Our Lives With Post Traumatic Stress Disorder and Traumatic Brain Injury

MELISSA

4th of July

070811_1913~01     I finally did it! After eleven long years, I finally attended a fireworks display with my kids! Guess what?! I survived not only the fireworks, but navigating the crowds with three little ones…by myself!

 

All in all, I actually enjoyed myself! The girls were able to play on the bouncy houses, get their face painted, and even stood in line for patriotically over-priced snow cones! The girls were able to get those twisted balloon things that end up being made into all kinds of things (one had an alien that rode on her shoulders, one had a sword, and one had a flower). Granted, none of the balloon characters made it home, but they were free, so I wasn’t terribly heart broken (especially since I’m allergic to the stupid things).

I had originally decided to attend because my teen invited me. I figured with her there, I’d be able to get through the fireworks. Well, she went AWOL with her friends and I only saw her once the entire evening. Thankfully, my best friend and her family showed up just minutes before the show started. Between her and Chauncey, they got me through. I purposely sat far enough away that I couldn’t hear them launching, and I enjoyed all but the absolutely largest shells. Those were the ones that I could feel the repercussion of their explosion in my chest and that would trigger me, but as I said, my service dog Chauncey (who did amazingly well with the fireworks) and my best friend saw me through.

I definitely think we will do it again next year. Perhaps I will be able to convince a couple of my fellow veterans to attend with me. Just showing up was a huge step for me and I hope I can share that with others next year.

Moral of this story: don’t be afraid to face your fears…you may be pleasantly surprised at the results. If they aren’t what you expected them to be, you will at least know that you tried. Perform an after action and see if there is anything you could do differently next time to improve the outcome!

 


A New ‘Leash’ on Life for the Invisible Wounds of War

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.

september-11th-photoSince 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 symptomsaddictions (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.

Jason axle 2United 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.

Works Cited

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.


Trust

a little trustHow does a veteran learn to trust again? When we are in a combat situation, we have to trust those to our left and right. Eventually, we learn to trust (at least on some level) all of those who wear our nations uniform. We may not like them as a person, but we learn to have some amount of trust that they will have our backs if the SHTF. While there will always be some numbskull that we would rather avoid at all costs, we know that we would still have their backs. So what do we do when someone we trust betrays us? Stolen Valor aside, what do we do when those we identify as a ‘battle buddy’ betray our trust in a fundamental way?

In the last year, I have lost several friends. No, they were not killed in combat. They lied to me. I’m not talking about the little white lies that we have all been guilty of from time to time. I am talking about the big lies. The kind of lies that either get the folks from Stolen Valor involved or were intended to manipulate and/or garner your sympathy…repeatedly.

We all have friends who have endured some horrendous shit in a short period of time, and those who seem to have a crappy hand dealt to them through their entire life yet somehow manage to keep their head above water. We know them, we support them the best we can, picking them up when necessary. It is part of the bond we share as brothers (and sisters) at arms. We have each other’s backs because we know no one else will fully understand the measure of what we have experienced through military service. We do this hoping and trusting that one day, if we were in need, they would unquestioningly return this honor. We are a family, for better and worse, we have each other’s backs.

When we return home, many veterans find it difficult to form that level of trust with civilians. Perhaps this is because we can’t know with the same level of certainty that they would support us the same way as our military counterparts would have done. We almost expect them to drop the ball, so it doesn’t hurt as much when they let us down. So what do we do when it’s our fellow service members who betray our trust?

Too often, I’ve seen my fellow veterans become hardened. They have lost all trust in their fellow human (military and civilian) and feel they are destined to go it alone. I have fought this battle several times in my life. Each time it gets a little harder to trust again. We, as a family, MUST make a concerted effort to reach out to our brothers and sisters. We have to know that even though we no longer wear our nation’s uniform, that we are still a part of the most prestigious fraternity in our nation. We must continue to have each other’s back. We also need to make it quite plain…there is no room for manipulation of facts or emotions. If we are to truly care for each other, we must be able to expect honesty and integrity from those we have learned to trust. Integrity is the cornerstone of what makes us honorable and trustworthy to others. It is also the one thing that cannot be taken from you; you are the one that destroys it. You are the only one who can repair it. It is something you must own, cultivate and maintain. Sometimes it can be personally painful to keep your integrity intact, but it is a cost that you must choose every time. Unlike respect, integrity is not something that you earn, it is something you must possess and exhibit in your daily activities and decisions. We all know this, it is drilled into us from the day we enlist to the day we hang up that uniform for the last time.

We should be able to trust those who are veterans just as readily as we trusted our squad, our platoon, and our fellow service members.

When we come across a veteran who has lost his integrity, we have the responsibility to each other to appropriately call them out. As a family member, they deserve nothing less from us. They need that opportunity to make things right. If, however, they choose not to fix the situation, then it falls upon us to take appropriate action. Whether that’s simply cutting slingload, or reporting them to Stolen Valor, etc. We have a responsibility to protect the rest of our family from the possible fall out.

As far as trusting again… all we can do is choose to try. Each time we are deceived or manipulated, it becomes more difficult to form that trust with another person, but we are the ones who must put forth the effort. Other members of our family do not deserve to be punished for the deception of another. Those who follow after us must be able to know that they are part of this brotherhood. We must take that step, no matter how many times we get burned. We are a family…for better and worse. We are the only ones who know the full measure of what we have endured. No civilian, no matter how well intentioned, could ever have our backs the way that we do. They are a great resource but they have not experienced the bond of being someone’s “battle buddy” and know the weight and the honor that title carries.

We need to continue to be each other’s battle buddy, we must continue to trust each other even if we trust no one else.