Let's Renew Together

Caregiving Goes On – Even if VA Information Does Not     

It’s February, and the realization that VeteranCaregiver has postponed creating new videos to support, educate, and even possibly sometimes inspire you hit me hard today.  Creating videos, and voicing thoughts you’ve had and wish you could have gives me joy and purpose.  So, today, we asked you what you want to hear?

Year ago, we began short, personal videos on medical conditions, how to better navigate the VA biosphere (little air in there…), manage the day to day, and the daily fatigue, frustrations, complications, and facts.  The realization that so many are confounded (us too!), that little to no information is forthcoming, and that background turmoil continues and has for so long is disheartening.

  

So, please share what you’d like to hear about – even if it’s silly, a life-skill like communicating better, or a serious issue that needs addressing, please tell us.  Like you, each day feels better with distinct purpose rather than responding to emails in a vacuum.  😊

It’s time to renew.  Let’s do it together!

Linda Kreter and the VeteranCaregiver Team

Loneliness: An Epidemic and A High Risk for Veterans

Loneliness has doubled in the U.S. In the 1970’s and 1980’s, Americans who responded that they regularly or frequently felt lonely was between 11 percent and 20 percent (depending on

the study).1 Just a few decades later in 2010, AARP performed a national survey that found that

loneliness had increased to between 40 and 45 percent among adults.2    And in 2017, former

U.S.   Surgeon General Dr. Vivek Murthy called loneliness an “epidemic” and stated that “loneliness shortens lifespans in a way similar to smoking 15 cigarettes / day”.3

The destructive effects of loneliness don’t end there. People who identified themselves as  lonely had a statistically significant 45 percent greater risk of death.4 "People aren’t [technically] dying of loneliness. But they are dying of cardiovascular diseases, cancer, accidents, suicide and diabetes. Based on your genetics and your environmental history, loneliness can make these conditions strike earlier than they otherwise would have," said Dr. John Cacioppo of the

University  of  Chicago’s  Center for Cognitive and Social Neuroscience.5    In fact, according to a

2018 study (by AARP, Stanford University, and Harvard University), Medicare spends $6.7 billion more annually on socially isolated older adults compared to adults that are not isolated.6

Isolated Veterans living at home have a high risk of feeling loneliness, so it’s that much more important to identify the warning signs that your loved one is feeling lonely.

Signs of Loneliness 

Here are some of the signs to look for so that you can seek help:

1.       Poor Sleep. Individuals who are suffering from loneliness often have poor sleep. According to Dr. John Cacioppo, "A handful of studies have shown that when you’re lonely, your brain remains alert for threats and you show more micro awakenings or sleep fragmentation. This has an adaptive purpose: If you’re isolated, you could be predated at any moment. It doesn’t matter whether you are sleeping next to someone—if you feel isolated, that causes the brain to remain on alert."7

2.       Frequent Sickness. Individuals that are lonely are more likely to get sick. Dr. Cacioppo stated, “We’ve found loneliness is associated with altered gene-expression, which makes you more susceptible to viruses, a correlation that has been shown in humans and animals.”8

1 See http://fortune.com/2016/06/22/loneliness-is-a-modern-day-epidemic/.

2 See https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf.

3 See https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic.

4 See https://www.ucsf.edu/news/2012/06/12184/loneliness-linked-serious-health-problems-and-death-among-elderly.

5 See http://fortune.com/2016/06/22/loneliness-is-a-modern-day-epidemic/.

6 See https://www.aarp.org/content/dam/aarp/ppi/2017/10/medicare-spends-more-on-socially-isolated-older-adults.pdf

7  See http://fortune.com/2016/06/22/loneliness-is-a-modern-day-epidemic/.

8  See http://fortune.com/2016/06/22/loneliness-is-a-modern-day-epidemic/.

3.       Longer, Hotter Showers. Studies indicate that lonely people take longer and hotter showers--the lonelier the person, the longer the shower and the hotter the preferred temperature. According to Dr. John Bargh, Professor of Psychology at Yale University and administrator at Yale's Automaticity in Cognition, Motivation, and Evaluation (ACME) Lab, "[P]eople tend to self-regulate their feelings of social warmth through applications of physical warmth, apparently without explicit awareness of doing so."9

4.       Buying More Stuff. Individuals that are feeling lonely may look to fill a void through more consumer spending. According to a study conducted by Dr. John Lastovicka of Arizona State, "We...find that material possession love is empirically tied to loneliness and social affiliation deficits, which suggests a compensatory basis of consumer well-being."10

5.       Having Friends Who Are Lonely. Loneliness can be contagious. According  to research published in the Journal of Personality and Social Psychology, individuals are "more likely to be lonely if a person they are directly connected to (at one degree of

separation) is lonely."11      Dr.  Cacioppo  theorizes  that loneliness is passed on through

negativity and lack of trust. "People who feel lonely view the social world as more threatening," he says. "They may not be aware they are doing it, but lonely individuals think negatively about other people. So if you are my friend, and I started to treat you negatively, then over time, we would stop being friends. But in the meantime, our interactions caused you to treat other people less positively, so you're likely to lose friends, and they in turn are likely to lose friends. That appears to be the means of

transmission for loneliness."12    Negative feelings can be passed on by people when they

frown or make unpleasant facial expressions, make negative comments, or even use anti-social body language.

