OK, so what's the deal? This week started off with me being a huge bundle of anger and anxiety. I was anxious about my psoriasis, work, my fundraiser. My anger was resurgent, causing me to have to use a lot of energy to keep it in check. My psoriasis was so bad that I had to be removed from handling food. My fundraiser was only half way to the minimum I needed and there were only seven days left.
Things were so off course that I couldn't remember to do even the little things that had become habit over the course of the previous months (washing dishes, drying the shower, folding my laundry). I caught myself thinking on Tuesday. If this is the reward I get for trying, why should I bother? I was as disheartened by my situation as I can remember being, compounded by the fact that I was seriously working to turn the corner.
Then I got REALLY angry. I mean blind rage, hatred filled, anger. Who was it directed at? Myself. It was like the part of me that has kept me going all this time had seen and heard enough. The thoughts that went through my head weren't pretty but they sure as hell snapped me out of it. I was able to channel that anger and regain my motivation, albeit with a little bit of a darker edge.
Then Wednesday came.
My fundraiser had a banner day and it now sits at $700 over the minimum I needed to start my non-profit. My psoriasis flare-up receded back to it's normal levels in the span of 12 hours, without explanation.
And Then Thursday:
The dermatologist decided to put me on Enbrel. I start this coming week. I initially expressed concern about how the injections would compromise my immune system but he told me that it suppresses the immune system in a targeted way that can leave people open to increased risk for infection, but if you don't have a history of chronic infections, it shouldn't be an issue. I thought about it and about all of the people I know who have seen dramatic results. Hey no harm no foul, right? Might as well and see what happens. If it doesn't work as advertised, I just cycle off of it, no harm done. The kicker: this ridiculously expensive regimen won't cost me a cent because my psoriasis didn't manifest until after starting military service and tearing up my knees and elbows in basic. Since it is service-connected, it's covered.
So here I sit. I talked to work and they said I was good to return to my old job and they recommended working with my area manager to create a contingency for future flare-ups. Again, going out of their way to accommodate my service-connected disabilities. And I'm still angry.
What. The. Hell.
Granted I recognize that my anger actually served a purpose this week and pushed me through a difficult spell, but I'm good now. Can it please go the fuck away? It is exhausting and I don't have time to be a zombified husband and father. If anyone has any ideas, I'm all ears.
When the week started, I thought it was going to be a good week. Overall, it was. I went to the gym a few times and started getting myself used to the feeling, did cardio on the nice weather days toward the end of the week.
Wee little problem: The more active I became, the more my anger flared back to life.
Needless to say, this worries me greatly. I didn't read about that in the small print when I signed on to get myself back into shape and improve my overall health. It just doesn't make any sense. The harder I worked out, the stronger the anger became. I am wondering if that was one of the underlying reasons I was putting off getting back into shape. It really makes me curious if I knew, on some level, that the exercise and weight training was going to bring back certain things that I wanted to leave behind.
I guess it's time to work through it. I am going to the gym a little later today and I am going to push myself to physical exhaustion to see if I can find an end to the anger or if it just makes me tired. I am hoping that I finally feel like I can safely let the anger out now that I have a constructive outlet. The problem becomes containing the anger when I am not at the gym. I have to be able to maintain my stability at work and at home or this is not going to work. It's not going to be an easy balance to find, but they offer Tai Chi at the gym as well and I am hoping that I can use the forms and breathing to channel my energies more effectively and coherently, rather than wanting to lash out at whatever's closest.
Some of my downtime this past week, I have been reading the book I was asked to review and I found myself unable to really devote my attention to it. My mind kept on wandering back to all of the things that were making my anger flare up and what I could do to contain it:
It seems like I have more to work on than I thought. It feels a little overwhelming, honestly. So...
I'm starting with the gym and making sure I get the constructive outlet for my anger worked into my daily routine. I don't see much of any other options right now. So, off to the gym I go. Maybe I'll find some more answers in the peaceful emptiness of cardio.
