Healing Combat Trauma

PTSD: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

Editor's Note: We commemorate the otherwise momentous, historic signing of the GI bill into law today with this little snippet of what life was like for someone who served recently.  For everyone who doesn't "get" what sacrifice is, and that those who've served have earned their accolades and rewards, here's a grunt's-eye view of the experience of combat trauma, and how that relates to PTSD and various other topics in the news.  It's doubtful that any one of us would like to have changed places with him, at such a young age.  Herewith, his story, emphasis mine:

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I'm no Vietnam vet, but a vet of Operation Iraqi Freedom. I turned 18 while in boot camp because I graduated high school at 17. I was discharged early for having "personality disorder" after I went to Iraq.

I was in the Marines, and my MOS was a ground communications electronics technician. A couple months after graduating my training for the job and going to my first unit, I was "volunteered" to join and train with another unit that was leaving soon. The new task I was given was "Mortuary Affairs".

This group was put together with a couple dozen other Marines from other sections. Our job was to go to locations where troops had been killed and not able to be retrieved by the group they were out with due to the fact they were under too much danger or whatever the case. I had no clue the effects this would have on me. It was a horrible experience.

It was not like going and picking up a corpse and that's it. For one, you were in a hot zone, where people were just killed, not just by gunfire.

Here are some brief descriptions of the missions I was a part of...
 

The first one wasn't too bad; the body was actually brought to us at the camp we were at.

 

It was a young male Marine. He was supposedly in a Hummer going somewhere and might not have been wearing his helmet. He had a silver dollar sized hole in the side of his head.

When we get the bodies back the camp we have to take off all materials on the body, and go through and bag each individual body part. It was more of a surreal experience really, I did not know how I was supposed to feel.

Once our troops invaded Fallujah was when things started to get worse. On another of the missions, a truck carrying fuel was crossing a bridge and was shot with an RPG. The truck went off the bridge and fell, the fire burning most of everything.

 

When we went out it was usually just a dozen of us with maybe 2 Hummers of security if we were lucky. For anyone who doesn't know, most the Hummers used were old and poorly maintained/equipped... almost no armor. So we get there and head down to the bottom where the truck fell and we had to pull out burnt bodies from inside of the cabin.

 

It sounds bad, but burnt bodies are almost like burnt food... so perhaps it wasn't as bad as the rest. It did not help our appetite when we had to eat in the same building we processed the bodies in. Our shop was just a medium-sized bunker, no walls or anything so yes we basically ate next to the bodies. It is obvious why some of us didn't eat the meat.

 

The worst mission I went on was when an army tank was traveling down a road and was blown up from a roadside explosive. The bomb was so powerful: you could not identify ANY part of the tank except for the tracks. It had been tossed a couple hundred feet in different directions.

 

It took us I think, about 15 hours to do this mission. There was gunfire when we first arrived but nothing more. I think we picked up a couple thousand pieces of flesh that day. Going through each one individually. They would range from small penny-sized pieces to legs, torsos, heads, feet, testicles, arms, etc.

 

There were a few more missions but we get the idea by now I'm sure. I guess it started to become noticeable that I wasn't doing well. I was taking whole boxes of NyQuil tablets and drinking bottles of medicine to get anything I could out of it at night. I smoked probably a pack of cigarettes a day, which is a lot for me because I have never really smoked more than a couple cigs a day if at all.

 

My officer had me go speak to the chaplain and from there a navy doctor who was a great person to have over there. He pulled strings and had me med-evac'd out of there a few weeks later.

 

In the meantime I had been moved out of my job until I was able to leave. I was harassed for leaving: superiors thought I was just faking to get out.

 

I had become highly depressed and my roommates noticed me screaming sometimes in my sleep.

 

From Iraq I spent a few days at an army hospital in Germany, talking to various doctors and such... going through the process.

 

I was being given pills for depression and for insomnia. Then I made it back to the US and once at my base I was seen by a psychologist. They actually gave me the option to get of the military, so I did.

 

I had been told the process takes several months to year until you finally leave. In the meantime I started drinking daily, and stopped taking the pills they gave me because they seemed to numb my mind and I could not stand it because I have always had such a wonderful and creative mind. It made me feel like a zombie, I could not even create artwork which was my biggest hobby.

