A Tired Caregiver - VA Visits

I happen to enjoy visits to the "big" VA clinic. It gets me out the house and gets us around other people. But -- my husband hates those visits.  He associates doctors with pain, because every visit causes him pain, dread, and fear.

Example:  he hates the dentist and we had to cancel several visits because he just plain refuses to get dressed and leave the house.  He knows he needs to go, but just sees the painful part.  PTSD, anxiety and mental issues make it worse. 

How do other caregivers deal with it when your Veteran refuses visits to the Doctor/VA?  When it’s hours away and turns into an all-day event?  Do you bribe with visits to certain places?  Do you risk them having a meltdown in the VA or wherever they hate to go?  We try to stay in our role as spouse, but it feels like being a mother, or shaming him if we insist.

Why is there no program at the VA for Veterans with Doctor-related anxiety related to enduring pain?  Every visit seems to incur pain and the further apart the visits, the more pain.  If we go to the dermatologist for a mole, that won’t hurt, but do I bring up the infected toe?  Removing part of a nail takes the VA three separate visits!  One to look at it and say "Yes, it’s infected and needs to be removed", the second is the actual surgery to remove the sides of the nail and the third is to look at it two weeks later. 

Each of those visits is a two hour drive -- one way.  Again, why can't they just make it easier for us?  PTSD and anxiety make this very hard.  Can’t this be referred to the big VA for surgery and follow-up locally?  No need to make a ten second visit with a Podiatrist turn into an all day thing.

I hope I can find an easier way to get his care to make his life and mine easier.  The care team doesn’t respond except to tell him to man up.  That doesn’t work because he doesn’t feel they care about him. I’m tired of badgering to do doctor visits; am I the only one who’s made out to be the bad guy in “supporting my vet” for care? 

A Tired Caregiver

Try NEW Things - With Thought & Planning, It IS Possible! -- Guest Caregiver Post

Many of our Veterans that suffer from PTSD and other mental health issues lose interest in things they once loved and enjoyed doing, or may not do them due to physical limitations. 

The man or woman that once was out hunting, fishing or playing or playing golf now just sits around at home doing nothing and watching TV.  Even a simple family outing seems all but impossible as they cannot handle crowds, noises, long lines and get just plain aggravated by most everything.  My own Veteran is like that. He just sat at home and watched TV.  He wanted to be left alone.

Going through trying out a new medicine turned out to be a disaster and re-adjusting to the old medicine took all summer. This meant sitting on pins and needles for what would happen next.  I paid close attention to what shows he was watching in a back bedroom he was holed up in.  He watched Food Network most of the day.  I also knew that grocery shopping is one of the few things he still enjoyed.  Good!  We could go during low customer times and he can walk as slow as he needs and can take breaks as needed. He likes eating (unfortunately).

But, as a family, we hadn't done a single thing all summer.  School was coming up quickly.  How could I combine groceries, eating and fun for some teenagers into one activity?  Impossible at first glance.  But, in our case, I had paid enough attention during hours and hours of Food Network to remember a place called Jungle Jim's in Ohio.  I suggested going there. As usual, he was worried. He came up with all the things why we couldn't go.  Do they have electric carts?  What if he has a panic attack?  What if his sunglasses break (he needs them to shield his eyes from bright light and they broke 2x before while shopping)?  I did hours of research. I promised to buy gear from his fav college team, and put spare shades in the car.  "Sweetie, they even have a Starbucks and I can buy you an iced coffee", plus we can take breaks as needed.  I mapped all the bathroom breaks, a trip to Skyline Chili AND a bucket of wings from the Lube.  I showed him pictures of the supermarket, how they had food from all over the World and the US.

This last point finally sparked his interest. Normal grocery shopping in a place also fun for our kids and two restaurants he likes. For the first time this summer he had done something new, and with the family.  We were so proud of him.  And of the family…

Even a Veteran that has virtually no interests left (or so it seems) can find things they can do with the family.  I had to pay close attention to mine. It was food for him. For your Veteran, it might be a favorite sports team, books they enjoy, tech gear, art supplies, or movies.  If you find what they still can enjoy, you can find something new to do. Is there a book store they haven't been to? Is there a place where a movie was filmed? (I took our family in better times to where they filmed “A Christmas Story”.) Restaurants they might enjoy? (Calling ahead might be necessary to see if they take out or can provide a quiet place for a Vet with PTSD -- we had to take food out and did a picnic.)