OK, a few months back, I made a concerted effort to get into the gym for cardio and weight training as often as I could with my work schedule. Due to the limited hours at the gym I was attending, that happened to be once, maybe twice, per week I was able to get there. I had read a lot about how everyone was saying how much exercise improves your mood and can help to stabilize your mood.
Hmm. What I discovered was something very different. When you are only able to go to the gym once per week, your mood is a little better that day. The other six days, you feel worse. I don't think I was necessarily feeling more depressed. I think it was because I had gotten a taste of what a good mood feels like and my body was seriously pissed that I wasn't feeding the hunger. It made me very frustrated and exceptionally demoralized. I thought about the trade-off. Was one day of a better mood worth six days of 'meh'?
Um...No. It sure as hell wasn't and it made me feel trapped in a body I hated to see in the mirror. I didn't feel like there was anything I could do to make a real difference, what with my retail work hours and such. Well, early last month, I had finally had enough. I started looking for ways that I could work out consistently and maintain a better mood. It was not an easy thing to do. I felt myself getting more and more impatient and frustrated as the days passed and I wasn't able to find any kind of workable solution.
Then, over this past weekend, it finally hit me: I need a gym that's open 24/7. After a little bit of digging on the internet, I found a gym that fit the bill. I visited the gym on Saturday and loved it. I signed up the same day. I know I feel better about myself when I don't see a fat guy staring back at me in the mirror. I am dedicated to this. I have already been exercising and it has improved my mood a bit. It also helps that I can work my exercising in wherever it happens to fit into my schedule on any given day.
It's been incredibly empowering and I just started. I am having fun and, for the first time in a long time, I feel like there's still a chance to get thin and happy again. I just need to make sure that I send the warning out there to all my fellow community members - If you can't exercise on a regular basis, things could get worse, and quickly. Please make sure you've talked to your doc about this concern. If you are prone to severe depression, please think this through and make sure you are committed to improving your mood. After feeling my mood get progressively worse with sporadic training, I know from first hand experience how negatively it can affect you.
So here goes nothing. I hope this word of warning gets to the people that need to hear it the most. Get up, exercise and take very careful stock of of how you are feeling. If it is affecting you, don't let your motivation stagnate. Caregivers, talk to your vets about their mood and find out how they are doing. Communication is key. It may seem counter-intuitive at first, but trust your instincts and your vet's gut. You know as well as I do how low our self-worth can be. Throw the listlessness of the medications we take and it can be very easy to convince ourselves it's not worth the effort. So...Support your veteran and do what you can to keep them motivated. I know it's not easy, but the rewards are worth the risk if you can help them get in shape.
Good luck out there and happy lifting!!
I knew I had been anxious about my first group therapy session with the new doc. I just didn't realize how anxious I really was. The two nights before the session, I didn't really sleep much. I was a bit of a hot mess. I arrived early as I always do. It gives me a few minutes by myself in the room to collect my thoughts.
Then the doc and the other veterans showed up and things took a turn for the worse for me. It became very clear early on that doc was going to work out. She's competent and runs the group well. She involves everyone.and does a good job directing conversation. The new doc was never the issue.
I kept on looking up and expecting to see Doc Casagrande. I kept on looking over the where he had habitually set up shop in the corner of the room. He wasn't there and it hurt, knowing he would never be there again. It's one thing to grieve on your own timetable. This was not. I had to force myself to move on and pay attention to what was happening in group. I didn't want to yet but I wasn't given a choice. It hurt like hell and I suffered for it all last night and today.
I kept on thinking, if grieving was this hard for my doctor, what the hell was going to happen to me if something ever happened to my wife or daughter? The fear intense, palpable. I have never been so scared of losing something in my life and I didn't know how to handle it. I ended up rocking and holding my head like someone kicked me in the groin. It wasn't continuous. Every time I would catch myself after a little bit and force myself to stop. It wouldn't take long before I was rocking again, unaware that I was doing it.
