Caregiver Peer Support - In Person...

Greetings,


We apologize for not writing yet in 2014; it has been a very busy year so far.  More postings soon, but for now, one important, recurring point.

Online caregiver peer support is great, but if it's possible for you, we suggest setting up an in-person caregiver meeting in your community. If you choose, include family caregiver supporters too.  It's up to you.


There's something about looking someone in the eye who understands, and nothing replaces a hug.  Pick a place, set a time, and whoever shows up - you can visit, talk, debate, and share.  If no one shows that day, give yourself the gift of quiet time.  We highly recommend it.


Caregivers and those who support them are exceptional people. In 2014, give yourself the gift of meeting other caregivers beyond the Internet. It's a very old Barbra Streisand song, but "People, people who need people are the luckiest people of all!"  Reach out and grow your in-person network through your community organizations, your churches, and your civic organizations.


Your heart and head will thank you.


 Linda Kreter and the VeteranCaregiver Support Team.

What Non-Caregivers Need to Consider...

Greetings,

Lately we’ve been noting how many times people are surprised at a comment or statistic about Caregivers of veterans.  It made us think that compiling several of them might make more of you aware of what people don’t know, and therefore they cannot offer to help you.  So, in the spirit of hoping others may read this (or you can send it to them), here is a brief and incomplete listing – feel free to add to the list!  This just might make your family holidays a bit easier?

1.      “The VA takes care of all medical care for your veteran and you, what are you complaining about?”  (The VA takes care of the Vet’s care and Caregivers receive CHAMPVA or TRICARE depending on service status, caregiver program, and other factors, but not all care is covered for the caregiver.  It can be very hard to find a doctor who takes CHAMPVA or who understands PTSD, so don’t assume life is “easy”.)

2.      “As a Caregiver, you are paid for your work.”  (Not in every case and not at market pricing for commercial caregivers. It is very challenging to explain to others what a "typical" day looks like, but the pay is not why you do what you do, but it helps meet the bills that stress you.  Ask that person to accompany you on your next set of doctor visits; it may open their eyes and their hearts.)

3.      “Besides, s/he’s your husband/adult child, you should take care of them just because you love them.”  (Judgment by others not familiar with your days of constantly being on edge, dealing with a large bureaucracy, trying to apply logic to an illogical system, scheduling countless appointments, juggling 20 medications carefully, and being bone-tired has nothing to do with paybacks for love.  Visible and invisible injuries take a great deal of patience and work to manage with the care team. It’s hard to keep the train on the tracks.  This is why there is a Caregiver program at VA that covers at least some of your needs because it’s fairly obvious that if you all dropped off your vet at the VA that the system would crumble rapidly.  These may be people you don’t need in your life…)

4.      “You should get a therapist if you are stressed or not sleeping.”  (That might be the case, but being a Caregiver is draining and stressful at times, and only a clinician can advise you.  Having said that, talking with your peers or a professional might lighten your load. We bristle when we hear the words "you should"...)

5.      “Never continue the conversation if the Caregiver is in tears.”  (We disagree.  We think this is a perfect time for active listening and compassion.  If you can’t let down with those you’re close to or who need you, they miss out on an opportunity for support.  Be a safe haven for them.)

6.      “Don’t discuss talk of suicide or suicidal thoughts if the Caregiver brings it up.”  (This is an excellent time to compassionately listen, and to also ask if they need other resources and professionals to discuss this serious topic.  If they are seemingly a danger to themselves or others, call emergency services.  If you are unsure, a call to the VA Lifeline would be appropriate to ask what to do for support.  Sometimes, though, just providing a shoulder and a kind ear calms the anxious moment and the almost-crisis moment passes.  However, when in doubt, always reach out for help!)

7.      “PTSD and TBI are excuses for acting like a jerk!”  (Perhaps, but unless you’re a physician and know the background and medical record of the veteran, the symptoms of either PTSD or TBI may not be managed well, or needs may have changed.  Educate yourself on both, and know what to look for when medications are changed or someone is in denial over needing help.  Great resources exist on both conditions, and alternative therapies may work when traditional first-line therapies aren’t working.  No two vets are alike.  No two Caregivers are either.)

8.      “You’re not the one with PTSD – s/he is!”  (Potentially false.  Secondary PTSD or Generational PTSD are the terms used for the cumulative effect of being around those with PTSD and having to alter your normal way of living to accommodate the veteran with PTSD.  Insomnia, hyper-vigilance, walking on eggshells, avoiding surprising someone, isolation, and altered communication may indicate that the Caregiver needs supportive clinical care also.  Again, it helps to educate yourself and your family so they don’t inadvertently trigger a situation unwittingly.)

