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

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 5^th 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 19^th, 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 chuckdusmc@yahoo.com.  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

www.HomelandMagazine.com 

How is CAM Helping Our Veterans & Caregivers?

Greetings!

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

Traumatic Brain Injury Updates

Greetings all,

Despite the enormous effort to provide articles, webinars, PSA’s, and more on the Invisible Injuries of PTSD and TBI, it seems that there are still too many families (and medical staff) that feel many of the symptoms are “in your head”.  There are two very good TBI blog posts by the Defense Centers of Excellence for Traumatic Brain Injury that may resonate with you and your warrior or veteran. 

The first addresses Neuroendocrine Dysfunction in TBI (http://www.dcoe.health.mil/blog/article.aspx?id=1&postid=402) and the second, older one discusses what the families may experience and how to best identify the problem and support your warrior (http://www.dcoe.health.mil/blog/article.aspx?id=1&postid=359).

Undiagnosed TBI can lead to devastating outcomes for relationships. Many families talk about the “lack of verbal filters”, the short-term memory loss, mood swings, paranoia, and the agitation that TBI may present.  And, if you or your veteran is unfortunate enough to not receive care for your TBI because the doctors say “you look fine; just adapt”, you may need to  persist and document the symptoms to obtain care.  Be alert to support those fighting to make sense of their lives when they suddenly can’t keep it together, but don’t understand what their list of symptoms may mean. 

The military is taking notice and working diligently to identify and treat TBI beginning in-country. A new blast exposure technical tool is in use for measuring blast exposure and potential injuries.  Protocols exist for first, second, and subsequent concussive events.  But, the families must be aware to bring specific behaviors to the attention of the warrior or veteran, as symptoms can manifest long after the last event. 

Consider the increased suicide risk without diagnosis and treatment of even mild TBI in this third article:  (http://www.traumaticbraininjury.net/diagnosis-of-traumatic-brain-injury-key-to-preventing-military-suicide/).  Traumatic Brain Injury is serious, but there are options.  Continually learn about new research and treatments alternatives -- and do not give up the quest for diagnosis and management.

With respect and care,

Linda Kreter and the VeteranCaregiver Team 

New Blog for TBI Caregivers!

Greetings, friends,


A very special member of our VeteranCareGiver community has just launched a personal blog about caregiving for those with TBI.  It does not matter whether you are a spouse, parent, friend, or other family member, chances are good that you will identify with many of Annette's observations.  You may find the blog at www.spouseoftbiveteran.blogspot.com.  Annette also has a very poignant video on the homepage of VCG and we applaud her efforts to support and spread awareness of the challenges of caregiving for the invisible injuries of TBI and PTSD.


Brava, Caregivers!


Linda