Monday, August 24, 2015

Traumatic Brain Injury: Share with Family & Friends for Understanding

Traumatic Brain Injury or TBI, is one of the “signature wounds” and a physically damaging, but often invisible injury of the most recent conflicts.  In some cases of traumatic brain injury, PTSD is also present. 

For families, it is often very challenging to have extended family and friends understand because there may not be a visible wound or scar and they can be judgmental.  Please share this blog with them, or the TBI Video on’s Video Resource section.  Support for you, the caregiver, is immeasurably valuable.

Traumatic Brain Injury or TBI, is actual physical or biological damage to the brain, and treatment can be complex depending on the severity of the TBI. There are multiple descriptions of TBI:  mild, moderate, and severe, leading to the diagnosis and treatment path with the severity of the injury.  For the caregiver, this designation also can be a measure of describing the tasks the injured person may have challenges with, but – it also depends upon which part of the brain was injured.

There is also a “penetrating TBI”, meaning something (shrapnel for example) has breached the skull and the membrane covering of the brain, the dura. There are also blast injuries to the brain, which in simplified terms means that the brain has been blasted and bruised inside the closed confines of the skull. Since the brain is crucial to executive decision making, personality, judgment, and countless other functions, any brain injury is meaningful to both the veteran and the caregiver. 

Some of the symptoms of TBI are headaches, intermittent dizziness, and fatigue, which can be initially shrugged off as adjusting to life in the community. Additional symptoms such as blurred vision, more consistent dizziness and balance issues, restlessness and agitation benefit from treatment.  Though the veteran may be unclear about their behavior, when memory and concentration issues complicate the relationship and household, getting help cannot be ignored.  Some of these symptoms may also be in reaction to vestibular (inner ear) issues, and having the correct diagnosis is important for VA ratings and treatment. 
Traumatic Brain Injury remains one of the most challenging undiagnosed conditions of the recent conflicts.  If you know that you are seeing personality changes, memory issues, balance, dizziness, insomnia, and/or frustration that manifests itself in anger or isolation, please ask for an evaluation ruling out an undiagnosed TBI.  Persist. Even if you’re told that playing football in high school is the root cause, remember that blasts and concussions are cumulative, and there is a rare FOB that didn’t take incoming rounds. 

Traumatic brain injury may also not show up right away, but over time, and unusual, agitated behavior that may include unfiltered speech can baffle and test all concerned. Relationships are often affected, and there is challenge to holding down a job, resuming the former routines, and fulfilling ordinary family roles. 

Communication and denial are common before diagnosis and persistence in seeking help is encouraged.  Leaving the brain injury undiagnosed or untreated can strain the best of marriages and partnerships.  As a caregiver walking on eggshells wary of a sharp comment, seeing the veteran forget how to drive home from a familiar place, or suddenly withdrawal from the family or relationship are additional signs.  Your family member may have no idea that there is something wrong until it becomes very obvious, or the relationship is tested beyond the breaking point.

With neurological assessments and cognition testing, the severity of the brain injury can be determined, and treatment plans coordinated.  Sometimes the most difficult thing for the caregiver is to convince the vet there IS something organically wrong, and it's important to seek treatment. 

It's important to remember this is a physical brain injury, and that significant recovery options should be considered and researched as everyone is unique. Interestingly, we have the NFL and football players bringing TBI into the news and urging new and innovative treatments. Know that help exists, and be vigilant in seeking help.  

If there is an undiagnosed TBI in your household, continue to keep a journal of symptoms that show a pattern to share with the care team. Help and improvement is possible with treatment, and learning more helps everyone in the care team and extended family and friends making things more supportive - rather than more isolating.  There are excellent resources for living with TBI and for newer innovative treatments such as Hyperbaric Oxygen Treatment; look at what is best for you and your family.

Linda Kreter & the
VeteranCaregiver Team

Monday, August 17, 2015

Positive Attitude Contagion & Your Support Group

Each day we have a choice to make about our attitude. 

