So the MRI results came back negative for TBI.  In fact, they said my brain health was incredibly good.  Talk about a relief. The only problem is that I still have all of the problems but they just don't stem from TBI.  The only other viable explanation is extreme sleep deficit.

So Now What?

Well, I talked with the docs and did research online and it appears that folks with PTSD are substantially more susceptible to sleep dysregulation.  Working shift work where your schedule is inconsistent at best wreaks havoc on our systems.  It leads to a substantial loss of quality sleep and overall hours of sleep resulting in a major sleep deficit that, over time, erodes cognitive abilities and short term memory (among other things).

Their solution is to recommend to my employer that I get put on a consistent schedule that will facilitate a strong routine.  They want me to get up at the same time every day.  Start and end work at the same times every day.  Go to the gym the same time every day.  Make dinner the same time every day.  Go to bed the same time every day.

They said it will take time, but it will eventually retrain my body to digest, sleep, and burn at appropriate times and intervals.  Now I just need to see whether my employer will be able to facilitate this or not.  That is the major concern I have with all of this.  If they can't facilitate that, what then?  Well, I'm not crossing that bridge yet.  Let's see what happens when I meet with HR tomorrow.

Today was one of those days.  I woke up tired and angry.  I was a little bit nervous about going to work because I didn't feel in particular control.  I went anyways.  Not even two hours into my shift someone did something that really triggered me (disrespect will do that).  Next thing I know, I am shaking from the adrenalin and fighting off some extreme anger.  My only saving grace was that I was responsible for tasks that left me to my own devices and allowed me to essentially ignore everyone.  I made it over six hours before my anger finally made it too exhausting and stressful to stay at work.

I just couldn't figure out what the hell caused me to wake up that angry.  Nothing seemed to make any sense.  After I got home, I got changed and went to the gym.  I did cardio until I couldn't sweat anymore.  It cleared my head a bit but I still couldn't figure out what the hell had set me into that pattern of barely concealed and controlled anger.  I hadn't been there in quite a while.

And then it hit me.

I only seem to get that angry when I feel particularly out of control of something - the spectre of TBI hanging over my head fits the bill nicely.  Now I just need to figure out what in the hell to do about it.  I am going to have to change some things in my lifestyle to help compensate for this.  I have no resolution to the TBI issue in the near future but the workout helped a lot.  Time to get serious about putting my life in order.  Adequate sleep, exercise to burn off the adrenalin, anything I can do to stay stable and prescient for my family.

Guess we'll see how it goes...

This issue would appear, on the surface to be cut and dry - the VA is understaffed, underfunded, and overwhelmed.  The truth is not that simple and anyone paying attention knows it.  There has been a coordinated PR campaign by the IAVA among others to 'motivate' the VA to square themselves away.

Unfortunately, I believe that, while they are making life uncomfortable for politicians and pressuring them to end the claims backlog, the way in which the IAVA has gone about it has caused too many veterans to not trust the VA.  This loss of trust is tragic.  It keeps many from coming forward to get the help they desperately need.  Pushing for reform cannot be done quickly and piecemeal.

Let's examine the issues with the VA more closely:

• Ingrained Bureaucracy:  Federal bureaucracies are all fundamentally flawed.  They all focus more on getting everything done through ancient and outmoded procedure than they do on making sure that the end result of their efforts matches the efforts the customer is seeing on their end.  How many hoops to veterans have to jump through to just file a claim?  Why are non-medical administrators with little to no knowledge of the intricacies of providing care the ones in positions to make uneducated decisions?  These are all part of the culture that has not changes for decades at the VA.  During peacetime, this was not noticed because we didn't have a massive influx of new veterans seeking long-term care.  Now that we do, the deficiencies in not having updated policy and procedure becomes glaringly obvious.  Unfortunately, the care providers on the front lines are the messengers that end up getting a bad rap because of this.
• Change Can't Happen Without Leadership Continuity:  One of my good friends and I were talking about this the other day and it makes a lot of sense.  In a large Federal bureaucracy with ingrained bad procedure and policy, there needs to be continuity at the highest levels of leadership for change to take hold.  Secretary Shinseki is finally filling that void in continuity - and that's why we are finally starting to see positive change in the manner in which the VA operates.  Before Shinseki, there was a revolving door in that office.  In large government organizations like the VA, the employees could just wait out policy changes.  They could just wait until that Secretary was replaces with another warm body and policy changed all over again.  Without continuity and accountability (both of which Shinseki brings in spades), there is no possibility for long-term changes to go into effect.
• The Behavioral Health Hiring Fiasco:  So much pressure was put on the VA to provide better care to veterans with PTSD and other behavioral issues that the VA has been, in many cases, not performing due diligence to ensure that the clinical social workers and therapist that they hire are actually qualified to administer to the needs of veterans.  The VA has always made sure that the treatment modalities that were used by therapists were evidence-based and had a lot of research to back up their efficacy.  This latest round of hires has seen a disturbing increase in the number of social workers and therapists using pseudoscience to 'treat' veterans with PTSD.  Emotional Freedom Technique and Thought Field Therapy have absolutely no place in the VA.  Honestly, it scares the hell out of me that these people are allowed access to veterans with PTSD.  When there is no peer-reviewed evidence that a modality works any better than the placebo effect...the well-being of at-risk veterans should not be exposed to therapeutic Russian Roulette.  The other side of it is that the VA can't fill the vast majority of the openings they created.  Truly qualified medical professionals have better paying options elsewhere.  Additionally, these same professionals have heard how the VA does not allow their therapists to dictate the frequency or duration of individual sessions with veterans.  I don't know many therapists who would want to subject themselves to 'revolving door' care.
• Clinician Burnout:  Not many are tracking the number of caregivers that are burning out due to the insane treatment tempo, intensity of care being provided, and the emotional drain on the caregivers due to long hours and severely traumatized veterans.  If a clinician is burning out, you can usually tell and the effectiveness of the care they are providing drops off precipitously.  Being a VA caregiver is a thankless job and takes a heavy toll on caregivers at the VA.  Remember that the next time you go into the VA and are not satisfied with the level of care you are receiving.  I have found being compassionate about their plight has helped to facilitate getting me the level of care I have needed in critical situations.