9.      “S/he’s been back for two years, what’s the problem?”  (War is hell.  People come back from war changed, and they change those around them.  Physical loss doesn’t get easier and invisible injuries are still misunderstood.  There are Vietnam vets who have suppressed their emotions and experiences for 40 years and they suffer still.  There is not a timeframe for “getting better”.  Please do not judge Caregivers or veterans on their issues; judgment is not yours to make.  Offer resources, a gentle ear, and recognize that everyone heals at their own pace and with appropriate care.)

10.   “You need to make time for yourself – you’re running yourself ragged!”   (We think that each and every Caregiver has probably heard this at one time or another.  And, if you have run yourself ragged by always putting others first, then please, ask for and access respite care, a half-day off, or even begin seizing 15-minute intervals to breathe.  Consider that if you fall down, the entire family structure will wobble.  Don’t underestimate your critical role; you are the heartbeat of the family and you matter, so taking care of yourself is critical.  To family members, please keep offering help proactively so that the Caregiver knows you really mean it.  Caregivers are an independent, resourceful group, so coax them to lean on you and be there when they do.)

There are many more, but this posting is long enough.  We wish you a Happy Thanksgiving, and may you have a calm and peaceful holiday.

Linda Kreter & the VeteranCaregiver Team

Mental Health Support - Individual/Group & Moral Injury/PTSD

Greetings, friends,

We've been talking about Moral Injury on the American Heroes Network radio broadcast lately (15Oct), and a new discussion yesterday has provoked new thinking.  

[An example of moral injury would be a fierce firefight that resulted in the inadvertent killing of innocent civilians that haunts a veteran afterward. This has gone on as long as war has been waged.]

Two issues are provided for your thought here today.  

When a unit experiences a trauma together that goes against personal values and creates a moral dilemma, service members are forever changed.  In past eras, it was very hard to reconnect with members of a unit, especially if the war fought was considered an Unjust War (Vietnam).  With today's Social Media capabilities, we learned a great deal from a wonderfully articulate Marine who has found 80% of his unit.  This online effort has now grown to include annual reunions that are highly significant and meaningful to them.

This unit/peer connection appears to be a growing phenomenon and began years ago with Facebook pages for a specific unit, and has morphed into using GPS geo-locators for identifying other veterans (POS REP). The action of organically connecting to prior unit members is showing positive outcomes for many, including finding some semblance of peace and improved mental well-being.  

Interestingly, most mental health care is administered to each individual. Which works best?This is a tough question to answer since everyone is different, but research appears to be saying that for combat vets, a shared experience and peer connection may be an excellent way to heal.  

Secondly, is Moral Injury separate or a component of PTSD?  Moral Injury is under study to discern whether it is separate from PTSD, even though many symptoms may be the same. Is moral injury defined by guilt and a moral disagreement with personal values and PTSD more a danger response (with biological, psychological symptoms) coupled with a spiritual outlook?  Does this help explain drone operators who are not in physical danger, but suffer greatly as we now know.

This topic will be discussed more fully on the American Heroes Network (www.AmericanHeroesNetwork.com) on 05 November at 11am EST and archived afterward on iTunes and the AHN website.  Let us know what you think of the group versus individual approach to Moral Injury and/or PTSD may be?

Linda Kreter & the VeteranCaregiver team

Moral Injury & PTSD - One Story

Greetings,

We will be talking Tuesday with two cutting edge researchers on the American Heroes Network about Moral Injury:  PTSD and Suicide in the U.S. Military. This term is not often heard, but the stark truth written below may help with greater understanding of our troops' sacrifices and invisible injuries that linger after they return home.  This story was written in 2005 and rings true today (link: http://www.commondreams.org/headlines05/0615-08.htm.

Wednesday, May 04, 2005

IT WAS STILL DARK...

--by Sgt Zachary Scott-Singley

 

It was still dark. I got dressed in that darkness. When I was ready I grabbed an MRE (meal ready to eat) and got in the truck. I was going to go line the truck up in preparation for the raid we were about to go on. The targets were three houses where RPG attacks had come from a few days prior. Sitting there in that darkness listening to the briefing on how we were to execute the mission, I let my mind wander from the briefing and said a prayer. "Just one more day God, let me live one more day and we will go from there..." It was the same prayer I said every day because every day I did the same thing. I left the base. With a small team I would go out each day on different missions. I was their translator.

There were different people to meet each day. There were some who would kill you if they could. They would look at you and you could see the hate in their eyes. I also met with people who would have given me everything they owned. People, that were so thankful to us because we had rid them of Saddam. Well, this day was not really much different from all those other days so far. After the briefing we all got into our assigned seats and convoyed out to the raid site. I was to go in directly after the military police that would clear the building.

