessness of that moment and then I externalize it towards my environment around me. And instead of facing the pain and anguish of being shot, I pick out other things, such as the bathroom door being locked, not being able to throw a dip in. So for all this time I was trying to address being angry at those things and trying to fix my environment, when all I really had to do was address my actual issue, of being shot and the anger and hopelessness that i felt at that time, and the things around me will become less of a burden and will most likely not cause all those problems.
So for me this is a huge step in realizing how severly PTSD can affect you when it goes unchecked or untreated. This is not to say that I am fully recovered and am healed, no, but know that i now what i need to address, i can curtail my symptoms and hopefully they will not affect my daily life as much anymore.
What if…Every bad decision in life, every opportunity not jumped on, all those days that you said i don’t fell like doing it, what if you had done them. what if you jumped, what if you felt like it, what if you had made a different decision.
That’s what I’m going to talk about right now. I read somewhere over this holiday weekend a little blurb from someone i can’t remember so i apologize for not giving him or her credit. But it said something along the lines of….what if you came home, what if you didn’t die in that god awful country. What if you alive and at home.
I have been trying to put that into perspective, have tried to grasp it, to realize what it means. I can that I have and i haven’t. The passage goes on to say, that what if you weren’t killed in war, but made it home alive. It wouldn’t matter if you were your regular old self, or had changed just a little. IT wouldn’t matter if everything other weekend some one had to bail you out jail because you were being stupid. What if you tried to cut yourself off from everyone, didn’t want shit to do with your friends. What if you got hooked on drugs or just got rid of everything you had and started bumming of everyone, lived on the street. Any number of things.
What if……even if everyone of those things happened all at once. every damn thing….at least you would freaking be here. You be here in this world with us. I am trying to grasp that concept, because sure as shit true. At least you here, albeit maybe its a burden or a pain in the ass sometimes but god admit you here, Your alive, your not buried somewhere like Arlington, or you home town plot in the back country.
Maybe you’re in a rehab center, maybe you have your own box under a highway overpass. Who cares, I would walk through every minute, every second of that with you just to say you made it home. That you got that opportunity to be a screw up, the opportunity to lose everything, and then turn your life around and then hell do it again.
The constant in all of that is you are here, the opportunity is there for you to what if ….I have know how hard it is to deal with almost all of those things.
So please all of you that are dealing with those things, family, friends, loved ones, shit complete strangers. Realize you got that what if…you safe still here and able to fuck it all up and start over. Those that gave their lives for ours can’t. I know first hand its hard as hell to grasp that, some days i do, most days i don’t.
Just remember what if….
Traumatic Brain Injury is a hell of a scary thing. But it really wasn’t even thought of in the beginning of the war, the invasion and the year or two after. And unfortunately, for a lot of troops this term didn’t even come into play until it was to late. The commanders, the doctors, everyone, just weren’t prepared to deal with the type of head injuries that were coming out of Iraq and Afghanistan. What it boiled down to was if you weren’t bleeding then you weren’t hurt.
Im sure when it happened, it just kinda started, 2010 when I went to AFghanistan, because I didn’t hear about it in Iraq in 07, 08 and damn sure not in 03, but they started giving head trauma a number, Grade I, II, and III. Grade I being the mildest and grade III being the worst. If you had a level I you couldn’t go outside the wire for 24/48 hours. If it was grade III it was 7 days. Now in theory this sounds like it might be an ok plan. But…..based off my experience and the “doctor” who was assigned to my battalion in Afghanistan, she had no business grading any type of Traumatic Brain Injury let alone trying to diagnose one. I Found out later she was a damn dermatologist for christ sake. Now I understand you can’t have a neurologist at every Forward Operating Base (FOB) but we had a level III Army trauma Center there which could have easily done more test on EVERYONE hit by IED’s. Even small IED’s, a measly 5 lbs of explosives will completely destroy a humvee. What do you think that will do to your brain?