If they fear regular movie theaters try finding a drive-in. This way you can stay in the car in the back row or on the side.   It gives them more security knowing they can get out fast if needed.  See what sparks their interest, be creative. 

Doing new things, even with a great deal of planning helps the whole family.  What has worked for you?

Caregiver Cornelia Malies, Kentucky

Guest Blog Post

Forgiveness

All relationships create opportunities for communications, or no communication, but both words and deeds are powerful and once said or done, very difficult to un-hear and un-see.  Forgiveness is a powerful concept, but one of the most difficult actions and choices to make in life. 

How do you repair or maintain a relationship following harsh or painful words and actions?  Choosing first to repair the schism is important.  And, it may mean a conscious choice to address some painful personal truths.  Many neglect to look inward to closely analyze what may be something you’d rather forget – introspection and bald reality can be difficult to manage.  Yet, if you fail to learn from situations, you are likely doomed to both suppress negative emotions, and to repeat the behavior.

If you received harsh or painful words, it takes a very strong person to look unflinchingly at what occurred and to calmly analyze it before addressing it. It’s easy to immediately lash out verbally in retaliation, especially if the words or actions were unjustified or unfair.

We are all familiar with words said in anger, and despite the nursery rhyme about sticks and stones… some words wound and scar.  Only you can determine the intensity of the exchange and whether forgiveness is an option, but without resolution, you may find yourself bitter, not better.  This decision to repair can be rapid or take years, but it’s worth considering for a calmer, happier life.

Many people cannot or will not deal with conflict.  If you’re one of these, consider how repairing the friendship will affect your life.  Usually, it clears the air, and both people can move forward.  No matter the timeframe, carefully choose accurate, but kinder words to explain how you feel – whether you are the deliverer of the harsh words, or the recipient.  It’s now time to fix the error, not to blame or shame.  This may not be possible on the first try, and you may find that some conversations are not recoverable, and that door must be closed. 

If both people are open to nurturing a relationship after harsh words – which happens to all of us – it is possible to move forward, even without an apology if that occurs.  Respectfully hearing or saying that the situation is now regretted may be enough to begin the healing.  Perhaps the apology is at first a Band-Aid.  But, over time, when forgiveness is applied and the situation is not a repetitive pattern of hurt, relationships can grow stronger than before.

Why is it that as small children we could easily say we were sorry when we knew we were wrong?  Why is it hard sometimes to stand up for ourselves when we have been wronged?  Either scenario is made better with resolution and kindness.

Forgiveness frees and releases the pain and increases self-respect and respect in the relationship.

Linda Kreter & the 

VeteranCaregiver Team

Korean War Veteran Caregivers

All Caregivers matter to us.  And, learning about illnesses and conditions other era caregivers experience helps when meeting another caregiver during a VA appointment or at a veteran event.  Specifically, cold-related injuries and nuclear testing radiation exposure trouble many veterans of this era.

Korean War conditions include some today’s conditions, but the prevalent differences were cold-related injuries.  Frostbite and Trench foot, were major problems during the Korean War.  Veterans of the Battle of the Chosin Reservoir had especially high rates of severe cold injuries, and over 5,000 troops required evacuation for the effects of cold injury during the winter of 1950-51.  Many veterans never sought VA help due to battlefield conditions or because their service medical records may no longer exist. 

Long-term delayed symptoms include peripheral neuropathy (nerve pain), arthritis, foot problems, stiff toes, and cold sensitization.  Age may worsen these conditions, and complications such as diabetes or peripheral vascular disease put them at higher risk for late-in-life amputations.

