COORDINATED PAIN MANAGEMENT NEEDED FOR VETERANS

The House Veterans’ Affairs Subcommittee on Health, at a recent hearing on pain management problems, said that complaints of chronic pain are all too common with Iraq and Afghanistan Veterans. The Center of Investigative Reporting did a study that found that in the past 11 years, the number of Veterans treated by the VA has risen 29% and prescriptions written by VA doctors and nurse practitioners have risen 259%. Prescriptions for opiates such as oxycodone, methadone and morphine have risen 270% in the last 12 years. While the VA’s health care system tries to address pain issues appropriately, comprehensive pain care may not be consistently provide throughout the VA’s Medical Centers.
I have heard Veterans talk about the frustrations of having to go to multiple sites (Muskegon, Battle Creek, Grand Rapids, and Detroit) for treatment. Physicians at each location provide pain medications, but there is no coordination among them. A Vet may end up being treated with several prescriptions of the same medication, just packaged differently and produced by different companies. This may result in over-medication or over-dosing.

Recent media reports suggest that the rise in VA prescriptions corresponds with data indicating VA patients are dying of narcotics overdoses at twice the national average. It’s a fine line to walk for the VA physicians between decreasing pain in order to increase quality of life, and creating situations where veterans are addicted or over-medicated. We certainly need to see coordinated medication management for Veterans as soon as possible.

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NO ONE WANTS TO TALK ABOUT IT

It’s true. No one wants to talk about MST…military sexual trauma, but it’s another elephant in the living room. I don’t know where the idea of the elephant in the living room came from, but it’s a good depiction of what it’s like trying to pretend that “nothing happened” when it really did. We all walk around pretending we don’t see the elephant (abuse) standing there, but it affects every aspect of our lives.

Military sexual trauma is the phrase used by the VA to refer to sexual assault or harassment perpetrated against individuals serving in the military. It may be a case of being pressured into sexual acts against your will, or refusing to be sexually cooperative with one’s superior officers. It may involve unwanted sexual touching or grabbing, comments about a person’s body or sexual activities or unwelcome sexual advances. It happens to men as well as women. It can cause long term damage both mentally and physically to the recipient. Some of the problems that may result as a consequence of MST include:
• Depression, anger, and irritable feelings
• Numbness and the inability to feel happy
• Sleeping difficulties
• Substance abuse
• Avoidance behaviors (looking for ways to avoid anything that brings back memories of the incident)
• Difficulty trusting others
• Difficulties in relationships
• Physical health problems such as sexual difficulties, chronic pain, weight or eating problems, or gastrointestinal problems

The VA takes MST seriously. They provide free, confidential counseling and treatment to both male and female victims for mental and physical health problems related to MST. You do not need to have reported the incident when it first happened or have documentation that it occurred.

If your medical health is compromised as a result of MST while you were serving, you may be eligible to get compensation. The VA will first determine whether there are current disabilities related to your military service. If there are, then compensation is based on the current level of impairment.

A Veterans Service Representative can explain the compensation program and assist in filing a claim. For more information, call the VA’s general information hotline at 1-800-827-1000, or contact the nearest VA Medical Center or your local Vet Center. (You may meet with a clinician of the same or opposite sex if it would make you feel more comfortable).

No one wants to talk about it, but talking about it is how you heal. Maybe it’s time now to throw the elephant out!

MALARIA

I don’t often think of malaria as being a current issue for veterans. After all, I thought it was supposed to be affiliated with jungle conditions where mosquitos breed in droves.

Actually, malaria is common in many temperate or tropical climates. It is not unusual to contract malaria if you’ve been in parts of Asia, Africa, Central or South America. For veterans seeking medical treatment, malaria should be considered if the veteran served in Korea, Afghanistan, Africa or any other malaria-endemic country.