When I woke up this morning, my emotions were still raw and I was anxious as hell about everything and nothing, all at the same time. I kept on taking doses of my anxiety medication until it made a difference. Then, off to work I went, hoping and praying that I could make it through the day without verbally decapitating someone.
Somehow, I have made it through and it is something I am very grateful for. My wife has been worried sick about me and was concerned that I was starting to regress back into a hole. While I haven't regressed, I had to explain to her that what I was mostly feeling was grief exacerbated by my PTSD. I was just grieving. That's all. It just goes to show that, while I have gotten closure on Doc's death, being reminded of that loss can still be profound and emotionally distressing. I haven't felt his loss as keenly at any other time. It is still difficult to explain to you the depth of the loss I feel and it has overwhelmed me for the past two days. Now I have to work out all of the jumbled mess that is my thoughts and see if there's anything else or any revelations hiding in the murk.
Well, let's just say that it's mostly impersonal, cold. You can't capture the imagination of readers online the way you can when you talk to them in person.
With this in mind, I will be focusing on "Boots on the Ground" (BOG) initiatives first to invest my local community in my message and the success of my non-profit. I will be planning a 5K in my area as a starting place. I will then use this proof of concept as a means for other communities around the country to become involved.
If you want to be some of those boots on the ground, please let me know. If you believe in my mission support its inception...and get in on the ground floor. Help me hit the ground marching.
This past Wednesday, I met with my individual therapist. She was concerned about what had happened over the course of the previous week and told me she wasn't sure what to expect when she showed up. After I left her a message in distress last week, she thought I would still be really banged up emotionally. She told me she was pleasantly surprised that I wasn't a hot mess.
She said, "Feeling less is not a sign of emotional growth: Feeling just as much but returning to emotional stability faster is." It made me feel really proud of myself. She was acknowledging that even though I had been through a gauntlet of emotional pain over the course of the past week, I was focused and calm. It was not at all what she was expecting and was happy that I was able to return to stability so quickly. I told her a large part of it was that I have had to grieve for too many people in my short life. I have grieving down. That was never the issue, in the first place. The real issue was being prevented from getting closure. That triggered me something fierce. Closure was the one thing I never got to any of the deaths I witnessed and experienced over in Iraq. This past week brought it all back.
And living to honor Doc's work and his memory has motivated me to move on and fight. So fight I will.
The conversation then moved on to how I handled the anniversary of crossing the berm into Iraq. I told her it really didn't affect me too much other than to give me pause. It took a little bit to really absorb the thought that a decade has passed since that fateful day. I decided to go out to lunch with my daughter and we had a blast all day long. It was great.
Then my therapist asked how I felt in situations where parent stand or sit around and talk while their kids play.
I shifted uncomfortably. I told her that I tried to avoid conversation as much as possible because I don't want it to come out that I am a combat veteran with PTSD. It's not for my sake, it's for my daughter's. I don't want other parents to not allow their children to play with Caley out of misplaced fear that I'll go nuts. Caley is at a fragile age where she will think that she did something wrong. I don't want to visit that stigma upon her life. My clinician asked me if I identified myself that way when someone asked me what I do. I said that I do because my advocacy work is what defines me, not my job.
Well, she told me in no uncertain terms that I need to work on my ability to engage in safe and meaningless small talk. It's what most people do when they are standing around while their kids play. She asked me to think about how else I could answer the question: 'What do you do for a living?'
Still working that out. But, for my daughter's sake I better figure it out and fast. She starts learning day care in less than two weeks.
I hope that other veterans that are reading this ask themselves that question, too. I know that I have a tendency to be blunt. Not only that, but I also believe that a lie by omission is still a lie. So vets out there, think about it. How to we engage in small talk? Is it something we are comfortable with? Or do we just avoid those awkward situations entirely. I know I have done my best to avoid those situations. I guess now I can't. Time to step outside my very small comfort zone and re-learn something new...