 Ways to Overcome Loneliness

 Where caregivers of Veterans are actively trying to help, often Veterans are still isolated for long periods of time and may still struggle with loneliness. Still, there are ways to combat isolation and loneliness:

1.       Have a Purpose. Regardless of whether Veterans live alone, they can still have a purpose. Even with advancing age, there is a world of opportunity for Veterans to  identify a purpose for their lives. Veterans can record their personal and family history, learn a musical instrument, or start reading that volume of books about World War II that they’ve always wanted to.

9 See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406601/.

10 See https://academic.oup.com/jcr/article-abstract/38/2/323/1894880?redirectedFrom=fulltext.

11 See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792572/.

12 See http://content.time.com/time/health/article/0,8599,1943748,00.html.

One exciting way of having a purpose for seniors is starting a “Bucket List.” What have you dreamed of doing in this life? Where have you dreamed of traveling? Whether the answer to those questions is whale watching, eating a new food like calamari, or finally reading “War and Peace,” anything is possible.

Psychotherapist and author Ross Rosenberg recommends to those wanting to overcome loneliness: "Open yourself up, take risks, and allow yourself to be vulnerable. Since loneliness results in isolation, experiment by sharing aspects of yourself, including experiences, feelings, memories, dreams, desires, etc. This will help you feel more known and understood."13

2.       Get Involved. Veterans who are isolated are at greater risk of loneliness. "There's no hard-and-fast rule that everyone needs to be involved with others all the time, but we tend to feel better when we're with others, and we may feel worse if we're often alone," says Dr. Michael Craig Miller, a Harvard Medical School assistant professor of psychiatry.14

There are many ways to get involved in your community. From joining a club (e.g., bridge club, mahjong club, jazz club, etc.) to volunteering (e.g., helping provide information at a local shopping mall, delivering Meals On Wheels, becoming a mentor, tutoring, etc.), there are lots of ways to get involved. Most cities have local resources available for Veterans that has a calendar of events (e.g., women’s events, hikes, golf events, holiday ceremonies, encampments, job fairs, benefit open houses, gun shows, etc.).

If Veterans prefer to stay at home or have mobility limitations, there are more and more resources available online, including online book clubs, online family history, online games (e.g., chess, Scrabble, fantasy sports, etc.) and online classes (e.g., learning a musical instrument, cooking, dance, gardening, mechanics, learning a new language, lectures and podcasts, etc.).

"When you're alone, you focus too much on yourself and dwell on regrets or worries. When you're with other people, you turn your focus outward. When you're thinking less about yourself, you're worrying less about yourself," says Dr. Miller.15

3.       Take Advantage of New Technology. For decades aging Veterans have had very limited options for companionship while living at home, other than family or caregivers. A new company, Veras (www.veras.com), provides a cheaper and easier alternative. Veras provides senior home care via video calling and allows aging Veterans to stay in the place they most love--their homes.

13  See https://www.huffingtonpost.com/ross-a-rosenberg/loneliness_b_4648417.html.

14  See https://www.health.harvard.edu/aging/5-ways-to-fight-loneliness-and-isolation.

15  See https://www.health.harvard.edu/aging/5-ways-to-fight-loneliness-and-isolation.

Veras leverages simple video calling technology (similar to Skype or FaceTime) to pair aging seniors one-on-one with Veras Remote Companions to provide companionship and personal assistance. Veras Remote Companions provide medication reminders, schedule doctor appointments, play games, and provide companionship through conversation. Veras Remote Companions also help family members stay in the loop by sending weekly email reports about activities (Watch video at https://www.youtube.com/watch?v=Fbo-NE0l2wo).

Thankfully there is growing awareness around the problem of loneliness, and, where we all make efforts to help those around us, we can make a difference.

Ben Zimmer

www.Veras.com

Suicide Prevention: Helping Yourself and Others Step Away From the Ledge

Suicide Prevention: Helping Yourself and Others Step Back from the Ledge

Photo courtesy of Pixabay by PublicCo

By Jennifer Scott, www.SpiritFinder.org

Chris Cornell. Robin Williams. Chester Bennington. What do all these names have in common? They all dealt with various addiction and substance abuse struggles. They all struggled with suicidal thoughts. And, ultimately, they all took their own lives.

