Presence: Improve Your Outcomes

Have you ever looked around the halls of the VA, or seen caregivers together in a group?  Do you automatically note those that seem to magically command more respect and response?  It is a troubling fact that if we don’t know how to present ourselves to others that we won’t receive the same answers, directions, or decisions – but it’s true.

One of the most common questions and concerns from caregivers is this:  “I always feel invisible and ignored by the care team, what can I do to change that?” Just as it’s often impossible to change the situation and circumstances, there are choices to make to increase your success percentage.  Remember that small changes add up, and you can try them and discard what doesn’t work for you.  If your life is made smoother by these small acts, it’s not only possible, it’s probable that you’ll continue to make positive changes.  These are skills and results that no one can take away from you.

Work with us for a minute.  Some may seem petty, illogical or unnecessary, but they work.  If you feel uncomfortable, add or adapt these skills to better suit you and work them in slowly.

First let’s start with doing your research.  Know what appears to be available to you, or know the information you need for your family.  No presence in the world will help if you are asking for something impossible.  Armed with the facts and the questions, look in the mirror.  Fact:  People are often ignored because they lack Presence.  You're tired, frustrated, weary of the strain of trying so hard to be heard, and it can show in your body language. 

The simplest way to be seen and heard is to change your posture and to stand tall. (Yes, the old adage of imagine yourself pulled up by a string, shoulders, hips, and heels in line.) Tired people often stoop and give an air of vulnerability. That can sometimes work to your advantage, but standing tall gives you a better physical presence.  We are a nation of “slumpers”.  People note someone who stands out in a room. 

Lift your chin and look people directly in the eye. This “speaks” firmly without saying a word.  It says "I know what we need to accomplish today,” and conveys to the other person you are (of course!) anticipating a professional response. It’s much harder to avoid/ignore someone who is direct, standing tall, and commanding attention.  You’ve watched it before.  Presented in a way different from the pack, certain people seem to get a good response from exactly the same question!  You want to be that person.

Know what you are seeking to make it easier for someone to help you.  If you don't know the exact words for the document or title of the person you seek, then ask if you're using the correct terminology. Your stand-tall presence quietly and your tone of voice says, "I'm here to find answers and I will still be standing here until you help me, or guide me to someone else who can."  Next step if they’re not helpful is to say, in the same calm, no-attitude voice, “Okay, I see this is more complicated than I thought; will you please direct me to your supervisor, or someone who can help me?”  Persist. Stopped by a regulation? Ask to see it or where to find it.  HIPAA hurdle?  Your paperwork says you're entitled to see the records if all is in order.

You've done your research and now follow the chain of command upward.  Persist.  As you go higher and you’re being reasonable, now people are more likely to help you, because the pressure is building - for them.  Is it really so difficult a question that five levels of people don’t know the answer?  Persist. We know many a caregiver who asked for directions to the Director’s office and sat waiting until they received an answer to their relatively simple question.

Engage fully with erect posture, direct eye contact, and increased presence - you will find you gain better results.  Presence is a leadership skill that has faded for many people in the same way a firm handshake is missed.  Enhanced presence and leadership skills are a work in progress and will always help you.

Make the choice to grow; leadership skills never get old.  Stand out in the crowd with an improved presence – and receive the answers you need to move forward.

Linda Kreter & the

VeteranCaregiver Team

LEARN: Managing Triangular Communication

This is a practical blog post to correspond with the video of the same name. Learning this skill can make your world much, much better.  It will also baffle your adversaries! 

Do you recall a conversation with one person where a third person inserted themselves into the discussion?  Did you notice that the conversation rapidly became frustrating as your one-on-one conversation became a two-against-one situation with another agenda?  Triangular Conversation is in play... where you previously had a direct conversation.

                          Person 1 <----------------------------> Person 2

Certain people regularly use Triangular Communication as a means of manipulation and control. It's a good idea to manage, alter, or avoid these conversational events.  We see it early in life, when two children playing together enjoy themselves; but when a third arrives, the dynamic may be competitive and adversarial.  This challenging discussion style may be found whenever people communicate.

Triangular conversations have the potential to take on a difficult dynamic and alter the previous one-on-one communication.  If the person is simply nosing into your discussion and offering unsolicited advice, the triangle is merely annoying, but still creates a Villain, a Victim, and a Hero.  If there is a negative intention, you now have a toxic triangle, where you may feel the effects long after the discussion.  In either case, which one do you think you will be?  No doubt, you don't need this in your day!

                                             Villain
                                                             .
                                                           .   .
                                                         .       .
                                                       .           .
                                       Victim   ...............   Hero
                                                       

Learn to recognize this destructive communication style and then intentionally remove yourself from the discussion. This happens among family members, the care team, children, and peers.  Awareness is key.  Once you've recognized the situation as a triangle, extricate yourself, disengage, and then re- engage when you can discuss the matter one-on-one.   

This is a drama you can identify and avoid. 

Linda Kreter & the

VeteranCaregiver Team 

LIVE: Self Check-In

So often as caregivers, we are running so hard, putting ourselves last, and not realizing we are burnt out until we fall ill. Or, we know we’re overwhelmed, but we accept it without question.  What happens when the caregiver is down for the count - the wheels have a tendency to come off, don't they?