 

A month down the road I started having nightmares, very detailed and morbid. A few times I would wake up with tears. I began having suicidal thoughts and crying at least a few times a day. Thank God my best friend was stationed not so far, he saved my life I think.

 

It was hard for me to wake up because of the medicine I had been taking, that’s another reason I stopped it, I was always drained. The first week I was back I never even reported back to my old unit, I didn't know what I was doing.

 

A week later they send somebody to come get me. There, I was harassed and treated like a piece of s%#t some more by my master sergeant. They had me sit in inventory room all day while I struggled to stay awake. I luckily had a very kind staff sergeant in charge of me at the time. He would let me sleep and go home early.

 

I admit I was very lucky in getting out, because it only took me about 2 months until I was officially a civilian again. I was going back home. I stayed with my older sister and her boyfriend at first, because I was not too fond of going back to my parents. My depression got worse and I started to drift further from sanity and comfort; people noticed I was a different person.

 

At this point I started smoking marijuana occasionally. Which was really the only time I felt anything, happy, able to think, speak, talk to people, feel normal.

 

Eventually I moved back with my parents and that's when things got worse for me. I had some additional problems I know was facing, I needed a job, and had people on my back constantly. I had no access to marijuana during this time.

 

My insomnia got to its peak to where I could not sleep AT ALL at night. I also began having more suicidal thoughts, nightmares got worse and I had them ANY time I could sleep which was usually from 7:00 AM to 12:00 PM, began having auditory and visual hallucinations everyday, and constant anxiety.

 

I knew I had PTSD and that the military used "personality disorder" so that they would not take the rap for it.

 

I finally couldn't take the insomnia anymore and was prescribed Ambien, which actually works extremely well and helped get my body back on schedule, only thing is I had to take it for 3 months and then no more because they said it was addictive.

 

So it became difficult without it. I did a long process of seeing doctors and filling out paperwork for the VA and was finally officially a disabled vet due to chronic Post Traumatic Stress Disorder, normally referred to as PTSD.

 

I started to be able to get a hold of marijuana again and when I had it things were more stable. My temper was not out of hand and I could sleep comfortably having less nightmares. At this point I had gone a year or more straight of having nightmares every night.

 

It has been three years now and I am much better. Time has healed me a little and I smoke marijuana as often as I can. I don't have hallucinations anymore, or rarely any nightmares. I do however still have bad anxiety, temper, and depression problems when I'm not high.

 

Another thing I forgot to mention is that PTSD has basically ruined my memory. Since I first showed symptoms until now, my memory does not work nearly as well as it should.

 

I still have major problems concentrating and working sometimes too. It makes interviews and other social activities near impossible for me, as I cannot speak or express myself as I used to. I get very nervous and my mind blanks out sometimes. I cannot say if marijuana will help all my problems, but I can say marijuana helps me feel alive.

 

Being high is the only time I feel good and happy, deep down. I can be around loved ones or any social crowd without tweaking out from anxiety, I can think and operate much more smoothly, I don't have a short temper, and it makes me want to live.

 

The past couple months have been rough on me and I have been going to the VA hospital here to try and get help. The first 4 times I went, they did the same exact thing which was to ask a series of questions, ask me if I want pills and send me home. I kept telling them I did not want pills because I have seen what they have done to people I know and what they have done to me.

 

All I wanted was someone to talk to.

 

After the fourth time of going in there feeling like I wanted to die, they finally got someone for me to talk to. We have just met once so far, but I think it will be good for me.

 

In the meantime I have not been able to smoke recently because I am trying to find another job, which is not going too well and I only have a couple weeks before my current job ends.

 

I have had a few interviews but blow them miserably because it’s getting harder and harder for me to go through the whole thing without my nerves choking me to death. It’s only been a week or two since I smoked last and my temper and depression are already busting through the door. I worry too easily and stress out to the extreme.

 

Take what you will from this story, but I know for a fact marijuana has saved my life numerous times.

 

-- One young former Marine's story, in his own words. Used with permission.