There’s been a 40% increase in the suicide rate in the last decade. Nearly 80% of those who commit suicide are male. Suicide is one of the leading causes of death, and is expected to overtake cancer deaths within the next 15 years. In fact, one person commits suicide every 15 minutes.

Some argue that suicide has become an epidemic in our society - with someone taking their own life every fifteen minutes. This has led to comparisons between the suicide epidemic and the cancer epidemic, with suicide and depression estimated to overtake cancer as one of the leading causes of death in the next 15 years. Russell Brand has even theorized that cultural changes in the developed world have led to an increase in the number of suicides each year.

It sometimes feels like there’s a new report of someone committing suicide on the news each week. For those who are struggling with depression, substance abuse, or suicidal thoughts, it can feel like the world is bleak and that there is no hope to be found. Nothing could be further from the truth.

There’s an unspeakable amount of grief and disbelief when we lose someone to suicide. Suicidal thoughts can happen to anyone, but that doesn’t mean we’re without hope. Luckily, there are some things you can do to help yourself and/or your loved ones:

Here are some things you can do:

Reduce the Stigma
Talk about mental illness, depression and suicide in the same way that you would talk about diseases like cancer. Spread awareness. Help share resources, crisis hotline numbers and prevention strategies. Avoid criticisms, name-calling, casting blame or showing judgment. You never know what someone else was secretly dealing with. Mental health conditions are every bit as serious as physical conditions like cancer, and should be treated as such.

Emergency Resources
If you or a loved one are dealing with suicidal thoughts, it can be immediately beneficial to talk to someone for help. Not only does this let you know you’re not alone; it can also provide coping mechanisms to help get through your current situation. There are many nonprofits and resources available to assist those in need. Here’s a list of suicide prevention & crisis hotlines available around the world.

Long-term Prevention Strategies
Even if you’re not currently in crisis, it is helpful to have a longer term strategy in case suicidal thoughts ever return. Prioritize your mental health care and make lifestyle changes to assist you in coping with your depression during difficult times. This might include surrounding yourself with positive, supportive people; being aware of the suicide prevention resources listed above; becoming more involved in your local church or faith-based organization; kicking an addiction or substance abuse issue; or even picking up a healthy habit such as yoga or meditation.

Losing even one person to suicide each year is losing too many. Suicides are preventable. Please use and share the crisis resources and suicide prevention strategies listed above. You never know whose life they might save - possibly even your own.

Jennifer Scott

www.SpiritFinder.org

VA Caregiver Program Changes & Awareness Recommendations

Points of new awareness about the VA Caregiver Program:

Please be certain to research beyond private, secret, and open Caregiver Communities on social media.  Rumors can spread like wildfire, even when the information is not accurate.  Rising anxiety levels within the family rarely does anyone good.  Find out the facts first.  Note that VeteranCaregiver goes directly to the VA Central Office with questions raised on specific processes, caregiver law, and changes.  The answers are not always clear and often raise more questions -- but these are direct responses from Caregiver Program Leadership.  

Something one Caregiver Support Coordinator tells you does not always confirm national guidance.  Each VISN has the flexibility to implement the program (*within the parameters of the Caregiver law*) differently.  We already posted the official response to new phrases used in 2016 regarding “short-term recovery program”, “graduation”, and the significant reductions in Tier 3 caregiving.  According to the VA, there are no quotas, no changes in eligibility requirements, and no changes in ADL measurement. Note possible discrepancies to the law, with date, person, VAMC, requests for clarification in writing and attach a Read Receipt to the short message.

ADL’s still form the basis for eligibility, as do safety and protection elements.  Here is an excellent example of the detail you may need to explain about only a single ADL:  bathing independently.  See below and other questions and responses may be found on www.VeteranCaregiver.com’s website in the “Ask Questions Here” section on the Homepage:

I’M CONFUSED ABOUT ADL’S. JUST USING BATHING AS AN EXAMPLE, MY WW HAS DIZZINESS, BALANCE, LIMITED RANGE OF MOTION THROUGH BACK AND UPPER BODY WITH CHRONIC PAIN. HE CANNOT WASH BY HIMSELF, YET THE CGC SAYS SINCE HE SITS IN THE SHOWER BY HIMSELF, HE CAN BATHE WITHOUT HELP. NOT TRUE! HE CANNOT WASH HIS HAIR SINCE HE CANNOT RAISE HIS ARMS. HE CANNOT WASH HIS BACK, BUTT, OR BACKS OF LEGS SINCE HE FALLS OFF STOOL IF HE RAISES ONE LEG TO REACH THE OTHER. HOW IS THIS NOT NEEDING ASSISTANCE?