Needless to say, there are a lot of problems at the VA.  Many of them are due to the fact that the majority of our politicians who voted for sending us to war accounted for the enduring costs associated with waging it.  Just remember - there's always three sides to every story:  Yours, Mine, and somewhere in the middle lies the truth.

We're ten days out from this year's 'After the Uniform' Panel at the National Press Club in Washington, DC.  This year's panel is dedicated to addressing PTSD.  With this in mind I will be outlining the major issues facing veterans with PTSD.  First up:

The State of Behavioral Healthcare
Behavioral healthcare in the United States is a disgrace.  Little has been done to truly modernize care and the stigma associated with having a behavioral disorder is damaging and debilitating.  Americans with behavioral disorders are treated like second class citizens by many and ignored by others.  This is felt even more strongly by our military and veteran populations.  The stigma associated with PTSD is such a strong deterrent that thousands never come forward to get the treatment they need out of fear of stigmatization -  fearful of either torpedoing their military careers or severely limiting their employment prospects after they transition back to civilian life.  Don't get me wrong, there are a lot of groups out there dedicated to educating the general public about behavioral disorders.  The real problem is that the stereotypes are so ingrained that people don't want to listen.

The advent of the internet age should have facilitated a fundamental paradigm shift in the way we approach treatment and awareness.  The sad truth - nothing has changed.  In our country, the internet is not used effectively to reach veterans or facilitate treatment.  While this deficiency has been recognized by our Federal Government, little has been done to rectify the situation.

Case and Point:  Earlier this month, the Federal Government announced the creation of a new website - 

It opened to such huge fanfare that no one I know even knew it existed or that it had launched.  Seriously, click on the image and take a look.  It's only taken the United States until the middle of 2013 to get these types of basic aspects of facilitating care onto the internet.

Great Britain, Canada and Australia on the other hand...They have online access to anonymous peer-to-peer support, online therapy, and the ability to refer people to 'real world' professional care.  One of the major pioneers in this modernization of behavioral healthcare in these countries is The Big White Wall - 

Their approach is modern and allows people to come forward and get support without the fear of stigmatization.  Their work has been lauded in many circles as the 'proof of concept' for the future of behavioral healthcare.  Ever heard of them?  No?  Did you know they have been trying to gain entry into the US market?

It makes me wonder how many more of our brethren-in-arms would reach out for help if they had this kind of option for support and care accessible to them.

So there you have it.  I think I have adequately drawn attention to the state of behavioral healthcare in this country.  Up next: The VA

Rating: 5 out of 5 Stars
Authors: Dr. Harry A. Croft, M.D. and Rev. Dr. Chrys Parker, J.D.

I do not make that claim lightly.  While some aspects of their approach have been written about before, it's the manner in which they organize it all that has a huge impact on the way you, as a reader, will absorb it.  The biggest impact they make with their approach is their focus on the physiological underpinnings that cause the behaviors attributed to PTSD.  Having someone tell you it's the 'battle brain' doesn't tell you anything.  When they explain to you that the basis for PTSD is physiological, when they explain in a way you can understand what is going on inside your body, I guarantee you will feel a great sense of relief.  I know I did.  I now have a reference to help me explain to others that my PTSD is not 'just in my head'.  It will make the reader more aware of the way they respond in varying situations and facilitate recognizing the signs of being triggered much faster.This can also have another major impact on the lives of veterans everywhere:  You now have a resource to give to your family to help them understand how you are different that 'before' and what they can do to support you effectively.