If you become mindful about the fact that only today matters, and that you cannot change the past, nor (usually) predict the future, your perspective can be changed for the better. 

This prayer/musing made me laugh because sometimes it reflects what we all feel:

Dear Lord/Higher Power/Other,

So far today, I am doing all right.  I have not gossiped, lost my temper, been greedy, grumpy, nasty, selfish, or self-indulgent.  I have not whined, cursed, or eaten any chocolate.  However, I will get out of bed in a few minutes, and I will need a lot more help after that.  Amen*

This practice of adjusting your attitude many times daily is difficult, but it’s nearly always possible to find something good, even on the worst of days.  Being around those who are negative, usually have something critical to say about you or your situation, or who just plain drain you is exhausting.  Saying to yourself these people are “just negative” or trying to avoid them altogether is nearly impossible.  So, what can you do?

The great football coach, John Wooden says this:  “Things turn out best for the people who make the best of the way things turn out”. 
 Isn’t that the truth?  Interestingly, if you don’t buy into the Negative Ones and their critical, harping, unpleasant responses, they eventually want to be around someone who will react to them and feed the negative. Work to find a handful of trusted friends who are positive, and can be called upon when you need a boost.  Do the same for them. You’ll find that the more positive your attitude and behavior is, the more you attract others with the same perspective.  Like attracts like, and allows you to weather the tough days, and being around the negative ones when you can’t avoid it.

We all have tough, seriously-I-can’t-take-one-more-thing days, but when we stop for a second, take a deep breath, and briefly wait instead of reacting with a knee-jerk response that you’ll regret the rest of the day, this habit you’ve been practicing can come to you more often.  And, more easily.

There will always be jerks in life, but don’t buy into their “jerkdom”.  Remember too that positive people evolve into groups – and find an ally, a friend, a kindred spirit to start your own group, and to keep helping you adjust your attitudes about the day.  Take each day at a time, look inward and adjust your attitude as the day progresses.  Finally, reflect on your day each night and see the growth, the slipups, and especially note what you’re thankful for, even if it’s the fact you got a shower today!  
We continue to believe in the best within you; best wishes on lifting today to be the best it can be!

Linda Kreter & the
VeteranCaregiver Team

*Prayer from Today Matters by John C. Maxwell

Thursday, August 6, 2015

Vietnam Era Caregivers - You Are Not Forgotten

PTSD is not only a condition of today’s troops, veterans, and first responders, unfortunately, it is a condition that affects our vets of much earlier conflicts.  When you consider the state of the country at the time of Vietnam, our troops came home to protests, rioting, and a very difficult adjustment for those serving. 

The stories were dreadful.  Like now, families felt somewhat isolated, but the country was far less respectful of those serving.  Today, even without full understanding of how to act or what to say, our troops are mostly warmly accepted and supported.  By contrast, my uncle was briefed to change out of his uniform immediately upon arrival in the States to avoid the chaos of the anti-war protests. Others were verbally and physically assaulted.  
The effects of coming home and working diligently to be invisible in the communities has also produced a long-term result – many of those from Vietnam did not receive treatment for their PTSD, nor did it have that name in the 1960’s, though the condition has been around as long as there has been trauma and conflicts. 

Another result is this aging population may come to seek VA care only in their later years, and they and their families have lived for decades with what is today openly discussed.  PTSD then and now will have many of the same symptoms of scent and sound triggers, sleep disorders, difficulty communicating and relationship challenges.  Add to this the possible loss of prime mobility, hearing loss, and aging issues, including presumptive conditions like Agent Orange, and we know we must actively communicate with the caregivers of each era.

It is less known, but very sobering that 80% of Vietnam veterans reported active PTSD symptoms 25 years after their service in a RAND study, with very high rates of depression and suicide.  These caregivers are hidden among you and please lend your support to them, include them in your peer groups, and learn from their experiences. 

PTSD may be a more familiar term these days, but our Vietnam era caregivers are only now coming out of the shadows.  To our Vietnam and earlier era caregivers, thank you for your quiet strength and service.

Linda Kreter & the
VeteranCaregiver Team