Wednesday, December 3, 2014

Traumatic Brain Injury & a New Beginning Though HBOT

 Marine Staff Sergeant Charles (Chuck) Rotenberry was proud to be in front – literally “walking point” before platoons in Afghanistan as Chief Trainer of the II (second) Marine Expeditionary Force (MEF) Camp Lejeune Military Working Dog Platoon.  In conjunction with Combat Engineers who manipulate metal detectors, these highly trained teams of handler and working dogs clear the path of potential improvised explosive devices (IEDs) with close scrutiny and awareness. 

On that day in March 2011 while on a combat patrol, SSgt. Rotenberry assumed the security and over-watch position for the K9 Team; thus freeing up the previously assigned member organic to the unit.  His mission while out with the K9 teams was to ensure the 30 teams were performing proficiently; both Marine and K9.

It’s the disciplined practice for those leading the way to follow a very strict protocol to ensure safety throughout entire patrol. This time, one hour into an early morning dismounted (combat patrol) clearing operation, Chuck Rotenberry was providing security behind one of his K9 teams on the front lines.  Together they proceeded, carefully clearing the way with highly attentive Marines, a military working dog, and metal detector. 

The job requires meticulous attention to detail, walking one after another in the footprint of the Marine ahead.  Right footprint, right foot.  Left footprint, left foot.  Man after man.  Slow step after slow careful step.

One misstep was all it took; the Marine behind SSgt. Rotenberry put his left foot in the right footprint, perhaps just barely out of step.  The catastrophic explosion that followed not only took both legs but caused many other injuries to the Marine behind SSgt. Rotenberry.  Havoc ensued.  Shrapnel blew everywhere; Chuck was thrown nearly 10 feet and he lost consciousness before coming to and rushing to the aid of the injured Marine. 

After carrying the stabilized Marine nearly 200 yards and running on sheer adrenaline, the K9 Team cleared the path of a landing zone for medics.  Chuck Rotenberry and the platoon pushed on with the mission for 6-8 hours more, encountering small firefights and apprehending a high-value detainee.

Upon returning to the small patrol base, a medic stopped SSgt. Rotenberry:  “Do you know you’re bleeding from the back of your neck and back?”  They cleaned him up, and he was ground MEDEVAC’d where the Battalion Surgeon removed the shrapnel and he was cleared for continued service.  That morning, Chuck called his wife, Liz (pregnant with their fourth child) and she became very concerned since “he sounded very bad and said he just needed to sleep”.  Four hours later, after learning that Headquarters Marine Corps (HQMC) had notified Liz, he called again to tell her he was injured and had sustained some small shrapnel wounds – he couldn’t remember having called her before.

Two weeks later he was showing blast effects:  uncertainty, short-term memory loss, headaches, confusion, and thought he could “just sleep it out”.  Chuck pressed on until medics held him back from further combat operations from April to July. MRI and CT scan equipment was scarce, and to the Medical Staff it appeared that his symptoms were surface-only, so no MRI or CT scans were done.

On July 5th at 3am, SSgt. Rotenberry returned home to the States.  Liz was told he was okay, and was very proud of his valor in coming to the aid of his buddy and earning a Navy Commendation and receiving the Purple Heart.  Chuck got into the driver’s seat of the truck to go home - but could not remember how to get there.  Perplexing.  That morning at 0800, movers came to relocate them and they “rolled right back into life”. 

On July 19th, baby #4 was born.  Chuck Rotenberry desperately struggled to adjust to transition from combat environment to the home noise level of the three older children and now a new infant.  Liz doubted that Chuck wanted to be with them.  He doubted himself, assuming everyone else was “messed up” and Liz knew that something just wasn’t right. They sought and received services from a Navy program called FOCUS (Families Overcoming Under Stress) that gave them a better understanding of PTSD and Traumatic Brain Injury and explained (especially to the children) that Chuck’s “invisible wounds” were very serious.

After waiting about four months, he finally got his first appointment in the Traumatic Brain Injury (TBI) Clinic on Camp Lejeune. Chuck entered their 16-week program and received physical therapy, balance techniques, learning to schedule appointment reminders and create new habits to compensate – until he was told “there’s nothing more we can do for you”.  With the aid of multiple prescriptions (and subsequent side effects and adjustments), he experienced some minor progress, most of which he chalked up as coping methods to counteract or avoid the forgetfulness, crowds, loud noises, and intense migraines. SSgt. Rotenberry, (admittedly) too stubborn to submit to a medical review board, then transitioned from Active Duty to the Marine Corps Reserves; not completing the 8 more years “until his 20” as he’d intended.