It's hard to believe it's been ten years since I crossed the border into Iraq. Harder still to fathom why it is still as clear in my mind as if it happened yesterday. I was initially concerned about how this anniversary would affect me, but I was pleasantly surprised that it didn't really do much to affect my mood. Well, I guess it did. I spent the day with my daughter, Caley. We had a daddy and daughter day. We went to Applebee's and had lunch and spent the afternoon enjoying play time. I was on and off the computer checking on my fundraising campaign. The whole time, I reflected on how I have spent the past ten years - my victories and, especially, my stumbles.
Needless to say, I have a lot to be grateful for. My wife, my daughter, my family. I wouldn't be here if it wasn't for them and I know now, more than ever, that I am one of the lucky ones. Suicide rates are embarrassingly high, disability claim wait times are so long that some have been waiting for compensation longer than the length of their deployment to Iraq or Afghanistan. PTSD is still a scary four letter 'word'.
Should I continue? We all know the score. Our struggles are the legacy cost of a decade of war. A decade that saw the burden of waging war fall on the shoulders of 1% of our population. The military community has become more and more isolated from the general public in spite of the best efforts of advocates everywhere. It makes me wonder: With all of the high-profile advocacy going on out there, why aren't there more 'boots on the ground'? What I see is tons of advocacy groups spending a lot of money and time marketing themselves and their image. I don't see advocates in the crowd wearing t-shirts, bracelets. I don't see fundraising efforts on TV like they used to have for Jerry's Kids. I see the same partisan gridlock in DC fouling up everything they touch (sequestration caused suspension of tuition assistance for our active duty service members).
Most importantly, I have seen too many veterans that are tired of the frustration of the VA, politics, PTSD stigma, and unemployment just give up and let themselves fall through the cracks.
You all know what I'm talking about. It hurts my heart to see it happen, day in and day out.
It just feeds my fire. I will not submit. I will not give in. Instead, I will give back.
All I need to make my dream of helping veterans a reality is $3165. That means I need less than 3% of my followers and supporters to make that commitment.
I have asked myself a thousand times why I made it back and others didn't. We all know that surviving war is like playing Russian Roulette. What they don't tell you is the guilt you will have to live with if you survive. It took me a long time to work up the courage to do this. It was in large part because of the guilt. I felt like I would be 'taking advantage' of those in need. Stupid Survivor's Guilt. I know now that my cause is just and noble. The only way I can do more is by having the resources to make an impact. Help me start small. On this day, of all days, help arm me to fight for those that suffer in silence. Let me advocate for those too hurt to fight for themselves.
Yours in Health,
I went out to the cemetery today. I had learned late Thursday night that Doc does have a final resting place and it was less than a half hour from my house. Needless to say, after spending Friday getting everything sorted out with the VA (that's another post for another day), I was exhausted and couldn't make it out the to cemetery yesterday.
So I went this morning. Talk about surreal. There I was, not a soul in sight anywhere. I was standing in front of his grave marker, solemn and contemplative, head down. No cars drove by the cemetery in that moment and the snow started to come down very heavily. It felt like one of those moments you read about in books or in serious dramas. Yet this was real life. This was MY life and, for some reason, it just felt right that I should have solitude and quiet in that moment.
And then it passed and the emotional pain hit like someone ripping off a Band-Aid. Intense, searing, yet short lived. I was left with the dull throb of missing someone I would never see again, but being there - seeing Doc in his final resting place - gave me the closure I needed desperately to fully move on. I didn't realize how badly I needed it until that moment. It made me wonder why I needed that closure, that finality, so keenly.
I thought about it on my walk back to the car, on the ride home and a good portion of the early afternoon. And then, it hit me. I needed this because I never got closure for all of the death and violence I experienced over in Iraq. It made me think about all of the other veterans with PTSD that were suffering just like me and it made me realize: If there is ONE THING that can trigger us and bring it all back into our consciousness, it's having someone close to us die and not getting the closure we need to move on.