Editor's note: "Mortuary Affairs" was also the detail highly-decorated Marine ("Marine of the Year") Daniel Cotnoir worked in Iraq, before a combination of circumstances, including PTSD, triggered an event in his hometown of Lawrence, Massachusetts -- which got him arrested, and barely escaped conviction.  We have blogged about Daniel Cotnoir's case many times on this blog, going back several years, when it was current.  It's safe to opine, that even within the trauma of war, some things are harder to endure than others.  Our guess would be, mortuary affairs really qualifies for extreme hardship and exposure to things that make PTSD an occupational hazard.

"Disposable Heroes" - Washington Times and ABC News Investigates Drug Testing on Veterans

On June 16th, the Washington Times, which has been following the "Chantix harm to veterans" story doggedly, and ABC News, produced an investigative piece called "Disposable Heroes," about the drug testing that takes place on veterans, sometimes with lethal consequences.   That interactive piece is linked here. (Ironically, earlier this week, we posted an entry about veteran' similar exposure, this time from the Vietnam War, that is still coming to light.  That post is linked here.)

Here's the lead from the Washington Times' story, by Audrey Hudson:

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundred of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan...

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects.  The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

If you want to find other entries in the Washington Times' extensive coverage of Chantix and veterans, use this link here, which will produce a list of the articles, or go to their website, linked here, and do a search for "Chantix".  Be forewarned, however. Although the information on the website is well worth learning, the Washington Times has an especially cumbersome user interface, irrespective of browser.  Get ready to enable popups, and then, even so, only be able to pull up the stories with great difficulty.  Someone really needs to improve that...)

Going Frantic over Chantix - Anti-Smoking Drug Causes Problems for Veterans with PTSD

An anti-smoking drug, Chantix, prescribed to veterans, including those with PTSD, has been linked to significant health problems:

The Washington Times reported on February 2, "Government regulators said the connection between Pfizer's anti-smoking drug Chantix [Vanericline] and serious psychiatric problems is "increasingly likely." The Food and Drug Administration said it has received reports of 37 suicides and more than 400 of suicidal behavior in connection with the drug."

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On May 16, the FDA issued a Public Health Advisory, linked here, about the drug, and mentioned -- of particular concern to those with PTSD -- that use of Chantix "may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur." The FDA warned those taking Chantix about the "possibility of severe changes in mood and behavior," as well as about "vivid, strange and unusual dreams" -- problems already for veterans with PTSD. Similarly, the FDA described symptoms that Chantix might cause may include "anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide."  Grrrreat.  Apparently, according to the health advisory, problems occurred both while taking Chantix, and during withdrawal.

Approximately a week later, on May 22, the Washington Times again reported that the FAA had banned Chantix for use by its pilots and air traffic controllers, after concerns about its use.

 

Congressman Filner on Health Care for Veterans

Closing remarks of Congressman Bob Filner (D-CA), Chairman of the House Committee on Veterans Affairs, on the momentous passage of the GI Bill.  While the rest of Congressman Filner's remarks addressed education, he also commented on veterans ongoing health care needs and concerns, here:

"Last year, Congress made the largest increase in veterans’ health care funding in American history, when we increased VA funding by 30 percent, successfully adding $12 billion more than the President’s request and $39 billion more over five years. The new GI Bill is an even larger fiscal commitment to our nation’s veterans - providing a quality educational benefit for those to whom we owe so much.

While we have made much progress, new challenges continue to mount. Tens of thousands of service members are being discharged from the military without adequate diagnosis or treatment for post-traumatic stress disorder (PTSD) and traumatic brain injury. Refusing to face this challenge, leaders at the VA have attempted to manipulate suicide data to portray a lesser problem. In addition, the claims backlog for VA benefits now totals well over 600,000. The VA also failed to protect our veterans when they became more involved with research than providing treatment - When Chantix, an anti-smoking drug, was linked to suicidal thoughts and aggressive and erratic behavior, the VA failed to immediately eliminate their testing of veterans, placing them under increased risk.

It is obvious that our work has just begun, and I will continue to fight to hold the VA accountable for their actions and provide the very best care to our nation’s veterans. I will work to transition the VA from Veterans Adversary to Veterans Advocate!"