Chuck, now a Gunnery Sergeant stayed on as a USMC Reservist and was fortunate to continue a civilian career in his field of expertise.  The Veterans Affairs Office determined Gunny to have 100% service-connected disabilities, with Severe PTS and Mild to Moderate TBI.  As life continued, Chuck found he could not tolerate other people, getting lost or confused, had constant migraines and even began to shun being around the family he so loved.  After getting settled in their new home they relied on the Veterans Affairs Medical Center (VAMC) for medical care, counseling, and caregiver support, but a random event like the popping of a balloon created havoc and breakdown.  Life for the last two and half years was a black hole, walking on eggshells and feeling like there was nothing more to do but rely on meds and patience to get them through their days. 

It took a major breakdown in March of 2013 for Liz to realize they needed more help… Chuck expressed his frustration with the distress he knew he was causing the family and how it might be better for everyone to be without him.  To not have a “visible wound” was breaking him, and this was very, very serious.

As a relentless and resourceful family advocate and dedicated caregiver, Liz researched alternative therapies and experts in Traumatic Brain Injury (TBI).  Among them was Dr. Paul Harch, a pioneer in Hyperbaric Oxygen Treatment (HBOT) which, through increased atmospheric pressure, forces 100% oxygen into the body and blood stream, allowing the brain to begin to heal and recover. (HBOT chambers were originally designed for deep water divers who surfaced too quickly and needed to balance their brain oxygen from “the bends”). 

Regrettably, HBOT is considered Off-Label use and not FDA-approved for TBI or PTSD.  The Rotenberry’s were determined to find help for Chuck and their family, paying the $18,000 cost for the initial 40 treatments, lodging and food out-of-pocket.  This cost was in addition to the brain scans GySgt. Rotenberry required at $1500-2000 each.  

These SPECT scans clearly showed frontal left lobe injury, hindered blood supply, and most likely showed the source of short-term memory and emotional function (motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control and social behavior).  They felt validated at seeing visual proof of an organic injury helping Chuck to confirm that there was in fact an injury, that it was not fake, and that he was not going “crazy”.  Relief and hope prevailed.

Chuck underwent the initial 40 HBOT treatments and almost immediately he improved.  After the first week, he noticed that he had not had a debilitating migraine since before the first treatment. He couldn’t believe it.  Liz said “A light’s been turned on inside of him”.  It was also disconcerting.  Chuck was hesitant and not sure how to react; “Is this permanent?  How long do I have before they come back,” he thought.  Today, he happily shares there are still no debilitating migraines.  HBOT is not a cure, but a life changing opportunity that has helped Chuck to learn to deal with everyday signs and symptoms of an invisible wound.  Stress is still apparent, and GySgt. Rotenberry still struggles with Post Traumatic Stress (PTS) and Mild-TBI. He remains hyper-vigilant, but is calmer and communicates better, and the family is stronger. 

There are pros and cons in any therapy and Liz and GySgt. Rotenberry will tell everyone to do their own research.  Yet, their HBOT experience was fortuitous and they learned to share with other families that the “condition was speaking, not the person” to those considering giving up their family relationships.  Today, the Rotenberry’s devote their time to sharing their positive experience with HBOT, starting a non-profit, and actively distribute HBOT material, including informative DVD’s, participate in roundtable military health discussions with legislators and policy makers, and they share the success of HBOT in giving GySgt. Rotenberry improved brain function and quality of life.

Recently, the family adopted one of the dogs from the Military Working Dog kennels at Camp Lejeune, who also suffered from PTS.  Together, they face their days with greater confidence, a close family unit, and a well-informed, compassionate and articulate team. The Gunny and his wife Elizabeth are inspired; “The Brave and their relentless Caregivers shall no longer suffer in silence nor endure alone, WE are Walking Point for PTSD & TBI.”

For more information on HBOT therapy for PTSD and Traumatic Brain Injury contact GySgt. Rotenberry and Liz Rotenberry on Facebook ‘Walking Point for PTSD & TBI’, or at  Ultimately, they hope to show sufficient clinical evidence to power up and use the HBOT chambers available at every VA facility today.