Their approach to writing this book is exceptional.  For every issue or topic they address, they clearly delineate who is presenting his perspective.  At first I didn't think that would work out.  Two people writing about the same issue as separate and distinct voices?  Wouldn't it be better to write collectively?

No. Unequivocally.

Yes, they both have their own unique perspective on the issues.  Yes, their tone and reasoning varies, No, their rationale does not conflict - it complements.  Croft has a tendency to take a more clinical, yet still conversational, tone to his commentary.  Parker, the more spiritual.  The change in voice also helps to keep the subject matter from getting dry.  It provides you a unique opportunity to learn about these issues from all sides.

I don't want you to just take my word for it.  Let me give you the guided tour and you can make the decision to read the book if you find it as beneficial as I do. For those of you not familiar with my review writing style, I break the book into sections and give my account of the 'good', 'bad', and 'unexpected' in each section.  I take this responsibility very seriously and strive for objectivity.  So let's dig in, shall we?

Recognizing when PTSD is in Your Life:
The Good:  In this section, the authors describe the types of behaviors that can be indicators of the presence of PTSD.  They cover all of the bases here and make some very astute and pointed observations about the behaviors attributable to PTSD that made me squirm.  They give anonymous real-world accounts of these behaviors from veterans in all different situations.  They focus on the different ways in which our ability to socialize is compromised in both personal and professional settings and if you don't know whether you have PTSD, reading these depictions will leave you with no doubt.

The Bad:  Depending on your state of mind, the examples they give could lead you to adopting a very stark outlook for the future.  The authors could have done a little more at the end of the chapter to temper this potential reaction by offering encouragement and empathy rather than ending with a three sentence blurb that says 'if this is you, read on'.

The Unexpected:  They depict relationships and how they impact all parties involved.  Their descriptions detail reactions and behaviors of those affected by the veteran with PTSD and allows loved ones reading the description to evaluate more fully, from both sides of the interaction, whether PTSD is in their lives.

Educating Yourself About PTSD:
The Good:  Croft and Parker explain how the things you experience can lead to PTSD.  They explain how experiencing trauma causes the stress that gets us 'stuck in survival mode' and how this causes those affected by PTSD to behave a certain way.  They go over the three major categories of symptoms: Re-experiencing, avoidance, and increased arousal.  They explain how doctors evaluate you and that no two people manifest symptoms in exactly the same way.  They do an amazing job of explaining all of this without getting lost in jargon that would be lost on the average reader.

The Bad: N/A

The Unexpected:  They explain that the basis for PTSD is more than just behavioral.  This is where they first posit that there is a strong physiological aspect of the disorder that is often overlooked.  While this is delved into in depth in the next section, even hinting that PTSD has underlying physiological causes left me feeling a profound sense of relief.

Connecting Biology to Your Psychology:
The Good and Unexpected:  The authors explain how people with PTSD have been done a huge disservice by the behavioral symptoms being discovered and documented before the physiological aspects of the disorder could be ascertained.  They explain how, physiologically, your brain and your hormones play a huge (and I do mean HUGE) role in PTSD.  They explain how the parts of your brain dedicated to survival become overstimulated.  They present it in a way that makes you understand that the underlying physiological effects on your memory, your subconscious, and endocrine system are real - not imagined.  PTSD is not something you can overcome with strength of will.  You didn't make it up and it's not just in your head.  To go into any further depth, I would have to plagiarize.  This section of the book does so much to relieve the stigma we put on ourselves.  If you know anyone who thinks this whole mess is just in your head, kindly shove this book in their face and tell them to shut the hell up and read.

The Bad: N/A

Organizing a Comprehensive Care Plan for PTSD:
The Good:  Croft and Parker do an excellent job of explaining the different types of treatment available to help manage your PTSD.  They talk about therapy, group and individual, and the most common modalities used to treat PTSD.  They talk about medication.  They talk about alternative treatments including massage, yoga, acupuncture, and meditation.  They even talk about naturopathic alternatives.  Most importantly, they explain that this is a plan - one that you control and direct.  If something's not working, try something else.  In essence, be your own advocate.  Learn what you need to learn about the treatments available to you and make educated decisions.  Don't let doctors throw medication and therapy at you and hope that something sticks.

