Service Dogs for Veterans

Oprah’s show last Thursday highlighted the Puppies Behind Bars’ Dog Tags Program. I first became aware of this awesome program when Sen. Al Fraken (D-MN) introduced his first piece of legislation in the Senate seeking to fund a program providing service dogs to veterans.

Sen. Franken joined with Sen. Johnny Isakson (R-GA) to introduce the Service Dogs for Veterans Act. Sen. Isakson saw firsthand what the love and comfort of a companion animal can do for someone suffering. Before his mother, Julia, died of Alzheimer’s disease in 1998, one of the few things that brought her noticeable joy was her interaction with service dogs at an Alzheimer’s facility where she spent her last years. Their bill was rolled into the Department of Defense Authorization Bill, which was passed by the Senate.

I’m crazy about dogs, and I think that their power to heal and comfort is unsurpassed. I never really considered the impact of companion animals on our wounded warriors until I read Jay Kopelman’s book From Baghdad to America: Life Lessons from a Dog Named Lava. Kopelman, a Marine veteran of Operation Iraqi Freedom, writes about his transition back to civilian life with help from Lava, who is not an “official” service dog. Needless to say, I cried like a baby nearly the entire time reading his story. Luckily, I was in Chicago’s O’Hare airport when I picked up his book and reading it while flying on a large jet, so it’s not like anyone saw me.

When Sen. Franken introduced his bill, I started doing some more research on service dogs for veterans, and I came across this Time article and this Wall Street Journal article. The WSJ article told the story of Capt. Luis Carlos Montalvan, an Army veteran who served in Operation Iraqi Freedom and now suffers from severe PTSD and other war-related ailments. Capt. Montalvan was the inspiration behind Sen. Franken’s proposed legislation, and he is also the proud recipient of Tuesday, one of dogs from Puppies Behind Bars’ Dog Tags program.

Photo by Leslie Granda-Hill

You can watch his story here and read his first person account here.

Besides tugging on my heartstrings for my love of dogs and our military, I am most impressed by the recognition of these charitable organizations and Sen. Franken’s bill of the disabling effects of PTSD and other mental health disorders as a result of war. Our minds are such powerful organs, and when they are damaged, they too need to be treated and given time to heal. Unfortunately, the damage is not visible like the loss of a limb, but the pain and suffering is just as real.

Other charitable organizations are doing great work by providing service dogs to our wounded warriors, including NEADS Canines for Combat Veterans, Freedom Service Dogs, Inc., America’s VetDogs, and Patriot Paws Service Dogs. If you know of any others, please let us know!

A Hero’s Journey Home

Killed in action the week before, the body of Sergeant First Class John C. Beale was returned to Falcon Field in Peachtree City , Georgia , just south of Atlanta , on June 11, 2009 . The Henry County Police Department escorted the procession to the funeral home in McDonough , Georgia.  A simple notice in local papers indicated the road route to be taken and the approximate time.

The link below is a short travelogue of that day’s remarkable and painful journey.

Sergeant First Class John Beale

INVISIBLE WOUNDS OF WAR by Saralyn Mark, MD

UPDATE:  Last Friday, after the hearing Sara talks about below, The U.S. Senate Armed Services Committee voted unanimously to adopt the Montana model for assessing returning combat vets for post-traumatic stress disorder.  Check out the story here

Last Wednesday, I had an opportunity to present to Congress my thoughts on the “invisible wounds” of war. According to a 2008 RAND report, nearly 20% of veterans who have returned from Iraq and Afghanistan suffer from post traumatic stress disorder (PTSD) or major depression. I think that these numbers are actually low, since the report was based on extrapolated data from a survey of less than 2,000 troops. We now know that the number of Army suicides has increased every year since the Iraq War began, and this is the first time since the Vietnam War that the Army suicide rate has surpassed the civilian suicide rate.