By Linda Kreter
Also in the December Issue of Homeland Magazine 

Tuesday, July 22, 2014

How is CAM Helping Our Veterans & Caregivers?


CAM, the acronym for Complementary and Alternative Medicine is gaining recognition for helping veterans adjust and heal after combat mental health injuries (Post Traumatic Stress/PTS and Traumatic Brain Injury/TBI), and for pain management and addiction.  Complementary methods are used with traditional, evidence-based therapies, and Alternative methods are used in place of standard medical practice. 

PTSD (mild to severe) is a complicated condition estimated to effect 20-60% of today’s veterans, and TBI (mild to severe) may overlap in 19% of all veterans.  While there is debate over the condition prevalence and diagnoses, additional treatments for symptoms such as hyper-vigilance, insomnia, anger, social isolation, depression and anxiety are better understood. 

Most CAM therapies are sought by the veterans themselves or family members when traditional, evidence-based VA treatment is ineffective or inadequate.  Newer therapies are slow to mainstream to the VA, yet most practitioners acknowledge there is no “one size fits all” care plan.  Veterans seeking augmented help often feel empowered by taking action, and will then blend traditional methods with their additional therapies. 

If you or someone you know is struggling with the symptoms of PTSD or TBI, researching alternative programs may be of help.  The following is a partial list to explore:

Service Dogs:  Many programs exist that pair a SM/Vet with a dog suited and trained to support their specific needs, ranging from dogs who can alert an impending seizure to those that provide solace and companionship.  Service dogs become part of the household and add a sense of purpose to the vet.

Equine Therapy:   Riding programs assist PTSD and those with physical disabilities that negatively affect their emotional health.  For many, being mobile away from a wheelchair or walker, and in tune with a large animal is a turning point for hope and acceptance.

Outdoor Retreats:  Opportunities for veterans provide not only the peace of the outdoors, but add a renewed camaraderie among their peers.  Retreats may provide learning a new skill (fly fishing, rock climbing, sailing), and others pair outdoor activities with group therapy.  Retreats may also include separate sessions for family members and children, who also benefit from the experience.

Yoga:  Yoga has proven very helpful in easing chronic pain, providing physical focus, and beneficial through adding a spiritual element through movement and breathing awareness.  A growing number of programs are taught by vets or family members who understand the aftereffects of combat, and the essential mind/body connection is nurtured through this practice.

Meditation & Mindfulness:   These practices restore many focusing on both physical and spiritual elements that elicit emotional stability and well-being and are used mainly for decreasing anxiety and depression symptoms and improving overall wellness.

HBOT (Hyperbaric Oxygen Therapy):  HBOT has proven life-changing for many veterans with TBI (and/or PTSD).  This treatment places an individual in a highly pressurized oxygenated environment that stimulates cell growth.  These highly oxygenated red blood cells move through the body, facilitating the repair of bruised and damaged tissue for faster recovery.  Brain scans are showing visible improvement and the VA offers HBOT at most facilities upon request.

Acupuncture:  This ancient practice of thin needles placed in the qi (“chee”) points of the body facilitates calm, promotes peace of mind for better sleep patterns, and is also a help for chronic pain.  Acupressure utilizes the same premise, but uses manual pressure on the qi points instead of the insertion of needles. 

Therapeutic Massage:  The soothing element of touch can be very helpful for emotional health, and is often used for pain management, anxiety, insomnia, depression, and physical conditions. 

Art, Music, and Expressive Writing Therapy:  Through personal expression through these mediums, veterans have found emotional relief and improved wellness.  These attentive sessions are often in a group setting, which adds the peer support to those expressing and releasing painful or negative emotions in a non-judgmental environment. 

Many other complementary and alternative therapies exist, and the key element is finding one that fits the veteran’s personal situation most closely.  The symptoms of PTSD and TBI can usually be managed once the correct blend of therapies is followed, and is crucial for the best possible medical outcomes. 

Linda Kreter & the VeteranCaregiver Team

Sunday, June 22, 2014

Caring for our Nation’s Veteran Caregivers - from Homeland Magaine, June 2014

To all:

They are quiet and often unseen. They are strong and resourceful, caring and compassionate. They will roar when needed to obtain the help they need. They are the Caregivers of our nation’s veterans.