-- Congressman Bob Filner, Representative for California’s 51st Congressional District, and Chairman of the House Committee on Veterans Affairs, linked here.

Editor's note: Regarding Chantix, we did a post the other day, linked here, which talks about how to learn more about the medications being prescribed for PTSD, and how to learn about possible interactions with other drugs, such as Chantix.

Needless Trauma: What Vietnam Vets Still Don't Know about Their Service Could Hurt Them

Saw this recent press release from a California congressman, who himself is a decorated Vietnam vet, and wondered about the pain that comes from NOT knowing the full extent of what you've been exposed to, as you were serving your country.  For the particulars, keep on reading:

– Today (June 12), Congressman Mike Thompson (D-CA) took another step toward helping veterans who were unknowingly tested with chemical and biological weapons in the 1960s and 70s.

The House Subcommittee on Disability Assistance and Memorial Affairs held a hearing on a Thompson-authored bill that would give these veterans health benefits and compensation for illnesses resulting from “Project 112” weapons tests. Thompson hopes this hearing will ultimately push his bill toward consideration by the House.

Project 112, which included ship-based Project SHAD, was conducted between 1963 and 1973 by the Department of Defense (DoD) and other federal agencies. The DoD now admits that during these projects, unknowing military personnel were involved a number of chemical weapon tests such as VX nerve gas and Sarin nerve gas and were exposed to biological weapons such as E. Coli, Tularemia (Rabbit Fever) and Q fever.

“First the government denied the tests existed. Then they said the tests happened but were harmless. Now they admit dangerous substances were used on our military personnel, yet they still refuse to give them care for their illnesses,” said Thompson. “We can’t change the past, but we can begin to right this wrong by giving these men the proper healthcare and compensation they earned.”

HR 5954, introduced by Thompson and Congressman Denny Rehberg (R-MT) in May, provides veterans of Project 112 a “Presumption of Service Connection.” This means the Department of Veterans Affairs (VA) presumes the relationship between service and a health condition, making the veterans involved eligible for medical benefits and/or compensation for their conditions. For example, veterans exposed to Agent Orange during the Vietnam War are already given a “Presumption of Service Connection.”

“I understand security classifications and the sensitivity of our operation,” said Jack B. Alderson, a retired Lt. Commander from the U.S. Navy Reserves and resident of Thompson’s district. “However, these were not volunteers but service personnel ordered to do a dangerous job and they did it, and did it well, now their nation needs to take care of them.”

In 1964, Alderson was the officer in charge of five U.S. Army light tug boats that were used to test chemical and biological weapons. The tug boats acted as sampling stations and targets for disseminated weapon clouds.

After the DoD admitted to Thompson that the tests did exist and included harmful agents, they released more than 6,000 names of military personnel used in the tests. However, the GAO reported in February that the DoD had halted their efforts to disclose additional names and many veterans remain unaware that they were even involved. The Thompson-Rehberg legislation would require the DoD to hand over all the names to the VA, which must then notify the veterans.

The Thompson-Rehberg legislation has been endorsed by the Vietnam Veterans of America, Veterans of Foreign Wars, American Legion, Disabled American Veterans and Paralyzed Veterans of America.

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CONTACT: Anne Warden at (202) 225-3311, (703) 338-4480 and anne.warden@mail.house.gov.

For a link to Congressman Thompson's office, click here.

What the VA Needs Is "The Odwalla Effect"

[If this blog were a newspaper, which it isn't, this particular blog post would be an editorial -- found in the opinion section, separate from the rest of the paper.  The editorial section is where the editor "puts together" what the news means to him or her, and sets out a point of view, about what we should do or feel, think or believe about something, based on what else has been in the news lately, that they've been keeping people up to speed on.  It's the opinion section, essentially -- but from the editorial management's point of view.]

Here's ours:

Kathie Costos has a great series of posts over at her blog, linked here, but there's one in particular we'd like to talk about - and we'll leave you the link to it in a minute, so you can read it for yourself.  First, the discussion.  Kathie is conducting a question and answer session with Paul Sullivan, head of Veterans for Common Sense, clearing up "rumors" about the veterans' lawsuit against the VA.  Sullivan's answers are clear and to the point, and contain some fairly galvanizing statements, pro or con.