In retrospect, I recognize now that a lot of the anger I have felt for the past few days was not anger felt but, rather, anger remembered. Grief. Not felt, but remembered. Helplessness, intensely remembered. I recognize now that this event, the unfortunate circumstances surrounding Doc's passing and the way in which I was informed, has been a blessing in disguise. It may take it a while for me to fully accept that, but I know I eventually will. What I have gained from this experience is how losing someone I care about will affect me in the future. It also equips me to support my fellow veterans if they find themselves in the same position.
So take heed. If it is in your power, do everything you can to provide adequate closure for veterans with PTSD. Don't blindside them. Do what you can to be compassionate and try to leave them feeling like they are in control of the situation and how they choose to grieve.
VA Admin, ARE YOU LISTENING?
After everything that happened yesterday, I needed to find answers. I was in no condition to work but tried anyways. I made through a little over two and a half hours of my shift before I couldn't hide my grief anymore. I was emotionally drained and physically exhausted. I left work and I headed straight to the VA and asked to speak to the Patient Advocate. I was ushered into his office and he asked me how I was doing and what he could do for me.
I told him about the past month and the way that I had been treated and that I was very upset with the manner in which I had been informed of Doctor Casagrande's passing. He responded without remorse that he and upper level administration had decided the best way to handle this 'situation' was to not allow non-clinical personnel to say anything and to keep mum until the vets came in for their next scheduled appointments. At that time another doc would be waiting to (sarcasm here) 'blindside' an unsuspecting veteran with this horrible news. I was stunned. I told the advocate that I don't have scheduled sessions with Doc Casagrande and that I was only in his group CPT session. The advocate responded, "So many people come and go through the groups that we didn't bother." Again - stunned. I told the advocate it would have been easy to see, if he would have bothered to look at the rosters that I had been at EVERY session for the last six to nine months. Remorseless, he deflected my comment with something along the lines of what's done is done and 'gee, we're so sorry you found out this way.' I followed up by telling him that no one offered me grief counseling, nothing. He very quickly offered, :"would you like to talk to someone now?"
It was at this point that I realized that the administrators had no flipping clue how to handle these situations. This advocate, along with administration higher up, put hundreds of behavioral health patients at risk with their approach to dealing with the doc's passing. I wondered if the disconnect flowed into the care side, so I said I would like to talk to someone. I was introduced to a clinician (I don't remember if she was a doc or a nurse or a social worker) and talked about how messed up I was from all of this and it became very evident to me that she was distressed at how distressed I was. She told me that every veteran that she had seen in connection to Doc Casagrande's death had reacted EXACTLY the same way I have. She also mentioned (although I don't think she really meant to) that there were still veterans that didn't know because they hadn't been in for their scheduled appointments yet. She told me, "I know, after everything that's happened that you have no reason to trust us, but would you at least talk to one of the docs tomorrow who is taking over Doc Casagrande's patients?"
I could sense her frustration with the whole situation. This was an utter mess and Doc's co-workers were just as caught in this storm as I was. I said I would meet with someone tomorrow and I scheduled my time to meet.
After I left and was on my way home, I thought about the whole situation and it made me incredibly disgusted. That patient advocate was to advocate for what was best for the patients. Either one of two things explain his decision: He was lazy and didn't want to put in the extra work and due diligence to make sure every one of the doc's patients was informed as quickly as possible OR he was put in the position to make this decision without any knowledge of what WAS best for us. The VA needs to understand how much danger they put the veterans in. If I was any less stable than I am, I would have done things I would have regretted (become a danger to others) or done something I would never be able to regret (committed suicide). Every veteran should have been afforded an equal opportunity to grieve and should have been told in enough time to attend the memorial services. The way they decided to handle this situation was reprehensible and inhumane.