Make a promise to yourself to Check-In at least weekly. Better yet, do the same with a trusted caregiver or friend as an “accountability partner” so you don’t neglect to consider your own health.

 Ask these questions to start:

·         Am I eating well? Skipping meals, snacking too much?

·         Do I laugh each day?  Red flag if you don't find something amusing each day, even if you don't laugh out loud. How many times do we text LOL, but not DO it?

·       Am I drinking enough water?  Do I exist on coffee and soda instead?

·         Do I spend quiet time, reflective time, prayer, or meditation each day?

·         Am I sleeping well or enough? 

·         Am I getting any exercise?

·       Do I interact with others each day?  In-person is preferable, but at least by phone to hear a voice or online if all else fails?

If you're aware that you’re not checking in, or struggling when you do, we urge you to talk to someone professionally. Many physicians are only now realizing the strain caregivers carry and how to assist you, but it's growing.  Seek community resources such as faith-based counseling, or call Give An Hour (www.GiveAnHour.org) for cost-free help.  

Life is so precious and perhaps you cannot change your situation, but you can change aspects of taking care of you.

Caregivers are the heartbeat of the family, and make the active choice to care for you.

Linda Kreter & the

VeteranCaregiver Team

LEAD: Self-Development

Caregivers of all eras say they miss their personal time to learn and remain sharp and inquisitive.  How do you find the time to keep growing intellectually, when caregiving is your priority?

A path of life-long learning keeps you sharper and more engaged, though caregivers often feel too weary or too constrained to begin.  First, know that you are learning each day as you walk this caregiver journey, and the skills you nurture along the way will eventually be clear and valuable to you when you look back.

As you consider one day at a time, begin a mind-shift to seek those small pockets of time that might be possible for you. There are some powerful “time-suckers” in each day, but if you can find even 15 minutes you devote to yourself, you will feel empowered.  Feel guilty?  Try not to, as small bits of respite time improve your caregiving.  There’s a good reason that on an airplane, the flight attendant tells you to put the oxygen mask on yourself before helping others. Yes, there are times this is impossible, but if you make the choice to find that small pocket of time, you won’t be as drained.  Hope is an energizer.

Reading quietly may challenge, but try turning your drive times into a mobile leadership class with an audio book.  That waiting time at the VA?  Listen to 15 minutes of good content or about a topic you care about. Turn your otherwise “wasted time” into a learning university.  You can download audio books free from the public library and listen to 15 minutes of meditation, your topic of interest, leadership or inspirational messages.

Leadership expert, Jim Rohn says that if you spend more time working on yourself than your job (caregiving), that the rest of your life is altered positively by what you've learned.  As you become involved in learning new things, you are also more inclined to talk about them and move outside your personal shell or bubble.  Sharing those thoughts with others spurs engagement and may inspire them to think differently too.  Sharing your new knowledge or perspective is reinforced by voicing it to someone else.  It's growth!

Think of yourself as a hermit crab who lives in a shell that fits his size.  Isn't it time you grew in learning new ways to think, vary your viewpoint, and learn empowering, positive skills - in your spare moments?  Be the hermit crab that grows to need a larger shell and grow during every phase of your life!

Linda Kreter & 

VeteranCaregiver Team

LEARN: Navigating the Military Medical System, Part 1

Navigating an enormous medical bureaucracy is not simple, but it helps if you know some basic elements to begin.  While you may not have raised your right hand and taken an oath, you now are part of the military medical system.  (More about the pros/cons of that role in another blogpost.) 

If you're new to the military system, there is an entirely new language of acronyms and chain of command to understand.  You’ll become familiar with these terms and learn them over time, but as the caregiver and advocate, your role is to support the best communication and care possible for your family member. 

Excellent communication is critical, especially at the acute stage of an injury when things are moving very fast and you are still reeling from that phone call.  If you're an older caregiver and haven't had to deal with the military medical system for years, you also have a sharp learning curve, but ask questions and keep asking them until you obtain an answer.

Practice proactive documentation.  Create a notebook or carry a journal and keep it accessible.  Record all appointments, referrals, visits, names, dates, care team changes, and new appointments or practitioners. This notebook or series of journals becomes your documented timeline and invaluable since it recalls details for you when you’re exhausted, overwhelmed, or have been in the medical system a long time.

Keep medical records on a thumb drive besides using the paper, images, and electronic records both the DoD and VA use.  Recognize that though changes are coming, there is not yet a seamless transition between both agencies and the records don't consistently mesh with each other. 

After a care team phone call, or an inquiry call you make, follow it with a brief email summarizing the call and any action steps.  You may not feel it necessary at the time, but be wise.  Staff changes, miscommunication and misunderstandings can be avoided or mitigated if you have detailed, accurate records.

Remain calm and civil.  You’ll receive better communication and sometimes, better care if you do.  Burning bridges with those whom you need to help you and your family is a very poor choice.  You are vital to good care, and with proper documentation of your communications and records, there is seldom a problem that cannot be resolved.  Be conscientious and prepared, and you're a step ahead!

Linda Kreter & 

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