The briefing was in the Dirksen Senate Office Building and was sponsored by Senators Max Baucus (D-Montana), Mike Johanns (R-Nebraska), and Jon Tester (D-Montana). The Senate hearing room, with its elegant wood paneling and high ceilings, was filled to the brim and every seat was taken. People were even standing near the windows and out in the doorway. I was seated in the middle of a very long table and was flanked by two colonels: Colonel Jeff Ireland, Director of the Montana National Guard, and Colonel Peter Duffy (retired), Deputy Director of the National Guard Association. We were joined by three others including two psychologists and Mr. Patrick Campbell, Chief Legislative Counsel for Iraq and Afghanistan Veterans of America. Mr. Campbell shared his experiences of how difficult it was to get mental healthcare while on active duty and how he was inappropriately questioned about his symptoms and needs when he returned home to the U.S.

During the briefing, staffers took copious notes and the audience remained completely silent. I don’t think I’ve ever spoken to a more attentive group of people. I usually don’t like to use prepared remarks, but we had tight time limits and I wanted to be sure I conveyed all my points. I’ve included my remarks here in this blog; many passages were actually taken from my prior BeWell blogs (“A Nation of Ghosts” and “Shock and AWE”), which focused on these issues. Congress is considering legislation to help veterans suffering from PTSD and other mental health issues. This was a chance to raise the level of awareness for other Senate offices to support this legislation. (I’ve since learned that other Senators signed on to support S.711-The Post Deployment Health Assessment Act of 2009 after hearing the briefing).

I must admit that it was cathartic to be able to formally share my viewpoints. I was having my own flashbacks to March of this year when I was on Capitol Hill to speak to congressional offices about pancreatic cancer. In some ways, talking about the mental health needs of the military was harder. Both touch my life very closely and I feel a need and a responsibility to make a difference and help others, as well as my own family. But talking about PTSD — or as I would like to call it “AWE” (Adaptation to the Extreme Environment of War) — was a more delicate topic for me.

Perhaps because I think that there is an understanding that military wives are not to speak out, especially to tell Congress that “it is not ethically or morally acceptable to send our loved ones off to war without the resources that they need to protect themselves.” I can only guess that other spouses might feel that they cannot talk about the painful changes they are seeing in their partners. It is a taboo topic filled with stigma, as if our loved ones are weak and not made of the “right stuff” for the military. I wonder if this silence is like a cancer that eats away at our loved ones and our families.

After the briefing, I stayed in the room for an extra 45 minutes taking questions from the audience, including Senate staffers who were officers in the military. Their stories were so poignant and courageous. I felt like we were their voices and I hope that we did them justice.

My three points that I wanted to make in that briefing room were the following: 1) War changes everyone and people adapt. Those changes (AWE) are a normal reaction to an abnormal situation with PTSD at the other end of the continuum, where the adaptation process has progressed to a dysfunctional state; 2) We should offer mandatory surveillance and rehabilitation before, during and post-deployment; 3) Family members need to be involved. Currently we have no where to go to confidentially report changes that we see in our loved ones without causing potential damage to their careers.

After the briefing I left the hearing room with Colonel Ireland we walked together to the train station. I felt a sense of sadness and exhaustion as I entered the Metro. It was an honor to have had the opportunity to speak and share ideas, but the weight of what we still need to accomplish is huge. I know that I am but one voice representing many. I hope that my message encourages others to speak out, as well, and to demand action. We are blessed to have a First Lady who is committed to the well-being of military families and her advocacy can make a big difference.

If we can afford to go to war, we have to afford to take care of the mental health of our troops. We must stop viewing mental health care as a luxury. It is a necessity to ensure that our troops, our loved ones, can defend our nation and come back and be productive members of our society and our families.

Saralyn Mark, MD

http://www.bewell.com Medical Editor

President, SolaMed Solutions, LLC

Associate Professor adjunct of Medicine

Yale and Georgetown University Schools of Medicine

Affiliate Professor

George Mason University School of Public Policy

Hug them even if they can’t hug you back.

My first post…to this blog was going to be scientific with statistics and research data. After all, I am a medical researcher, data analyst, I manage information; constantly seek answers, always curious. This afternoon however, I had a conversation with a mom whose son has TBI and PTSD…and orders to deploy again. Perhaps then, you will indulge my speaking from the heart instead of from ‘my brain’. I guarantee enough of that will be forthcoming.