Caregivers are the heartbeat of the military family and the backbone of the veteran medical care system.  According to the most recent RAND study, there are 5.5 million military Caregivers in 2014, with 20% caring for veterans of our most recent conflicts.  But, few know they exist.

For a brief moment, imagine a “National Take Your Vet to VA Today” event.  This would be a day where the 1700 VA medical centers, vet clinics, or sites of care would attend to the hourly needs of the veteran to provide the caregiver a single day of respite.  It’s nearly unimaginable given the sheer numbers, isn’t it?  But it would be an excellent visual to show the vital importance and contribution of our veteran Caregivers.

Veteran Caregivers are intrepid; going where others fear to tread in their quest for answers.  They soak up information and education about Invisible Injuries like PTSD (Post Traumatic Stress Disorder) and TBI (Traumatic Brain Injury) and myriad physical and more visible conditions.  They learn to navigate a labyrinthine medical system, all the while reminding medical staff they are an integral part of the care team.  It has been a slow road to understanding in a system that previously focused solely on the veteran, and large bureaucracies are seldom swift change agents.

Caregivers carry a heavy load, and some examples are shocking.  One OIF veteran, raped by another soldier tried to hang himself; he was saved by his caregiver spouse grabbing a chair and raising him on her shoulders to elevate him until EMS arrived.  Another soldier was shot by one of his squad mates in Iraq (the only survivor of four in the room) in Iraq; his caregiver mother could not discuss her situation with anyone due to the investigation.  One caregiver sibling had to explain to the rest of the family that her brother preferred addiction to facing his combat PTSD.  The complexity of caregiving is great, with role changes, steep learning curves, and isolation. 
In providing Caregiver Workshops at military installations this year, several common themes emerge.  Though present in most communities and at every military base/post, Caregivers feel invisible and isolated, even from each other. They wish they knew more about how to live with someone with combat injuries, and how to best understand how to help their spouse/adult child/sibling/friend. They are grateful for the Internet, but nothing can take the place of a hug from a peer; someone who has walked in their shoes.  Finally, they realize that helping others also helps them to grieve for what might have been, restores their strength, and empowers them to share what they’ve learned.  Peer support is critical.

We are a generous nation, and we move to fulfill unmet needs.  Most people know a veteran, and some know many.  From this day forward, reach out to help a Caregiver of a veteran of any era.  Our WWII vets have aging and end of life needs, our Vietnam veterans have often shunned formal help until absolutely necessary, and tamped down combat experiences and their aftermath.  Those in Desert Storm and the Gulf wars, Kosovo, Grenada, Kuwait, and so many other places are smaller in number, but not in contribution.  And, for our OIF/OEF/OND veterans, successfully returning home is aided when the community recognizes and supports the entire family.

Proactively offer assistance to a caregiver who may not have the energy to ask, know the power of a smile of understanding, and the ease provided by listening without judgment.  Caregivers will not be alone if we practice outreach, increase awareness, and integrate them with their families more smoothly into the community. It is a matter of respect, compassion, and grace. 

Caregivers, know that you matter and that America is learning to express their support and understanding more each day!

Linda Kreter & the VeteranCaregiver Team

Thursday, May 15, 2014

Our Hearts Hurt Over Our Aging Veterans - Does Anyone Care?

Greetings, friends,

In the last three months, we have been serving caregivers in increasing numbers from our nation's long ago conflicts.  There seems to be so little that we can do, and it is so definitively wrong that the stories don't seem true. We know that the VA testimony is happening on the Hill today, but wonder if leadership is aware of what goes on in the middle and supervisory ranks? There are so many layers at the VA that the bureaucracy cannot get out of its own way so often -- but these are Veterans.  They deserve the medical care they have earned, and they are running out of time.  Literally.

Example 1:  A Vietnam veteran who served in Vietnam, Laos, and Cambodia, was exposed to Agent Orange, and has one of the cancers and another of the conditions deemed Presumptive and service-connected by the VA cannot receive help.  VA claims no record of service; his wife sent his dog-tags to prove it. He is in hospice.  They have worked with the VA, their county service officers for the last five years, and more recently we connected them to several private foundations that have service officers to help.  What does this caregiver spouse do when the typical lengthy wait times for responses mean she may lose her husband before anyone can help?