Yes we wear helmets, yes they have gotten better since the beginning of the war, but they can’t really protect you from an explosion. The blast goes everywhere, your head goes up, down, to side, your brain slams inside your skull. In my battalion, on my last go round, we had the three strike rule, if you were in or around an IED blast 3 times, you were out. You weren’t allowed to go out again. In theory this sounds like a good plan, and trust me I understand the man power issue more than most (having to help build and structure a battalion to go to war). But research has already shown that after suffering a bad concussion, a TBI, you are more susceptible to more, basically means even less trauma could give you a worse TBI. So you could get a grade I or your first IED strike but getting hit again at the same level or even less could push you to a grade II or III. Again, the adage of if your not bleeding (on the outside) your ok. We destroyed Marines and Soldiers and didn’t even know it.
Take me for example, I lost consciousness on numerous occasions from different blasts in different years and spread out. But now, like I’ve said in previous posts, I can’t remember shit. I lose my train of thought during the most mundane conversations, I forget what I walked into a room for, hell Ive forgotten where I’m at for gods sake.
I will say its gotten better, the treatment and the help, but its still a huge ass pain to try and get help. I can’t imagine what its like for our junior troops. I can’t say what they are doing in country now, i haven’t been back since 2010. But I hope its better than before….
As you can see from my profile, I suffer from PTSD, TBI and a GSW. I am only going to talk about the TBI right now. M graciously asked me to be apart of this awesome blog and I jumped at the chance, to try and get people to understand what we go through. This is a challenge that I’m more than happy to accept…even if i can’t remember what the hell I’m doing half the time.
Traumatic Brain Injury or TBI, sounds bad because it is. Here is the basic definition thrown out by doctors:
“Traumatic brain injury (TBI) is a non degenerative, non congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.
The definition of TBI has not been consistent and tends to vary according to specialties and circumstances. Often, the term brain injury is used synonymously with head injury, which may not be associated with neurologic deficits. The definition also has been problematic with variations in inclusion criteria” http://emedicine.medscape.com/article/326510-overview
This is the basic nonsense that I have heard every time I have gone to see a doctor. Basically what it means is its not a disease, you don’t get it like a cold and supposedly it doesn’t worse (horses shit) and they can’t do really tell you have it until you die. If you have followed the NFL at all you will see the same basic functions, in the fact that you can not truly test for a Traumatic Brain Injury or the most common theme the “concussion” until you are dead. The most recent example of this in the NFL is Travis Henry and quite possibly Junior Seau, which they aren’t sure about yet.
But most Vets with multiple blast exposures exhibit the same symptoms NFL players with multiple concussions do. Horrible headaches, memory loss, motor function loss, sleep loss and several other symptoms. I can attest to all of those. The headaches I have are debilitating, memory loss is ridiculous; I walk into a room and forget why I’m there. I won’t tell you how many times that i have left my keys in the ignition and the truck running at work, only to come out at lunch and realize what I did.
The worst part of TBI at least for me is the headaches and the memory loss. The headaches hurt like hell, and when i get them, if i do not catch them in time i have to waste half a day in the ER waiting on a shot to make it go away. The memory loss does not physically hurt, but its extremely unnerving (which doesn’t help with PTSD) and very frustrating. I have forgotten numerous “special” things I have done for my wife over the years, i.e. when i have given her a piece of jewelry or something like that and obviously that sucks. Most people would say I do that all the time…but most have some sort of memory of the event, a snippet here or there, for me, its gone. All of it, nothing there. I will pose this scenario to you, and let you dwell on it. This is my life and what i have had to deal with for the last 8 years, and its only gotten worse, after each successive blast exposure. Walk into a bathroom in gas station, or any where for that matter, or go somewhere where you can not see the outside, walk out and have no idea where you are or how you got there….tell me how you would feel. That’s half the reason I stay in basement, or carried a gun for so long. Being scared out of your mind or thinking about being scared out of your mind, because you don’t know the next time its going to happen is….debilitating. Think about that…till next time.