Today marks the third day, or the 65.5th hour of my 72 hour juice fast and I feel incredible! It wasn't always a wonderful feeling, at times it was down right hell but I made it through the tough moments and feel better for it.
A few years ago Derrick and I attempted a week long juice fast, definitely not for the faint of heart. We lasted 4 and 5 days respectively and the results were fascinating. It had been a while and recently I have just let life take hold of my body. I realized I needed to take it back, I needed to regain control.
As I sit here sipping my cucumber juice (very refreshing btw) on this beautiful Friday morning I can tell you that Tuesday evening was the last meal I ate. A very yummy home grilled cheeseburger and mixed steamed veggies. I wasn't 100% that I was going to start my fast after that meal but looking back I'm so glad I did.
Wednesday morning I juiced a pineapple (huge mistake for me) and drank it all over the course of the morning and early afternoon. I LOVE pineapple but have a tendency to eat too much which causes my mouth to get numb and tingly. Magnify that times 10 and that was me by Wednesday afternoon. Aside from that I was really motivated, Mind you though, this was when Derrick was still at work and the kids were at school. I knew that after school snacks and dinner were soon to come and I was doing this fast solo. I made a trip to the commissary to get the fixins for Derrick's special spaghetti, which is not a favorite dish of mine. I thought it would ease my cravings for food.
No such luck! I took my tomato, celery, carrot, pear juice upstairs and sulked in my room with the beginnings of a killer headache. By the end of day one and through much of day two that's just something that's going to happen. Endurance though reaps the reward. The headache was caused by all of the toxins leaving my body.
Yesterday was even harder than Wednesday evening. I had a doctor appointment on one end of town and knew I was leaving there with at least one script, had to make a stop at a jeweler on the other side of town then had to run back to my pharmacy (inside Walmart) back across town before going home. Of course, the bulk of my running took place right around lunch time and I swear I passed EVERY stinking fast food restaurant in this town. Places that would never catch my attention did and oh how it sucked!
As we reviewed my lab results and vitals at the docs office I realized my fast was not going to be in vein. I thought I was doing well when I told my doc my blood pressure was down and I hadn't been taking my prescribed medication (because I didn't like the side effects). He then very tough lovingly told me that my 130/88 was still too high and that I was at a 2x greater risk of a heart attack or stroke than someone with a BP of 115/75. This being day two of my fast I can only imagine how high my blood pressure was on day one or even earlier.
The pharmacy was just around the corner so I wasn't bombarded with food distractions. I was in and out and just had to pop back in 45 minutes later to pick 'em up. Now off to the Jewelers to get Derrick's ring repaired. I had just finished a glass of mixed berry/orange juice I had made for the road and I was feeling good. Then I passed Taco Bell, Mc Donalds, Subway, Duncan Donuts, BK, Dairy Queen, Wendy's, quite possibly a Hardy's and maybe even a KFC in addition to all the Mexican restaurants that line just Hwy 17. On any other day I can tell you which places I would actually stop at: Subway and once in a while Taco Bell but yesterday EVERYTHING looked, and worse, smelled uh-may-zing! I made it down 17 without hitting a drive thru, though mind you I was fighting reason the whole time and now I am traveling down Western. I've past all the fast food and now I'm in land of the sit down joints. Ahh look it's Ruby Tues, Chili's Olive Garden, Cracker Barrel, O'Charlie's and then some. Will power where are you now?
In and out of the Jewelers quicker than expected so now I have time to kill as I make my way back to the pharmacy, back past each and every one of the torturous restaurants. I can't tell you where my will power came from because honestly I could probably list all the excuses I had in my head for why I just had to stop in at Wendy's to try their new Asiago Chicken Club- but I didn't. I kept on driving, hungry and now very grumpy. I made my way to the pharmacy with about 15 minutes to kill. I needed a few things for the house, one being butter so I have to walk past the amazing deli that I had never paid any attention to before and continue through the whole store just to grab some butter. Hunger pangs were killing me. I grabbed the other household stuff and made my way to the pharmacy. I watched as 4 techs walked around in what appeared to be circles all the while ignoring the fact that I was in line. What seems like an eternity passes and I'm hungry and now very grumpy too when a tech acknowledged my presence only long enough to tell me that it'll be another 15-20 minutes. I wonder if they saw the smoke coming out of my ears and the whole head spinning deal. I just left.