Photo:  John P. Collins

Many Korean War veterans may have participated in 250 atmospheric and underwater nuclear weapons tests conducted primarily in Nevada and the Pacific Ocean between 1945 and 1962.  These vets are known at A-Vets or Atomic Veterans, and number 560,000 troops. Approximately 195,000 surviving "Atomic-Vets" alive today may not know that their "oath-of-secrecy" tied to their nuclear weapons testing duty has been lifted, allowing them to now speak freely of their personal experiences.  A-Vets may be entitled to "service-connected" benefits for illness caused by their exposure to atomic radiation particles while on active duty, and benefits are also available to spouses of deceased Atomic-Veterans.

The National Association of Atomic Veterans is a strong resource, and please go to the Video Resource section of www.VeteranCaregiver.com to have a larger list of resources mailed directly to your inbox.  We appreciate the caregivers of the Korean War and hope that caregivers of every era support one another in whatever ways possible!

Linda Kreter & the

VeteranCaregiver Team

Plan Ahead with a PTSD Alert Signal

Let’s talk about PTSD and triggers – and a way to communicate ahead of a full-blown anxiety situation.  As you become more familiar with what causes situations to move toward a negative situation, or a rising sense of foreboding, you’ll likely learn what triggers set off you or your family member.  Yes, it’s important to include you in this equation, since many caregivers also have accumulated symptoms of secondary PTS, and the resultant hypervigilance, mood changes, effects of insomnia, and stress.

Working together as a team, a family can learn to mitigate certain situations, such as crowds, loud and volatile situations, including family holiday dinners.  Creating a non-verbal signal puts you and your family member in charge of alerting one another.  Keep it simple, a tap on your wrist, a hand signal or perfect the Let’s-Get-Out-of-Here-Soon glance.  Demonstrating that you understand your family member (or you) are feeling rising anxiety, stress, or discomfort with the situation is helpful and allows you to more gracefully depart most situations promptly.  What a relief to avoid gutting out every difficult occasion! 

Recently, I heard a wonderful follow-up to this trigger signal by a smart and thoughtful caregiver named Lauren.  After these signals are given, departure is complete, when the next quiet moment comes, she and her husband engage in a short discussion.  Either one asks: First, are YOU okay?  Second, is the Situation okay now? And, Third and most important, Are WE okay?  This is a strong team effort that is kind and intuitive.

Take time this week to create your own PTS Alert Signal, practice it until the all feel united and comfortable, then consider asking those three key questions to keep the calm channels of communication open and willing. 

Linda Kreter & the

VeteranCaregiver Team

Autism Caregiving: Early Diagnosis & Early Interventions

VeteranCaregiver receives inquiries every month about information and support for military and veteran caregivers also caring for a child with Autism.  There is a great deal of crossover in caregiving with the lack of time, overwhelm, fatigue, concern, and lack of adequate self-care.

We’d like to raise awareness about early diagnosis and early interventions. Timing can be critical in life, and just as with TBI and PTSD, the sooner effective treatment begins, the more beneficial the outcomes.  Earlier genetic testing can provide earlier interventions, critically important for future capabilities and quality of life.  Please seek the advice of your care team with questions about your personal situation.

Autism is the leading developmental disability today, with nearly 3% of the population falling on the spectrum.  While leading experts have yet to find a definite cause or cure, there is help and support available. We recently interviewed Scott Fowler on our radio program.  He is a retired special education administrator, an Autism Subject Matter Expert -- and a parent caregiver of a child on the spectrum.  A common saying is that if you know one autistic person, you know one autistic person, since each are unique.  The radio program is titled More Alike Than Different and is available on Military Network Radio.com (http://bit.ly/AutismEarlyDx).  

Coming soon:  Autism Outreach Network

Autism is diagnosed through often lengthy behavioral observation, with most diagnoses coming between the ages of four and five.  This is the ‘diagnostic odyssey’, referring to the time-span from initial concerns to an actual diagnosis. New technologies now make diagnosis possible through specialist referral to genetic testing from birth forward, which can lead to available interventions at an earlier age, which is an advantage to your child and the family.

Occupational Therapy and Speech & Language Therapy are the two most commonly used early interventions.  Occupational Therapy addresses the child’s relationship to the environment around them and Speech Therapy helps with the range of speaking issues that promote communication. The sooner these services are started, the better the overall life outcomes for your child. 