The Bad: N/A

The Unexpected:  In this chapter, they explain how some treatments need to be approached with caution.  Some forms of therapy require that you need to be ready to actively engage in them.  They also explain that certain medications can inhibit the positive effects of some forms of therapy.  If I would have known these things previously, I would have demanded a change in my medication.  This is powerful knowledge that will help every veteran with PTSD better direct their own treatment.  In fact, some prescribing doctors and practicing therapists should be reminded of these 'minor' details.
  
Viewing Your Issues in a New Light:
The Good:  In this section, the authors discuss how looking at your PTSD from a different perspective can be life-changing.  They ask you to consider how it affects your spouse, your family, and the importance of protecting your children from trauma, emotional or physical.  From my experience, PTSD is inherently ego-centric.  You are in your own head all of the time.  In this chapter, the authors forcefully suggest you take a look at how your behavior impacts those you love and what you can do to manage that aspect of the disorder.  They also discuss how you can learn to view your environmental triggers as manageable.  They even offer up an approach that was developed by one of the authors, Chrys Parker.  It is called the 'I Am Able Method' (Copyright 2010, Chrysanthe L. Parker, All rights reserved).  It is a quick and functional way of helping you manage your triggers and associated behavior.  What astounded me is that it took until 2010 for someone to come up with this approach.  Lastly, they talk about high risk behavior and substance abuse.  While I am not an adrenalin junky or a substance abuser and these portions of the chapter did not pertain to me, I could see how they could be helpful to a veteran who is at risk.

The Bad:  N/A

The Unexpected: N/A

Empowering Yourself Through Strong Systems of Support:
The Good:  Croft and Parker explain the necessity of having strong systems of support.  They detail how disparate the effects of PTSD are on people that have created strong support networks and those that haven't.  The talk about family support, support from friends, getting support by giving support, and spiritual support.  I have mentioned how lucky I am to have a strong support network.  My family is loving, compassionate, and supportive.  While my PTSD has caused me to alienate many of my friends over the past ten years, I am finally learning how to make new ones.  For two years, I have been offering insight and support through my website and blog.  Just one small problem.  My life has no spiritual component.  None.  Zip.  Nada.

The Bad: N/A

The Unexpected:  I didn't know why blogging and giving to others always made me feel better, more stable.  Now I know.  The authors explain in physiological terms why showing compassion for others and giving of yourself is so rewarding.  When I finished reading that section of the chapter, I felt vindicated and motivated.  It was a wonderful feeling and one that has persisted.  Additionally, the authors forced me to evaluate my spiritual health.  The verdict - on life support.  I have said on more than one occasion that what I experienced shattered my soul.  While I have attended to healing and gaining support in the other three areas, I have conscientiously avoided confronting the spiritual pain and loss I have felt.  It was an unpleasant but necessary revelation and one I plan on addressing as soon as I can figure out who to talk to about it.

Redefining the Meaning of Your Life: Posttraumatic Growth:
The Good:  In this final section of the book, the authors talk about how to 'keep the faith' long term.  They talk about dispositional optimism, the importance of maintaining your support networks and social ties.  They emphasize the insidious nature of self-doubt.  They also talk about the importance of holding onto your core value system -  the system of morality and beliefs that define you,  Those who tenaciously hold on to this core of their identity are better equipped to manage their PTSD.

The Bad:  After all of the insight I gained in the other sections of the book, this section seemed slightly anti-climactic.  While I understand their intent to leave the course of your recover open, it felt like it was rushed.

The Unexpected: N/A

Conclusion:
Croft and Parker have done something amazing in this book.  They have tied together all of the pieces of the puzzle - and have done it in a way that speaks to the experience they have working with veterans. Their R-E-C-O-V-E-R Approach is comprehensive, simple, and approachable by all, regardless of their progress on their personal road to recovery.  The most important aspect of this book is the emphasis that they place on the physiological nature of PTSD.  It has given me much clearer insight and understanding into my behavior.  I highly recommend that veterans and their loved ones read this book.  You can't understand what you don't have knowledge of.  Take the time - you won't regret it.

Hey Folks,

Recently, I have noticed an uptick in the severity of my PTSD symptoms and my coinciding depression.  It's starting to make me worry a little bit that not having a functional group to attend is slowly eroding my ability to cope and adversely affecting the effectiveness of my coping mechanisms. Or...It could be just a temporary uptick because of the uncertainty surrounding my upcoming TBI evaluation.  Either way, it's decidedly annoying and not something I am handling well.

What to do?  I am going to have an individual therapy session this week and I plan on talking to my therapist about my concerns and my frustrations with not having a group to attend.  My PTSD is fighting to get through - the anger, the depression, the nightmares, and the insomnia.  I also have been dealing with a higher than usual level of hypervigilance.  Most nights I toss and turn so badly that I end up sleeping in my recliner, uncertain as to why I don't feel safe - I just don't.