Malaria can be fatal if not treated properly, and can lie dormant in the liver for more than 4 years. If you have a history of overseas service in an area where malaria is common, your doctor should evaluate you for malaria any time you show any of the symptoms:
• Recurring fever
• Fever of unknown origin
• Shivering
• Sweating
• Malaise
• Weakness
• Gastrointestinal complaints (nausea, vomiting, and diarrhea)
• Neurologic complaints (dizziness, confusion, disorientation, and coma)
• Headache
• Back pain
• Anemia
• Jaundice

The incubation period may be 9 to 30 days after infection, but in some cases may be as long as 12 months. If treated unsuccessfully, symptoms may reappear years after the initial infection. Some drug resistant forms of the disease are now showing up too.

Once a diagnosis is confirmed, treatment should begin immediately, guided by 1) the infecting species (multiple species may be present), 2) the condition of the patient, and 3) the susceptibility of the species treated to the drugs used.

SECONDARY PTSD

I’ve been searching for information on a disorder that I could not even name, yet I knew existed. Recently I hit on a website that labeled the condition: Secondary Post Traumatic Stress Disorder. I can’t imagine a veteran exists who doesn’t know what Post Traumatic Stress Disorder (PTSD) is, but most people don’t know what Secondary PTSD is. Without a name for it, I had a very difficult time finding information about it.

My eureka moment came when I stumbled across an article in the Examiner. It gave some clarity to the thoughts I had on the topic. Secondary PTSD is not clinically recognized which is what makes it so difficult to find information. It is PTSD brought on by living with someone with PTSD. Sounds simple, doesn’t it? It’s not.

Living with someone with PTSD isn’t an easy path to follow. Sometimes the veteran’s PTSD results in emotional volatility where they blow up unexpectedly and strike out at their spouse and children. In response, the spouse and kids learn to “walk the line” and not do things that might trigger an outburst. In spite of this, things go wrong and the veteran will again become aggressive or out of control.

When you live with someone with PTSD, you may notice you are beginning to develop some of the characteristics of the disorder yourself. You may respond to your loved one’s outbursts with anger, confusion, depression, frustration or anxiety. In addition, you may listen to stories of how the original trauma came about thereby suffering vicarious traumatization. While you’re expected to help your veteran cope, there is little support for you.

Fortunately, that’s changing. There are now counselors available to help treat Secondary PTSD. Treatment usually involves some prevention measures, and the usual interventions used for treating PTSD. If you believe you are dealing with Secondary PTSD, consider talking with your physician and ask for a referral to a counselor. Help is available; please don’t hesitate to ask.

GOOD MENTAL HEALTH

Recently I’ve heard many of the veterans I work with talking about how helpful the classes they take through the VA are for them. The PTSD and Anger Management Classes especially allow them to share their feelings without fear of ridicule or shame. That’s an important part of developing good mental health.

Yes, it’s possible to work on improving your mental health. While we readily think about exercising, cleaning, shaping and toning our bodies, rarely do we think about doing the same thing with our minds. Yet, it’s possible to set goals and design a program for improving your mental health.

Sometimes poor self-esteem requires an effort to overcome, but accepting yourself as you are is an important first step. You can read books or go on line to learn ways to increase self-esteem; remember “I’m Ok, You’re Ok”? If it’s an engaging book, it can be a big help.

Work on nurturing your personal relationships. Treat your family and friends well. If you make life miserable for them, chances are you’re just going to be making life miserable for yourself too. After all, you have to live in that environment too.

Think positively. That’s a choice you can make: choose to be happy! I was doing it on the way to work this morning: a truck pulled out in front of me so I had to slam on my brakes. He just wanted to get through the light before it changed, but my first response was to chew him out even though he wouldn’t hear me. Instead I quickly reined in my anger and said aloud, “I’ve done that before too.” We all do stupid things now and then. Forgive and move on.

Just as you have to work at being physically healthy, you’ll also need to make an effort to pull yourself out of negative thinking. In the long run though, it’s worth it.