Medication Management 101 for Veteran Caregivers

VeteranCaregiver received this message recently:  “Hi, I'm new to this [caregiving] and yet, I'm thrown in the deep end and need to manage 19 daily medications; can you help? No one will help me manage this now that we’re home!”

This is a challenge many caregivers confront and you are not alone.  There was even a television news photo (below) of a plastic grocery bag of meds for a single month – now that's a visual!  Many veterans are on multiple medications and as caregiver, keeping track of the medications is one thing, and tracking the effects of them is another.  It’s critical to start at the beginning:  create a Medication Log.  If you are hurt, absent, or sick, someone else may need to step in, so this is not an empty exercise.

CBS News Image 2014

You probably have a notebook, binder, or journal you keep appointments in, or some way to track this medical journey.  Add to your system the Medication Log, and note the drugs, dosages, time of day to take, and learn what each medication is for.  There are many good apps that consolidate this information for you.   In the large medical bureaucracy, and with the lack of fully centralized records, share this Medication Log at appointments to be sure each practitioner knows of the med prescriptions.  Every time a drug is changed, dosage adjusted, or medication removed, keep an eye out for any changes in behavior that might be connected.  YOU are the one living with the vet day in, day out, and you'll notice these things sooner than anyone.   

It’s important to know that meds mailed to your home should be called in earlier than needed to allow for on-time delivery, and be especially aware of months with 31 days in them with an automated system. If the 30th is on a Friday, it has happened that the mailed prescriptions may arrive after the weekend, meaning that well-managed pain or other condition under control will now go untreated until Monday.   Request a contact to call if more urgent behavioral or physical effects to medication occur; this can help you avoid a trip to the emergency room. 

Be aware that if you relocate to another VA that the medications may change, which means you'll be keeping track of changed meds, dosages, or differences in the drug formulary (if there are any). 

Keep a copy of the medication list in a set place in case something happens to you and someone else must step in to assist.  Over time, using a watch, alarm clock, or a smartphone, it may be possible to create more independence with your family member as they schedule and remind themselves of medications and timing. With planning, communication, and observation, managing medications and noting their effects will help convey important messages to the care team.

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

Social Media: Joy & Peril ... It's Here to Stay!

We’re sure you’ve argued both sides of the fence on this topic of whether social media and the Internet has made a caregiver’s life better or worse.  We think it's done both. With a short phrase typed into a search engine, you can find multiple sources of information in milliseconds. 

There is ease in using social media to connect you to smaller groups who understand your situations and allow you to connect with someone across the world. Medical information can help your caregiving, and you can find apps for most everything.  Yet, it’s still up to you to find credible sources and to check the validity of the information.  Believe it or not, not everything you read online is correct!

The opposite view is that we are now at arms-length from people and more isolated from one another.  Online friendships can form instantly when someone agrees with a Facebook posting you made.   It also has the potential for harm when a comment is perceived negatively or judgmentally.  We've seen serious actions and consequences when a caregiver is hurt by public comments or even betrayals of trust.  Comparisons are made nearly every day, and the lens with which you view a comment can turn an innocent post into a hurtful jab, or you may miss the point entirely as you grab a view on your phone at the stoplight.

As caregivers, it's nearly universal that support and information will be sought online.  But, because studies and good old common sense are telling us that we’re often “overly attached” to our phones and tablets, and we know it, what are we doing about it?  Science also proves that in teens, social media is adding to depression, what others are doing/buying/saying, and cyber-bullying continues.  Think it’s only in teens?  No, it can happen to any of us.

What to do?  Try to keep yourself in a healthier, more balanced place, and set limits on what you will share online and to whom. There are full medical histories on the Internet, and that's your choice, but think of the potential years from now.  Know that anyone and everyone can access some of your information somehow and if you don’t want it out there, do not post it.  Employers still Face-stalk, and so do other officials, so don’t leave yourself open to interpretation that may harm you or your family.

UNPLUG sometimes. A certain hour of the evening, a cyber-free Sunday, two hours during the day so you accomplish more of what you set out to do.  Yes, you’re likely to be texted a million times if you go out, but sometimes adding space in your caregiving relationship can help you both.  Inter-dependence and co-dependence is hard on a family, and even medical staff can add to the dependence versus independence.  Be mindful and be aware.

Balancing your time can start with seizing back one or two of the many intervals each day you check your Facebook, Instagram, or Twitter page.  Or, use that time to go to a personal learning or favorite hobby website and take your mind off tasks for a while.  The best alternative is day-dreaming – it’s a hopeful and non-electronic means of recharging! 

Linda Kreter & the 

VeteranCaregiver Team

The Burn Pits Registry and 2015 VA Report

In June, the VA released an update on their research of conditions potentially related to Burn Pit exposure; you can read it here: http://www.publichealth.va.gov/docs/exposures/va-ahobp-registry-data-report-june2015.pdf. 

For those unfamiliar with the term, Burn Pits refers to open-air burning of plastics, medical waste, and trash – sometimes creating fumes that some scientists say are new, unique compounds that may be toxic to humans.  Not every respiratory problem is related to the Burn Pits, but a recent report provides new information based on the VA Burn Pit Registry and continuing research. 