There is nothing more heartbreaking than to look into your child’s eyes and feel compelled to ask”what have those eyes seen?” And the eyes, well what you see is ‘dead air’.  The definition of “Dead air” is “unintended interruption in a broadcast during which the carrier signal is unmodulated-no sound on a radio signal or a black screen on a television signal.”

I’ve asked my son this very question. I imagine many of you have either asked or wanted to ask your son, husband, sister, brother, wife, boyfriend, girlfriend; Army, Air Force, Marines, Navy, National Guard, Reservists…

After my son’s first tour of duty to Iraq, his wife (my daughter-in-law) asked him to tell her “what it was like over there.” His reply was it would be very difficult for her to understand because she had no context in which to do so.

Prior to March while researching and preparing materials for my web site Military Health Matters Resource Center for “Brain Injury Awareness Month” I came upon a set of  presentation/video packages  designed to train senior NCOs and Officers on the proper  identification of TBI, mTBI and PTSD and correct redeployment protocols. We’ve all seen films or documentaries of the wars, videos of IED explosions, combat support hospital operations, or the like but none of these have ever come as close to making the kind of impression these did. They were vignettes or scenarios with real people and real situations.  Agonizing to watch but impossible to turn away from; invoking the very same feelings you may experience while watching a horror movie that never seems to end. Only this isn’t a movie…but it is absolute horror.  I am writing an article on PTSD and TBI that I am subtitling: “the living hell within”. That would be an understatement.

I was very encouraged to hear Secretary Gate’s 2010 budget proposals this week in particular the priority of investment in ‘human’ capital – our kids and loved ones. More on this next time… as soon as my brain returns.

Karen

Proud 82nd ABN Mom

Karen Estrada’s Profile

Shock & Awe by Saralyn Mark, MD

“Shock and awe” is a phrase that was introduced and quickly woven into our conversations during March 2003. We knew that it conveyed our military’s strength and superiority fighting the enemy in Iraq. We were transfixed by the fireworks illuminating the night’s sky over Baghdad. Six years have gone by since “shock and awe” transformed our lexicon and eight years since our troops landed in Afghanistan. Battles have been fought in distant lands to protect our freedom and security.

Now we are finally acknowledging that this war is coming home. On March 18, 2009, in two locations in our nation’s capital, the truth about this war reached our shores. For years we knew that this was coming, but it was difficult to face. The casualties are not just our troops”the collateral damage includes their families. At the Pentagon, the secretary of Veterans Affairs and the deputy secretary of defense hosted a screening of the PBS special “Coming Home: Military Families Cope with Change”–a show that highlights families who have faced amputations, traumatic brain injuries and post traumatic stress disorder. While at the same time, there was a hearing of the Senate Armed Services Committee to discuss the rise of suicides among military personnel.

What connects these two events is shock and AWE. It is time for our nation to accept and understand a new version of this concept–one still grounded in military strength but now associated with a benevolent action rather than destruction. Military jargon is filled with acronyms. So to continue that long-standing tradition, AWE can be an acronym for “Adaptation to the War Environment.” AWE is a normal process that the body and psyche experiences to adapt to the extreme environment of battle in order for a person to survive. By just changing the nomenclature, we can begin to change a climate filled with stigma, fear and humiliation. Instead of saying post traumatic stress disorder or PTSD to describe the signs and symptoms that our troops experience–which can imply victimization, weakness, disability or disease–we can describe it as AWE, a normal reaction to an abnormal situation.

During the Senate hearing, every military leader expressed concern over the soaring rates of military suicides. These rates are higher than the general population. In 2009, 24 Army soldiers may have committed suicide and possibly another 18 in February, despite an increase in suicide prevention programs. General Peter W. Chiarelli, vice chief of staff of the Army cited long deployments and separations from family and the perceived stigma and shame associated with getting help. This point was also expressed by Admiral Patrick Walsh, vice chief of Naval Operations.