Parents have highly attuned intuition about their children, and if you have doubts or concerns about the timely development of your child, don’t wait, but talk with your care provider immediately.  Ask directly about diagnostic genetic testing and for prescriptions for both occupational therapy and speech/language therapy evaluations and have them completed.  You are building your child’s care team, and the sooner you act, the sooner your child can realize their fullest potential.

Linda Kreter & the

VeteranCaregiver Team

DARE to be Happy - Go Ahead & Step out on the Limb (Where the Fruit Is)

Happiness can be an elusive concept if you’re not consciously working toward it.  Quick – ask yourself when you last felt happiness?  Hopefully, you can identify something that made you laugh, or a warm conversation that boosted you one afternoon.  However, if you feel as though you’re unable to lift your spirits doing things that usually make you happy, and nothing makes you smile anymore, those are signals you may need professional help for dysthymia or depression.

Let’s shift back to happiness.  Are there times as a caregiver when you don’t feel it’s okay to be happy?  Do you ever feel guilty or pause and tell yourself that someone else has it worse than you do?  It’s important to not compare ourselves with others, and undeserved guilt can hold you hostage.

Caregivers are often so hard on themselves that even when time becomes slightly more available, you don’t dare to be happy. Well-being is an intentional shift to more positive thoughts and fewer negative ones.  While easier said than done, happiness really is a choice. Did you know that when you learn to redirect your thoughts to the positive, your brain will physically develop new neural connections?  With time and practice, happiness can become your default mindset.  The Happiness Advantage book by Shawn Achor is a great reference and easy to read. 

Happiness can be promoted by eating properly and ensuring your body has sufficient Vitamin D, obtained through food, supplements, and synthesized from sunlight.  Millions of people are Vitamin D deficient and during the winter, lack of Vitamin D is linked to SAD or Seasonal Affective Disorder. 

Exercise is a classic boost for endorphins and feel-good hormones, and a great step toward more restorative sleep.  The American Psychiatric Association has found exercise very helpful even when used as a stand-alone therapy for depression! Combined with talk therapy, there is value in the physical activity, and for the accomplishment.  

As you dare to focus on yourself and the potential of happiness, we come once again to a powerful means of viewing life with a brighter perspective:  appreciation and gratitude.  Consider the people and situations you’re grateful to have in your life.  Keep a gratitude journal, note thoughts on your smartphone, and recall that “how you feel is how you see the world”.  The head follows the heart, so it’s important to share thoughts of appreciation and thankfulness. 

Take time to consider how you fit activities, connections, or moments into your life.  Dare to be happy, and recognize that caregiving is only part of who you are.  In changing your mindset, it’s very possible that you’ll positively influence others around you.  Take a chance, and dare to be happy -- then make it a habit!

Linda Kreter & the

VeteranCaregiver Team

The Positive Efffect of Pets

Pets matter.  They make our lives richer.  Pets can play a unique role in our lives, providing unconditional love, reducing anxiety, and releasing stress.  If you’ve been wondering about getting a pet during your caregiver journey, consider that science supports pets as providing a calming, balancing, and enjoyable relationship.  

Those in the healing arts know that pets make a positive physical and psychological difference for many.  For decades, retirement homes, cancer wards, rehab centers, and children’s hospitals are just a few venues where animal visits are the highlight of the week and eagerly anticipated.  The simple act of petting an animal can rapidly reduce stress and promote calm.  Soothing.  Comforting.  Pets are often cherished.

Sweet girl - protective & wise

We’ll stick here to the common dog and cat pet choices.   You’ll hear people express they are a “dog person”, or a “cat person” for a variety of reasons, but both can make wonderful pets.  Dogs have a wonderful ability to “read” your moods, understand certain words, provide comfort and a canniness to read your mind when you need a non-judgmental guide to listen to you mull over a problem. Cats also sense your moods, will sleep trustingly even as you talk to them, and purr as they curl beside you. When you need an extra measure of hope, warmth, and kindness, cats are low maintenance and exercise on their own.  Most dogs and cats are social animals and want to be around people and follow you everywhere if you’ll let them.