An important note:  if you were deployed and exposed to one of many of the Burn Pits in Iraq or Afghanistan, it’s important to join the Burn Pit Registry at the VA and to be evaluated.  If you’re unsure and have questions, you can contact the Environmental Health Coordinator at your treating VA medical center, or call 877-222-8387. 

VA Blog Photo

Higher concern rose in 2008 when a greater than expected rate of respiratory conditions and symptoms were noted from serving troops exposed to fumes in both Iraq and Afghanistan. Frequent exposure to the foreign dust storms and the unusually small sand particles also appear to be increasing common illnesses among previously deployed troops and include asthma, chronic bronchitis, emphysema, and COPD or (Chronic Obstructive Pulmonary Disease). At first, this was discussed among troops, not widely accepted at the medical level, but it wasn’t long until the potential number of veterans affected reached a critical mass with media coverage. 

In a new study released in July, 28,000 veterans who completed the questions in the Burn Pit Registry, also noted additional health effects such as higher blood pressure and insomnia, though it’s often difficult to isolate those symptoms from other conditions.  Current findings are that about 30% of veterans have been diagnosed with respiratory conditions other than allergies and include quality of life issues including a reduced ability to run, walk stairs, or continue their prior physical activities. Almost 46,000 veterans have responded to the lengthy questionnaire.

If you know a veteran who served in the following conflicts and times, and who was repeatedly exposed to burn pit fumes or multiple dust storms with possibly related respiratory conditions, please urge them to join the VA Burn Pit Registry to assist in this research and analysis. 

·        Operations OEF/OIF/New Dawn

·        Djibouti, Africa on or after September 11, 2001

·        Operations Desert Shield or Desert Storm

·        Southwest Asia theatre of operations on or after August 2, 1990

The Burn Pit Registry is found on the VA.gov website (http://www.publichealth.va.gov/exposures/burnpits/registry.asp), you can speak to the Environmental Health Coordinator at your nearest VA facility, or call 877-222-8387 for more information.

Linda Kreter and the

VeteranCaregiver Team

.

Traumatic Brain Injury: Share with Family & Friends for Understanding

Traumatic Brain Injury or TBI, is one of the “signature wounds” and a physically damaging, but often invisible injury of the most recent conflicts.  In some cases of traumatic brain injury, PTSD is also present. 

For families, it is often very challenging to have extended family and friends understand because there may not be a visible wound or scar and they can be judgmental.  Please share this blog with them, or the TBI Video on VeteranCaregiver.com’s Video Resource section.  Support for you, the caregiver, is immeasurably valuable.

Traumatic Brain Injury or TBI, is actual physical or biological damage to the brain, and treatment can be complex depending on the severity of the TBI. There are multiple descriptions of TBI:  mild, moderate, and severe, leading to the diagnosis and treatment path with the severity of the injury.  For the caregiver, this designation also can be a measure of describing the tasks the injured person may have challenges with, but – it also depends upon which part of the brain was injured.

There is also a “penetrating TBI”, meaning something (shrapnel for example) has breached the skull and the membrane covering of the brain, the dura. There are also blast injuries to the brain, which in simplified terms means that the brain has been blasted and bruised inside the closed confines of the skull. Since the brain is crucial to executive decision making, personality, judgment, and countless other functions, any brain injury is meaningful to both the veteran and the caregiver. 

Some of the symptoms of TBI are headaches, intermittent dizziness, and fatigue, which can be initially shrugged off as adjusting to life in the community. Additional symptoms such as blurred vision, more consistent dizziness and balance issues, restlessness and agitation benefit from treatment.  Though the veteran may be unclear about their behavior, when memory and concentration issues complicate the relationship and household, getting help cannot be ignored.  Some of these symptoms may also be in reaction to vestibular (inner ear) issues, and having the correct diagnosis is important for VA ratings and treatment. 

Traumatic Brain Injury remains one of the most challenging undiagnosed conditions of the recent conflicts.  If you know that you are seeing personality changes, memory issues, balance, dizziness, insomnia, and/or frustration that manifests itself in anger or isolation, please ask for an evaluation ruling out an undiagnosed TBI.  Persist. Even if you’re told that playing football in high school is the root cause, remember that blasts and concussions are cumulative, and there is a rare FOB that didn’t take incoming rounds. 

Traumatic brain injury may also not show up right away, but over time, and unusual, agitated behavior that may include unfiltered speech can baffle and test all concerned. Relationships are often affected, and there is challenge to holding down a job, resuming the former routines, and fulfilling ordinary family roles. 

Communication and denial are common before diagnosis and persistence in seeking help is encouraged.  Leaving the brain injury undiagnosed or untreated can strain the best of marriages and partnerships.  As a caregiver walking on eggshells wary of a sharp comment, seeing the veteran forget how to drive home from a familiar place, or suddenly withdrawal from the family or relationship are additional signs.  Your family member may have no idea that there is something wrong until it becomes very obvious, or the relationship is tested beyond the breaking point.