So, I stand by what I said yesterday in my post. The VA needs radical change. And it needs it now. No longer can we continue to put our nation's heroes at risk due to the ineptitude or apathy of bureaucrats. I will fight from now until my last breath to make sure this change happens. Come hell or high water. I have had people tell me the system is too big to change. I respond with this. Bullshit. When the people you are designed to serve are forced to go elsewhere to ensure they receive quality care and compassion, you have failed to meet the most basic of requirements for your continued existence. I will not bear the legacy costs of a broken VA when those legacy costs are paid for with the blood of my fellow veterans who have lost hope and take their own lives. The time for change is now. Let's be heard, folks. Don't stand silent and condone this with your inaction. Fight for the change we all deserve.
I try to keep the tears from hitting the keyboard as I write this. I found out today that I lost a man who held a special significance in my life. In his honor, I want to share what I knew of the man.
Read His Obituary Here: Dr. Joseph Casagrande
I never even knew his first name. We just always called him 'doc'. I didn't even know him for very long, but Doc Casagrande had a huge impact on my life. About a year ago, when I was out on short-term disability and learning how to cope with my PTSD, I found out about his Cognitive Processing Therapy (CPT) Group and asked to join it. That's when I first met him. We met one on on and he asked me pointedly whether I was committed to learning the tools I needed to learn to better my life.
That should have been the first clue that this doc was different. I went to my first group session two weeks later...and my life was changed forever.
Over the course of the past year, I have taken control of my life. I still have horrible nightmares, I still get triggered. I still have to fight the depression, the anxiety. The difference is that I have acquired, through emotional growth and a considerable amount of emotional pain, how to better cope with these symptoms of PTSD. I learned these skills in my CPT group and at the direction of Doc Casagrande.
He was an amazing man. He never wore his heart on his sleeve but his passion for helping veterans came through in his straightforward attitude and brutal honesty. He told us what we needed to hear, no matter how difficult. This was his gift to us, he taught us to look at our behaviors and beliefs unflinchingly, to never back away from a problem. Doc always knew what we needed to hear and talk about the most and directed group discussion. He didn't drone on and monopolize group time. He asked pointed questions and, throught his direction and the support of the other veterans in the group, each of us learned more about ourselves and what we could do to make changes for the better.
Four weeks ago, Doc wasn't at group. Neither was anyone else. When I asked where everyone was, I was told that Doc was out sick. Concerned, I let it ride. Two Wednesdays ago, someone else was leading the group, a clinical social worker (for more about this group session, click here.) By this time, Doc Casagrande had already passed away. No one said anything. When I asked about Doc, the social worker evaded the questions with 'I don't knows'. Growing more and more concerned, I went to group today and noticed that the room was empty again. I didn't wait around. I left and drove around for a little, thinking. In the end, I came back just after the group was ending and I ran into another doc that I have worked with and asked him for a no-bull explanation as to what was going on. The doc stared at me, stunned. The look in his eyes told me everything I needed to know but the doc said. He passed away. I found out that Doc Casagrande had passed before the last group session that I had been to and I felt the lights grow dim. My world took on a much more threatening glow.
As I said in my previous post, 'The VA Screwed Up, Big Time.' I was angry and very distraught. My grief was eating me alive. As I have had many times in the past when I have worked with Doc Casagrande, I felt a moment of clarity. The grief is still there and still profound. The fact that I never got the chance to say goodbye, to have closure, will haunt me for quite some time. What that moment of clarity gave me was resolve - to continue to do the work he would have wanted me to in order to make the most of my live. And to make a difference for others. That moment of clarity showed me that, while I was robbed of my right to honor the man after he died, I could live my life - the live he had made possible - in his honor. To live my life as he lived his: with compassion, honesty, integrity, and unflinching resolve to do the right thing.
It is with this in mind that I share with you my vision. I want to take what he has taught me and make a difference for veterans with PTSD. As I move forward with creating my non-profit, I will be needing a physical location. In his honor: It will be named the 'Joseph Casagrande Center'
I ask for your support in making this a reality. Please help me and others that knew him honor his memory and his mission.
As I continue my life with PTSD, I will share my challenges and discoveries on this blog.