[I should insert the caveat here, in an effort to be balanced, that I DON'T believe the VA is "all bad," nor do I imagine Costos or Sullivan does.  Every once in a while you DO read about people who are extremely thankful and grateful for the care they're received through the VA - I read an item the other day where a veteran was reminding us that they have one of the best healthcare systems in the world.  True.  But that also brings up a question of which metric you're using, since while they are succeeding in some areas, they are clearly failing in others (and those are the areas which are making the news, frustrating veterans and families, and where they're being sued.)  Highly competent, concerned and caring individuals DO work for the VA -- many of the leading lights of care in the PTSD segment in particular have come from, or worked with, or still do work with, the VA.  People who are tremendously significant in the history of caring for veterans in an extremely high quality, enlightened, empathic way -- so people like that DO work for the VA, and always have.  Look through the "Experts" section on this blog, and see how many people have an affiliation with the VA, past or present: Ray Scurfield, Shad Meshad, Jonathan Shay, as well as others, all come to mind. (For the record, these people were probably "born" (wonderful) not "made" (wonderful) by their association with the VA as caregivers, but still -- they worked there and in some cases, still do.  And God knows, the VA heavily reads this website -- even at odd hours -- including very late at night, on weekends, on national holidays -- times when the rest of America is out grilling a hotdog with their family, throwing a ball in a park, or just snoozing the night away -- so clearly there are some very dedicated individuals there, trying to learn all they can in order to deliver better care to those who are suffering.  (Though they may also be reading to keep up with public opinion, to see which way the wind blows...)

I do sometimes wonder when I see what the VA is searching for, on this site, because it either seems kinda elementary (like they should know about it already), or a little "weak" in the efficacy of treatment department (like things that are waaaaaaaaaaay down the totem pole or triage pile of things to actually try with a demographic of patients who are suffering greatly). To give you an idea of what I'm talking about, frequent searches -- and the topics change regularly -- by the VA include such things as "spirituality for PTSD," "does recreation help?" and things like that, where, really, yes, even if they do -- they're only adjuncts and pretty far down the list at that, compared to more likely things that seem worth trying or are known to have some benefit.  But maybe I should just be patient, and it's more a case of "if you build it, they will come."  Maybe there's a huge lag time afoot, where if the information is laid out there, eventually the searches will catch up -- on the VA's part, that is.]

(Huge digression -- but the point is, the VA's not all bad, and that's NOT the point of suggesting they change, which it certainly seems like they should.)

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Deep in the Q&A between Costos and Sullivan is this exchange, with the comment of importance highlighted:

Do you know about the Freedom of Information request to the VA by CREW and VoteVets?(Which we blogged about earlier here, by the way.)

Yes. It is too bad that VA still plays games with FOIA. VA should be forced to turn over the information. Embarrassing information is never a reason to deny a FOIA, as VA frequently does.

Alrighty now.  That was the warmup (the foregoing).  Here's the pitch:

If the VA wants to control the flow of embarrassing information about it -- such as the Katz and Perez emails have provided us with -- there's one extremely simple way to do it.  It's NOT hiring a PR firm that specializes in crisis management and controlling the spin.  That's morally and ethically disgusting -- when contrasted with the concept of just changing -- and, it's ridiculously expensive -- a true waste of money that could be better spent on taking care of veterans and their families, with the needs the VA already knows about. And by promoting good works, like those of combat veteran Jay White, at the VA Center in Hartford, Connecticut, which we blogged about here.  Those ALSO make the news and contribute to public opinion, though everyone knows, and it's unfortunate that it's true, bad news travels first.  (And bad news here is definitely the Katz and the Perez emails, and the lack of putting patients first they describe, not to mention the rash of veterans suicides, etc.) Denying patients adequate care?  There's just no way to put a positive enough spin on that.  And the extent of the media coverage has been such, yup, we pretty much all know about it by now, if we even remotely care to.  Game over.  What needs to happen next is what happened with the Odwalla juice company -- what the VA desperately needs is the Odwalla effect.