No matter your animal preference, talking with such a great listener who doesn’t interrupt you, doesn’t judge you, and who is always there for you means a lot.  Another benefit to a pet is that taking care of something else takes you outside yourself.  This animal needs you, and can create a routine interaction that automatically helps with reducing depression and lowering anxiety.  Walking a dog gets you out of the house at least twice a day, providing exercise and socialization, sparking conversation. Pets energize you, make you laugh out loud and can bridge loneliness and isolation. Facebook is filled with silly home videos of pets with thousands of views; they fill a need in our souls. 

A purring machine & cuddler

Animals are genuine, they don’t gossip, they rely upon you while giving you stress relief, laughter, empathy, companionship, and unconditional love.  There is great power in pets, so go ahead, talk to your animals, they’ll love you all the more – and it’s great therapy without an appointment and immediate.  Consider THAT for a moment…

Linda Kreter & the

VeteranCaregiver Team

Hormone Replacement Therapy for NED (symptoms of TBI and PTSD)

PTSD and TBI have physical symptoms that can be evaluated and treated if we ask our care teams about the newly emerging treatments that can help manage some of the symptoms.  Most of the time, the VA will guide a service member or veteran to CBT (Cognitive Behavior Therapy) or PET (Prolonged Exposure Therapy) as their first standard of care.  Yet, if you look at many of the symptoms of TBI and PTSD, these conditions may have resulted in reduced levels of important hormones.  These invisible injuries have a “neuro-endocrine” component; hence the psychological elements, but also the physical one.  Considering hormone replacement therapy is a complementary therapy option.

Physical injury to the brain with these (often) precipitous drop in hormonal levels, may contribute to many psychological and physical symptoms such as anger outbursts, depression, anxiety, mood swings, memory loss, concentration issues, learning disabilities and sleep deprivation. Many vets also experience high blood pressure, diabetes, loss of sexual drive, obesity, muscle weakness, and in women, menstrual changes. 

Hormones are powerful in our bodies, and may strongly impact quality of life for the veteran and their families.  It’s never fast enough for us, but studies are ongoing with hormone therapy to address the specific areas of reduced hormone production.  These hormonal deficits cover hormones regulating the thyroid, pituitary and adrenal glands, growth hormone, and the sex hormones, estrogen and testosterone. 

Researchers at the VA Puget Sound and the University of Washington found that up to 42% of veterans with blast injuries could suffer from low levels of pituitary hormones, causing some of the most troubling and lingering effects of mild TBI, such as fatigue, insomnia, lessened cognition, memory loss, sexual problems, depression, concentration and mood disturbances.  The primary investigating physician on the study said this:  “If PTSD does not resolve, it’s very possibly due to hormonal deficiencies”.

How many of you have heard the term “NED”?  DCoE for Psychological and Brain Health recommends screening for NED, or Neuro-Endocrine-Dysfunction in veterans with a history of TBI and symptoms lasting longer than 3 months, or which present within 3 years of injury. One example is with low levels of testosterone.  In the past, testosterone was delivered via injections, which caused spikes in blood levels, translating to the comments made by caregivers in two categories:  “too much sex drive, low energy, mood change” or “too little sex drive, aggressive, mood change”.  Newer administration is through pellet delivery (small as grains of rice) through a shallow incision in the buttocks or elsewhere for roughly 3-4 months in women and 5-6 months in men.  This delivers the bio-identical hormone in a steady fashion to the body; a blood test can determine if the levels have been optimized for each of the hormones (thyroid, adrenal gland, pituitary and gonads).  Sometimes, hormones are administered through oral supplements to complement the therapy an individual will require. 

This isn’t only about sex drive; it’s about quality of life with energy, mood, concentration, focus, and the potential to feel more like before deployment.  Note: this may be used as a complementary or alternative therapy, and no single therapy works for 100% for all taking it.  Research hormone therapy as a possibility with your primary care physician, since studies are showing real promise for improved quality of life.  More information is available through an Internet search or at the www.USMedicine.com website and search for “hormone replacement”. 

Linda Kreter & the 

VeteranCaregiver Team