The raid began without a hitch. Inside one of the courtyards of one of the houses, talking to an Iraqi woman checking to see if her story correlated with what the detained men had said, I heard gunfire. It was automatic gunfire. Ducking next to the stone wall I yelled at the woman to get inside her house, and when the gunfire stopped I peeked my head around the front gate. I saw a soldier amongst the others who was pulling rear security by our vehicles. This soldier I saw was still aiming his M249 (a fully automatic belt fed machine gun) at a black truck off in the distance. His was the weapon I had heard.

I ran up near his position and overheard the Captain in charge of the raid asking what had happened and why had this soldier opened fire. The soldier kept his weapon aimed and answered that he was sure he had seen a man holding an AK-47 in the back of the black truck. I was amongst the four (along with the soldier who had fired on the black truck) who had been selected to go and see what was up with that truck.

We were out of breath when we got to the gun-truck nearest to the black civilian truck (a gun-truck is a HUMMWV or sometimes called a Hummer by civilians, with a .50 caliber machine gun on its roof). There was a group of four Iraqis walking towards us from the black truck. They were carrying a body. When I saw this I ran forward and began to speak (in Arabic) to the man holding the body but I couldn't say a word.

There right in front of me in the arms of one of the men I saw a small boy (no more than 3 years old). His head was cocked back at the wrong angle and there was blood. So much blood. How could all that blood be from that small boy? I heard crying too. All of the Iraqi men standing there were crying and sobbing and asking me WHY? Someone behind me started screaming for a medic, it was the young soldier (around my age) who had fired his weapon. He screamed and screamed for a medic until his voice was hoarse and a medic came just to tell us what I already knew. The boy was dead. I was so numb.

I stood there looking at that little child, someone's child (just like mine) and seeing how red the clean white shirt of the man holding the boy was turning. It was then that I realized that I had been speaking to them; speaking in a voice that sounded so very far away. I heard my voice telling them (in Arabic) how sorry we were. My mouth was saying this but all my mind could focus on was the hole in the child's head. The white shirt covered in bright red blood. Every color was so bright. There were other colors too. The glistening white pieces of the child's skull still splattered on that so very white shirt. I couldn't stop looking at them even as I continued telling them how sorry we were.

I can still see it all to this very day. The raid was over there were no weapons to be found and we had accomplished nothing except killing a child of some unknowing mother. Not wanting to leave yet, I stayed as long as I could, talking to the man holding the child. I couldn't leave because I needed to know who they were. I wanted to remember. The man was the brother of the child's father. He was the boy's uncle, and he was watching him for his father who had gone to the market. They were carpenters and the soldier who had fired upon the truck had seen someone holding a piece of wood and standing in the truck bed.

Before I left to go back to our base I saw the young soldier who had killed the boy. His eyes were unfocused and he was just standing there, staring off into the distance. My hand went to my canteen and I took a drink of water. That soldier looked so lost, so I offered him a drink from my canteen. In a hoarse voice he quietly thanked me and then gave me such a thankful look; like I had given him gold.

Later that day those of us who had been selected to go inspect the black truck were filling reports out about what we had witnessed for the investigation. The Captain who had led the raid entered the room we were in and you could see that he was angry. He said, "Well this is just great! Now we have to go and give that family bags of money to shut them up..." I wanted to kill him. I sat there trembling with my rage. Some family had just lost their beautiful baby boy and this man, this COMMISSIONED OFFICER in the United States Army is worried about trying to pay off the family's grief and sorrow. He must not have been a father, otherwise he would know that money doesn't even come close... I wanted to use my bare hands to kill him, but instead I just sat there and waited until the investigating officer called me into his office.

To this day I still think about that raid, that family, that boy. I wonder if they are making attacks on us now. I would be. If someone took the life of my son or my daughter nothing other than my own death would stop me from killing that person. I still cry too. I cry when the memory hits me. I cry when I think of how very far away I am from my family who needs me. I am not there just like the boy's father wasn't there. I pray every day for my family's safety and just that I was with them. I have served my time, I have my nightmares, I have enough blood on my hands. My contract with the Army has been involuntarily extended. I am not asking for medicine to help with the nightmares or for anything else, only that the Army would have held true to the contract I signed and let me be a father, a husband, a daddy again. 

New Suicide Prevention Tool - Vet-Tested - Coming Soon!

We must talk.  We must reach out.  We must care.  And, we must trust that we can make a difference together.

Twenty-two Veterans take their own lives every day.  That’s one every 65 minutes.  Every day. Many have sought care, and many refuse to seek care.  All need new options.  Service members, veterans, and their families are suffering in relative silence when so many in our communities and nation are willing to help.  