With neurological assessments and cognition testing, the severity of the brain injury can be determined, and treatment plans coordinated.  Sometimes the most difficult thing for the caregiver is to convince the vet there IS something organically wrong, and it's important to seek treatment. 

It's important to remember this is a physical brain injury, and that significant recovery options should be considered and researched as everyone is unique. Interestingly, we have the NFL and football players bringing TBI into the news and urging new and innovative treatments. Know that help exists, and be vigilant in seeking help.  

If there is an undiagnosed TBI in your household, continue to keep a journal of symptoms that show a pattern to share with the care team. Help and improvement is possible with treatment, and learning more helps everyone in the care team and extended family and friends making things more supportive - rather than more isolating.  There are excellent resources for living with TBI and for newer innovative treatments such as Hyperbaric Oxygen Treatment; look at what is best for you and your family.

Linda Kreter & the

VeteranCaregiver Team

Positive Attitude Contagion & Your Support Group

Each day we have a choice to make about our attitude. 

If you become mindful about the fact that only today matters, and that you cannot change the past, nor (usually) predict the future, your perspective can be changed for the better. 

This prayer/musing made me laugh because sometimes it reflects what we all feel:

Dear Lord/Higher Power/Other,

So far today, I am doing all right.  I have not gossiped, lost my temper, been greedy, grumpy, nasty, selfish, or self-indulgent.  I have not whined, cursed, or eaten any chocolate.  However, I will get out of bed in a few minutes, and I will need a lot more help after that.  Amen*

This practice of adjusting your attitude many times daily is difficult, but it’s nearly always possible to find something good, even on the worst of days.  Being around those who are negative, usually have something critical to say about you or your situation, or who just plain drain you is exhausting.  Saying to yourself these people are “just negative” or trying to avoid them altogether is nearly impossible.  So, what can you do?

The great football coach, John Wooden says this:  “Things turn out best for the people who make the best of the way things turn out”. 

 Isn’t that the truth?  Interestingly, if you don’t buy into the Negative Ones and their critical, harping, unpleasant responses, they eventually want to be around someone who will react to them and feed the negative. Work to find a handful of trusted friends who are positive, and can be called upon when you need a boost.  Do the same for them. You’ll find that the more positive your attitude and behavior is, the more you attract others with the same perspective.  Like attracts like, and allows you to weather the tough days, and being around the negative ones when you can’t avoid it.

We all have tough, seriously-I-can’t-take-one-more-thing days, but when we stop for a second, take a deep breath, and briefly wait instead of reacting with a knee-jerk response that you’ll regret the rest of the day, this habit you’ve been practicing can come to you more often.  And, more easily.

There will always be jerks in life, but don’t buy into their “jerkdom”.  Remember too that positive people evolve into groups – and find an ally, a friend, a kindred spirit to start your own group, and to keep helping you adjust your attitudes about the day.  Take each day at a time, look inward and adjust your attitude as the day progresses.  Finally, reflect on your day each night and see the growth, the slipups, and especially note what you’re thankful for, even if it’s the fact you got a shower today!  

We continue to believe in the best within you; best wishes on lifting today to be the best it can be!

Linda Kreter & the

VeteranCaregiver Team

*Prayer from Today Matters by John C. Maxwell

Vietnam Era Caregivers - You Are Not Forgotten

PTSD is not only a condition of today’s troops, veterans, and first responders, unfortunately, it is a condition that affects our vets of much earlier conflicts.  When you consider the state of the country at the time of Vietnam, our troops came home to protests, rioting, and a very difficult adjustment for those serving. 

The stories were dreadful.  Like now, families felt somewhat isolated, but the country was far less respectful of those serving.  Today, even without full understanding of how to act or what to say, our troops are mostly warmly accepted and supported.  By contrast, my uncle was briefed to change out of his uniform immediately upon arrival in the States to avoid the chaos of the anti-war protests. Others were verbally and physically assaulted.  

The effects of coming home and working diligently to be invisible in the communities has also produced a long-term result – many of those from Vietnam did not receive treatment for their PTSD, nor did it have that name in the 1960’s, though the condition has been around as long as there has been trauma and conflicts. 

Another result is this aging population may come to seek VA care only in their later years, and they and their families have lived for decades with what is today openly discussed.  PTSD then and now will have many of the same symptoms of scent and sound triggers, sleep disorders, difficulty communicating and relationship challenges.  Add to this the possible loss of prime mobility, hearing loss, and aging issues, including presumptive conditions like Agent Orange, and we know we must actively communicate with the caregivers of each era.

It is less known, but very sobering that 80% of Vietnam veterans reported active PTSD symptoms 25 years after their service in a RAND study, with very high rates of depression and suicide.  These caregivers are hidden among you and please lend your support to them, include them in your peer groups, and learn from their experiences. 

PTSD may be a more familiar term these days, but our Vietnam era caregivers are only now coming out of the shadows.  To our Vietnam and earlier era caregivers, thank you for your quiet strength and service.

Linda Kreter & the

VeteranCaregiver Team