Years ago, Odwalla was a new company with a great product: fresh juice, delivered nationally.  I knew someone whose three college friends had started it, and because of that, I guess I paid attention to what it was, and when I had the chance, tried the juice.  It was great, and for a while, everybody I saw who wasn't carrying some bottled water, seemed to be carrying a container of their juice.  They had, and still have, a number of blended juices, as well as the straight-up orange and apple.  And they had a novel, and in hindsight quite unwise, approach.  Their juice was unpasteurized, which they felt was needed to keep the juice as fresh-tasting and delicious as possible, but which also carried some known health risks, because pasteurization kills bacteria.  Children (particularly babies) and the elderly, as well as a few other groups (those recovering from illness and surgery, etc.) have weaker immunities -- in other words, are more susceptible to bacteria.  And I don't remember that Odwalla plastered their juice labels with big warnings about: "Warning! Our lack of pasteurization makes this juice likely unsafe for children and the elderly!".  They probably just made their juice, concentrated on getting it to market, and hoped people toasted each other with its deliciousness.  But over time, the inevitable happened: a few people who tasted their fresh, delicious (and unpasteurized) juices got sick - and, horribly - died.  And some of the affected were children, which the American public finds of course especially heartbreaking, and worthy of media attention.

In an instant, it seemed -- everyone turned on Odwalla, the juice and the company.  It went from being a media darling, to an object of abhorrence and fear.  How could they have let their juice kill people -- young children, even?  Horrifying...  Based on the immediate and complete backlash in the press and public opinion, I easily imagined Odwalla going under, and my friend's three college friends being put of work, and skulking away in public disgrace.

What happened next was amazing, though: and it shows you the power of good, and of doing the right thing.  (There's a conflicting story on the Web, but if you read the date on it, it's from 1999, which is ridiculously old news -- before the Odwalla success story of managing its PR happened, and before the company was later sold to Coca Cola - another evidence of its success. Plus, the guy who wrote it is by no means is a PR specialist, nor does he even seem to understand how PR works. I did work in PR, though I'm no expert on crisis management - I do get how it works.)  Odwalla didn't go bankrupt, didn't go out of business, didn't leave the marketplace in shame and disgrace.  What DID they do?  Simple as could be, and oh so powerful:

They accepted responsibility.  They apologized and paid the families' bills.  And they changed their process, so more people wouldn't be hurt by it.  They were wrong; they admitted it; they did what it took to make it right; and they changed.

In other words -- EXACTLY what the VA needs to do.

By now, we all know what the problems are, if we've cared at all to listen and learn.  They're kinda obvious.  And no amount of re-spinning the truth is going to make the problem go away.  All the media attention and lawsuit has done is show us the gaps in the system, the problems with care.  And because most caring, compassionate, fair-minded Americans care MORE about their veterans - we "get" the price they've paid -- than we do about hearing excuses and spin -- there's only one real solution here.  Admit the problem(s), apologize to those you've affected (veterans, their families, and the rest of us, who while less directly involved, are nevertheless put off by what we've learned), and fix the process.  Let tomorrow be vastly different from today, because you're starting to work -- really work -- on the problem, now.  The problem that we -- you, me, veterans, their families, the media, Veterans for Common Sense, the IAVA, the Disability Rights Project, Paul Sullivan, Kathie Costos -- all know exists.

Lack of pasteurization, denying veterans care -- and, if you'll allow me -- O.J. Simpson have all have been linked to killing people.  But in a contest between two kinds of OJ -- Odwalla and Simpson -- please, VA, we beg of you: show yourselves to be more like Odwalla, and less like Simpson. Fess up, come clean, do what's right by veterans and their families, make it right.  Now more than ever, what the VA seriously needs to re-create good public opinion is not denial, spin and blocking legitimate FOIA requests, in case something embarrassing gets revealed -- it's a simple thing called "the Odwalla Effect."  Also known as, doing the right thing, for the right reason, makes public opinion bounce right back.

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Editor's note: Kathie Costos' Q&A with Paul Sullivan of Veterans for Common Sense about the veterans' lawsuit is linked here. Kathie Costos' blog, "Wounded Times," is linked here. Veterans for Common Sense is linked here.