This is a great example of when detail explains what the needs are. If you haven’t already, write all this down, since if the questions are not asked about detail, then assumptions are made. What you describe fits the definition of needing assistance with bathing, but if the right questions aren’t asked, or the vet glosses over his not wanting to say personal details, there is a chance that this will be overlooked. Write this up and ask that the evaluator/RN/PCM add it to his medical records.

If you need to appeal a VA decision, you will need to know the precise reasons to address points specifically in your appeals documentation.  Appeal justification is best explained using language similar to the clinical language provided to you as the reasons for the caregiver program change in status.  Specific points, evidence, and documentation is best delivered in a succinct document, and excess emotion removed. Abusive language is not advised even if you feel it is warranted.

Appeals timing of document submission will vary from VAMC to VAMC, but will be shared with you upon request.  Also ask specifically for "confirmation of the receipt of the documents for appeal", and again request "confirmation that the Appeals Panel reviewed the materials prior to their decision" in writing.  Note the timing of decision letters and the receipt of documents.

There are separate VA non-medical databases that contain feedback on the caregiver and veteran.  This information may not be available to those reviewing appeals, and request copies of both the Patient Advocate Tracking System (PATS) notes, and any Caregiver Application Tracking System (CATS) notes.  (This may mean a FOIA request.) The noted information may be used for decisions and unless you’ve verified the information is correct, or that information is missing, your status may be adversely affected.  It appears that access to this information varies per VAMC.

The specific reasons for Caregiver Program reduction or termination" will be explained to you in a transparent, understandable manner" per VACO.  It’s best to receive this in writing, and we have seen only a single VA do this in the status change letter.  You may request to record a Skype call if you’re far from the VA and a meeting is offered, and you may request to tape a meeting for an in-person meeting.  We recommend responses in writing so you can review and compare to your veteran’s needs, the responses used for the decision, if records were changed or missing, and to determine your response.

Trust, but verify information.  It is very possible to receive a VA response that is accurate, but literal.  If you don’t receive direct answers to questions, rephrase them politely in an email and request clarification of the response.  It should not be necessary when direct responses and transparency would be more efficient, but ... Make use of an outside advocate (AW2, Legion, AMVETS, etc.) when in doubt.

Please stay informed, use trusted resources and advocates, and know how absolutely vital caregivers are to the care of our nation’s wounded, ill, and injured.  We will continue to post direct VACO Caregiver Program responses to your questions for your increased awareness.

Linda Kreter & the VeteranCaregiver Team

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

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

Caregiver Self-Identity: Who Am I Now? It's YOUR Choice --

A caregiver wrote VeteranCaregiver recently saying, "I used to be a marketing executive before becoming a full-time caregiver.  But I've lost my identity and don't feel accomplished or even know myself anymore?"

Such a good question; our self-identities can be swallowed whole by caregiving.  It can happen gradually over time, but you are not alone.  It's very easy to get lost in the daily grind, completing tasks, becoming more and more tired, and tending to everyone’s needs except your own.  You are last on the list.

Truthful statement:  only you can carve out time for you.  If you have become accustomed to putting aside everything that once gave you joy, does that help your situation at home?  Does it help you feel good, or like a martyr.  A therapist once said this:  “You need to choose, are you a martyr or a victim?”  Neither of those labels felt good, and were rejected.  How dare she say that?! 

But, if we make the conscious choice to set our boundaries, set aside a small portion of the day, and refuse to relinquish ourselves to others’ needs entirely, we will be better caregivers and individuals.  You haven’t lost your gifts and talents, and those unique traits are inside you – you just need to take the tarp off and give yourself permission to claim them.  

There will always be those who complain, and complaining is fine if it leads to possible solutions, but of little value if not.  No judgment here, but only you can help you begin your personal growth or to beef it up.  Best of all, you have now learned new skills, some of which you may take for granted.  Did you ever think you’d be able to direct the medical care of a loved one, or wade through bureaucracy with determination and purpose?  These new skills have made you a stronger, more accomplished version of yourself if you’ll stop to recognize it! 

Take the time to write down your skills; what are you good at, what are your new talents, even write a resume.  Add notes on your smartphone, and read them to yourself or post it on your mirror to remind you that you are worthy, smart, savvy, and you matter.  Create a LinkedIn profile because in doing so, you’ll realize your skills are valuable, and you'll have an identity outside of your daily role.  Then Follow other people of interest and start learning anew. This is Post Traumatic Growth.  Many caregivers find new skills and experiences give them new capabilities, and IF they consider them, new self-confidence.  You are "more" than your daily caregiving!

With introspection, time spent thinking about you - yes, you - you will see ways to reinvent yourself, recall your strengths, and take back you.  You are worth it - take the time to believe it!

Linda Kreter & the
VeteranCaregiver Team