A new suicide prevention tool is launching very soon.  With a single touch, a smartphone app, CallApp, becomes a virtual crisis center that provides choices to a vet and reduces confusion at times of great stress.  Users can select direct connections to crisis lines, battle buddies, trusted friends, clinicians, organizations, and faith and community-based support.  CallApp will be free to our service members, veterans, and their families, and each can personalize their contacts to readily reach trusted friends and support. 

All features are Vet requested and Vet-tested.  Safe locations, peer support, and options in 36 languages will help encourage rapid adoption.  Additionally, continually updated information on PTSD, TBI, anxiety, depression, MST, chronic pain, and local resources will provide further support.  CallApp provides a unique bridge of communication between the extremes of a crisis intervention or waiting and faltering for help, often alone.   

Ninety-seven percent (97%) of all military families receive information from the Internet or their smartphones according to a recent study, making smartphones the optimal choice for outreach.  Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), Military Sexual Trauma (MST), financial strain, relationship fractures, substance abuse, homelessness, chronic pain, depression, anxiety, and feelings of isolation may be precursors for suicidal ideation.  With an average of 25 suicide attempts before a completion, there's enormous opportunity to save lives and guide our service members, veterans, and their families to clinical services they trust, and to compassionate people who care. 

Technology doesn’t save lives; people do, but it’s essential to first connect with and support our service members, veterans and their families. 

Together, we can and will stem the tragedy of military suicides.  

Linda Kreter & the VeteranCaregiver Team 

Post-Disaster Care for a Rabbit, but not a Veteran? Consider this during Suicide Prevention Month...

Greetings,

One of the most difficult things for a caregiver to deal with after a suicide attempt is obtaining postvention or aftercare.  VA protocol says you should receive contact within 24 hours, but this happens more in theory than in practice.  We know of cases where an SPC has not returned a call after six weeks, even with intervening advocacy calls.  We cannot know the full statistics, but we sincerely hope this is an exception rather than the rule for most at-risk veterans.

If you view a suicide attempt as a “disaster”, then perhaps you’ll relate to the paragraph below requiring contingency planning at the USDA for a rabbit.  Don’t our veterans deserve to have an operational after-care plan from the VA after a suicide attempt “disaster”?  Or even a combined caregiver/VA care-team plan?  Here’s the link to the article from the Washington Post http://articles.washingtonpost.com/2013-07-16/politics/40610671_1_rabbit-magician-u-s-department.

The U.S. Department of Agriculture is working hard to ensure that Americans have safe food to eat. The latest case is that of a children's magician in Missouri, who received a letter from the USDA requiring him to develop an emergency evacuation plan. For his rabbit. "I just received an 8 page letter from the USDA," he said, "telling me that by July 29 I need to have in place a written disaster plan, detailing all the steps I would take to help get my rabbit through a disaster, such as a tornado, fire, flood, etc.," and "what I will do after the disaster, to make sure my rabbit gets cared for properly." (italics added).

Let's show better postvention care of our veterans who are taking their own lives every 65 minutes - every day.  Let's support and care for the family members who bear heavy loads and are also at-risk.  Each life is so complex, with no one solution, but with an average of 25 suicide attempts before a completion - that's a LOT of room for help, support, and a new perspective on living.

Linda Kreter & the VeteranCaregiver Team

The Little Things Matter

You don’t ask for much for yourself, and you do so much for everyone else.  

Sometimes it’s the little things that matter when you’re a Caregiver. 

It’s the person in the grocery store line that urges you to go first because you have your hands full with a small child or two and a visibly uncomfortable veteran spouse.

It’s when someone you know writes you an “I’m thinking about you, how are you?” email, card, or posting.

It’s when a small child pats your daughter’s artificial leg and asks if she can still play soccer?

It’s a hug from a friend when no words need to be spoken, and you really needed that hug.

 

It’s when you’re in a crowd, things start feeling dicey for your family, and without a blink, a kind stranger guides you out to an open space.

It’s a callback, a referral, a resolution to a long-standing challenge, or an appointment that fits your schedule without juggling.

It’s when your son shows a glimmer of his old self; a remembered quirk, a breakthrough comment.

It’s a jug of wildflowers left outside your door with a note saying, “Sorry I missed you”.

It’s when someone offers you a flexible job because you clearly have it together and they love your work/life ethics.

It’s when you sit down and weep for what you’ve lost, and at the same time, you realize that you’re wiser/stronger/better than you were before.

It’s when your pet curls up beside you, simply because they sense that you need it.

And, when those small things occur, and you’ve noticed them?  You have become someone extra-extraordinary with a grateful heart.

Blessings and care,

Linda Kreter and the VeteranCaregiver Team