Recently, General Carter Ham and Brigadier General Gary Patton courageously went public about their reactions to the stress of war and the need for mental healthcare. They wanted to encourage service members to come forward and ask for help. Some junior officers and enlisted personnel may still be reluctant to do this, believing that the generals were able to be open about their situations because they were at the pinnacles of their careers, and if they seek help they will be passed over for promotions. This conception will be hard to change if the climate is not dramatically altered.

We need to not only provide the superficial modification of wording from PTSD to AWE, but also dispel the notion that only a few are affected by war. Everyone comes back changed. We are fighting an unconventional war that will continue for years. It is now time to take an unconventional approach to prevention and treatment of this issue. Otherwise, we will continue to be a nation haunted by ghosts. I have written that even when our loved ones return, some with physical injuries, it is the invisible injuries that damage the fabric of lives. They may have come home, but emotionally they have disappeared. Family members, holding on to these precious spirits, disparately search for healthcare which could bring back their loved ones. We have created this environment because our mental health care programs have failed.

It is time that we come forward and state that we expect that all our troops will return with reactions to the extreme environment of war. It is the norm rather than an abnormality. It then becomes a shared experience and not associated with shame or dishonor. This approach has worked in other settings such as within NASA. For example, it is expected that all astronauts will experience bone loss secondary to the microgravity environment in space. Astronauts undergo training to achieve maximum fitness before they fly, utilize countermeasures such as physical activity during flight to mitigate loss and all go through extensive rehabilitation programs when they return. The severity of the bone loss and recovery varies by astronaut, but they know that they will all lose and will require assistance to protect their health at home and “flight readiness” for their missions.

This model could work for our military. We can help our troops better prepare in advance for the stresses of war, have countermeasures in the field such as well trained mental health personnel and mandatory rehabilitation and surveillance upon return to a non-hostile environment. If we assume that everyone will have adapted to the war environment (AWE) and will require mental healthcare, it removes the stigma associated with it.

This novel approach can help to protect the “fight readiness” of our troops for the battlefield and for their adjustment to the home front. Imagine the day when it will be a badge of courage and honor to say “I’m in AWE.”

Saralyn Mark, MD, BeWell Expert

Associate Professor of Medicine adjunct
Yale and Georgetown University Schools of Medicine

Affiliate Professor
George Mason University School of Public Policy

Senior Medical Advisor
NASA
*The opinions expressed are the views of the author and not of NASA.

More on DoD Coffin Policy

The first story in This Week in the Pentagon covers the Department of Defense’s new policy on allowing media access to the coffins of American soldiers returning home to the United States.

Flag Policy Story

We’ve heard some of this before, but it was heartened to hear that the DoD will pay for family members to come to Dover if they want to. It was also touching to see just how seriously Secretary Gates has taken this issue.

It Made my Heart Ache

“I needed to know why” [two of my brothers were putting their lives on the line in the Army in Iraq.] That is the reason Director Jake Rademacher gave for making the movie Brothers at War. I saw the movie this afternoon. I’m still kind of recovering. I don’t know if Rademacher answered his question about why. I can tell you he answered the what. The movie chronicles Rademacher’s two trips to Iraq during which he tried to figure our just what his brothers did there. Now we know.

Without any gratuitous violence we saw exactly what it was like to do his two brother’s jobs in the Army, in Iraq. It was interesting and scary and funny and sad. I think Rademacher came away with what he wanted to know. He gives the rest of us a kind of “month in the life” of just a few of the people who put their lives on the line for our country every day. In the process he was able to show the burdens his brother’s military service placed on his family; he also showed the the rewards the brothers themselves found in their service.

I can’t say I enjoyed watching the movie exactly. I can tell you it moved me profoundly. What it showed about the relationships of brothers was deeply affecting. The five brothers weren’t all the same. They were living different lives like most siblings. Even the two in the Army didn’t seem much alike. But the bond between the brothers (and their two sisters) was a tangible thing.

I wish I could make my older sons go see this movie, together.  (I can’t, by the way, make them do anything – they are purported grown-ups.) I wish there was some way to impart the feeling the men had for each other to my sons. It made my heart ache. For my older sons, who don’t have the feelings I saw on the screen today. For all the families who are going through, or have gone through, the trials of being separated from their loved ones who serve. I highly recommend the movie, even if it isn’t always fun to watch.