Example 2:  A World War II veteran who fought in the South Pacific has fallen into a terrible situation where the also aging spouse did not know of the VA's responsibility to her husband.  So, when their state demanded that she sign away their home, their car, and his life insurance to pay for additional bills after he dies, she saw no other alternative. She also has to pay nearly $1400 per month for a nursing home that should be closed for neglect. She lives on less than $800 per month.  

Those of us who work in this space understand the lack of urgency.  We even understand the bureaucracy.  But how is that those who are paid everyday to help our veterans and alleviate their concerns are not held accountable? Why are there bonuses paid when someone does (or doesn't) do their jobs? Where are the people who care?

We are amazed at the influx of past conflict veterans who enter the VA system only in their later years, mostly because of their distrust upon returning home. The two families above received VA care in the past, albeit minimal (hearing aid batteries, for example), and deserve and have earned VA care at the end of their lives.  We have no idea what will transpire out of today's hearings and subsequent investigations, but we do know that if people are uncaring, aren't held accountable, and the system isn't changed from the inside out, these stories will continue to be told, and the shameful treatment of our veterans will continue.

Please say prayers today for our oldest veterans among us going through these immense challenges, and that those whose job it is to help them actually do it.  Quickly.  Efficiently.  And, with care.

The VeteranCaregiver Team

Friday, April 4, 2014

Simple Pleasures


If you woke up today mentally listing all the things you needed to do, to be, and to complete, you are not alone.  It seems that many if not most people are straining to shoehorn “one more thing” into an already hectic schedule.  Years ago when multi-tasking was a key phrase, it seemed that instead of achieving more, it meant each task was done less well than if a focus was given to singular tasks. Not quite the outcome you were trying to achieve!

Today can be more pleasurable if you accept small glimpses of joy or recognize the small gifts along the way.  A fresh view can make an enormous difference in your perspective, and we can all use the peace in small moments.

What are your simple pleasures?  If you’re fortunate, today can provide a simple pleasure for each of your five senses. Open your mind and consider these examples:

Sight: blooming trees, tulips, bird nests, crazy squirrels, flags whipping in the breeze, smiles given and received, someone who lets you into the merging lane first, the gorgeous view you drive by seen with different eyes, a shared grin.

Hearing: chortling song of birds and scurry through the underbrush, sound of children playing, the laugh of a loved one, a compliment given or received, the gift of music, silence, or city bustle, or crashing waves or a meandering creek.

Smell:  clean, line-dried laundry, a great meal cookie, or the waft of the scent of coffee, chocolate, bacon, hyacinths, the sea, perfume that evokes a fond memory, baby shampoo, Grandad’s pipe, or an outdoor fire pit.

Taste:  your favorite cookie, ice cream, fruit, childhood Rice Krispies treats, s’mores, tall glass of sweet tea, the tart of a lemon twist, the zing of sea salt in caramel, comfort food, burgers on the grill, popcorn, barbeque, savory and sweet.

Touch:  fresh sheets, cozy towels, your favorite T-shirt, the softness of a sweater, the swish of fringe, the coat of your pet, the walking-by-touch that shows you care, a warm hug, and the feel of your child trustingly taking your hand. 

Trust that each day will provide gifts of simple pleasure, if you take the time to notice.  Today is a gift; enjoy it!

Linda Kreter & the VeteranCaregiver Team

Monday, February 17, 2014

Caregiver Peer Support - In Person...


We apologize for not writing yet in 2014; it has been a very busy year so far.  More postings soon, but for now, one important, recurring point.

Online caregiver peer support is great, but if it's possible for you, we suggest setting up an in-person caregiver meeting in your community. If you choose, include family caregiver supporters too.  It's up to you.

There's something about looking someone in the eye who understands, and nothing replaces a hug.  Pick a place, set a time, and whoever shows up - you can visit, talk, debate, and share.  If no one shows that day, give yourself the gift of quiet time.  We highly recommend it.

Caregivers and those who support them are exceptional people. In 2014, give yourself the gift of meeting other caregivers beyond the Internet. It's a very old Barbra Streisand song, but "People, people who need people are the luckiest people of all!"  Reach out and grow your in-person network through your community organizations, your churches, and your civic organizations.

Your heart and head will thank you.

 Linda Kreter and the VeteranCaregiver Support Team.