Cross-posted at Not Exactly a Princess

Amazing women –

I watched ABC News last night, and saw a report that hit me very hard.  A few  young women, all recent widows from Iraq and Afghanistan, have started a group called the American Widow Project. And it has grown and grown. They are trying to make sure that all the widows have more support, that they have someone to talk to that understands what they are going through, who has faced the same pain, confusion and anger that they have.

Their website has  DVDs,  phone numbers to be able to talk to someone, they go on trips, and most of all, they hold on to each other – even if it’s online.  Right now, the founder and President, Taryn Davis, is on a trip around the country, driving an RV with the names of the fallen on it, trying to meet with as many widows as she can. None of the bases or posts she has contacted have acknowledged her or her request to meet with chaplains and casualty officers.  I do hope that they will reconsider, or that perhaps these chaplains and casualty officers will be able to talk to this group in a different way

This is an amazing group of mostly young women, who are showing all of us their grace and fortitude, their love for their husbands, their love for each other.    I have to say, as an Army Wife and Army Mom – I’m so proud of these women.  Educating each other and more importantly, as one young widow said:

Stacey Markham was one of the first women to find her husband’s name, Sgt. Jonathan Markham, on the list. “It is amazing that everybody’s name is up there,” she said. “Wherever this RV is at, people will be reminded, not just, ‘Oh, we lost another soldier today, but look at all these families that have suffered this loss.

Honoring a Fallen Warrior, Writer and Blogger

H/tip to Milblogging.com.  We mourn the loss of a young man, who wrote a blog from Afghanistan.  In the story from Military.com, his mother reads from his journal for the family

“I know you don’t enjoy the path I have chosen for myself but trust me it’s so very rewarding,” she read. “You know I know it bothers you that I am here. … but what kind of person would I be, Ma, if I didn’t try to make this better.

“OK?” she said at the end. “That’s my son.”

That was a young man who cared, who made a difference, who will be missed, and that every mom would be proud of.

*********

March 23rd, 2009

Sgt. Christopher P. Abeyta, 23, of Midlothian, Illinois, was killed last week while serving in Afghanistan. Sgt. Abeyta and two other soldiers who were with him, Sgt. Robert M. Weinger and Spc. Norman Cain III, were also killed when the vehicle they were riding in was struck by an IED.

Sgt. Abeyta ran a military blog from Afghanistan called The Chronicles of Butters! and according to a news story Sgt. Ab eyta had kept a journal since he was 11-years old…

More here.

Duties That Are Best Shared – Go Read It!

In the Washington Post last week, Matthew Bogdanos, a Marine Corps reservist, shared a wonderful essay on the divide between the civilian and military worlds.  He writes eloquently about how military veterans (and their families) no longer have the sort of shared cultural and generational experiences like the World War II and even Vietnam generations did.  He reminds us:

As the British general Sir William Butler warned a century ago, “A nation that will insist upon drawing a broad line of demarcation between the fighting man and the thinking man is liable to find its fighting done by fools and its thinking done by cowards.”

Bogdanos goes on to say:

Without greater understanding between the military and civilian worlds or, better, a return to a synthesis of the two, we risk a future without all of us working toward the same ends — whatever society decides those ends should be. And we risk misusing military force because of misunderstandings about what it can and can’t do or, once used, its being prematurely withdrawn because of unrealistic expectations. The solution is an educated citizenry that understands its soldiers, sailors, airmen and Marines — understands that we are you.

Go read it.

One of the founders of Blue Star Families, Kathy Roth-Douquet, has a similar message in her book AWOL: The Unexcused Absence of America’s Upper Classes from Military Service – and How It Hurts Our Country, written with Frank Schaefer.  Our civilian leadership is truly hindered by its lack of experience with the military and its failure to understand military service.

The message that Bogdanos and Roth-Douquet and Schaeffer preach is the whole point behind Blue Star Families.  Our goal is to support military families by bridging that gap.  If you haven’t been to our new website to join and to take our military families survey, please do so.