It was time for me to be home. I was in no mood to be out in public. One more mishap and I might have hurt a person. The feeling of hunger sucks. It makes me a very mean person and it took all I could to control myself. I came home and quickly learned the facebook has no room for me either. I had never noticed how much people talk about food on that darn site.
The rest of the day was full of struggles, the worst was dinner. Melanie has been my biggest cheerleader through this fast and to help out she cooked dinner last night. She threw together a great meal too: teriyaki chicken, steamed broccoli and mashed potatoes. My favorite- mashed potatoes :( This Irish girl loves her potatoes, not eating them, that was a huge test, and I passed. :)
I survived the first two days and woke up this morning feeling fantastic and ready to face day 3. The headache is long gone, I feel a sense of clarity and love the medical benefits of no sodium, processed foods or additional hormones/toxins from food have been washed from my body. I took a look at my blood pressure this morning and it looks even better today: 122/88. I still have a few more points to drop but it sure beats the 140s/90s it used to be. Another added bonus to my 3 day juice fast is the 7 pound weight loss. A few more hours and this fast will be a success!
*A side note for anyone thinking about doing a fast. Do your research. Know why you want to do it and make sure you have moral support. It is TOUGH but if you're doing it for the right reasons, have the dedication and support the reward is so worth the efforts.
Friday, February 18, 2011
Monday, February 14, 2011
When doing the right thing turns out to be the wrong, and oh how hit bites ya...
This blog is just a huge vent. Ignore, skip past or endure because you're just plain bored.
So, most or many of you know or have heard my backwards story about Derrick and I. It wasn't until The Real Housewives of DC that I heard something that summarized us in a nutshell. One of the cast members said she and her husband "met, fell in love, got married and had a baby... just not it that order." Well that's us perfectly.
In our backwardness I decided what I thought was right all things considered. I was in CA, he was in TX and we were far from the happily married couple we are today. Not in a million years did I expect that three and a half years later we'd be on speakng terms let alone getting married. Honestly, I didn't think I would ever speak to him again (on both our accords).
September 22, 1993 Melanie was born and I decided, to be fair to her and Derrick, that I would give her my last name. Fair to her because I didn't want her growing up wondering why she was different than the rest of the family that surrounded her, and fair to Derrick because I felt like he should have a say in giving his name to someone else.
Wow has this decision bit me in the ass time and time again.
(Now mom, if you're reading this I blame you for some of the run around I've gotten and don't you worry, I'll get to why in just a second.)
In 1997 we have our whirlwind craziness (I may have a blog about it, but you'll have to scroll a good long ways to find it) which included a wedding. Shortly after that I updated my drivers license with my new last name but I probably waited 2 years before legally changing my name through social security and for whatever reason, I didn't think to switch Melanie's at the time. It wasn't until we enrolled her in school that I realized my mistake.
I attempted to do what my mother had done when she married her second husband, she changed her last name and ours to her married name. I applied for a name change using the documents she had used. An original birth certificate and my marriage license. I assumed because Derrick is her biological father AND on the birth certificate that these documents would be enough. Apparently 10 years makes tons of difference. I was told that Derrick would need to adopt her, his own daughter, in order for her to take his name. We moved from CA to NC, deployments happened and happened again then we were in Okinawa (where more deployments ensued). Family legal issues like this are hard to do from there so we choose to wait until coming back. Now we're back.
I decided since it had been another almost ten years I'd give Social Security a call and see if anything had changed. Thirty plus minutes of being transferred put on hold and finally... SCORE! All is a go. Fill out an application and bring in previously mentioned documents and presto chango, we have a Cordova!
But we don't. We made the trek- an hour each way. Waited almost an hour and hit the same roadblock we'd hit before. Apparently the gentleman we spoke to was a little confused. So with a very emotional Melanie in tow we left the SSA building. It was devastating for her (and I). We were told it was a go, even in the office they told her she would be leaving a Cordova then in the last minute the woman changed her story. Melanie was so excited and for them to tell her it isn't going to happen, it broke my heart. Is it bad that that I got a little pleasure in the fact that her emotional breakdown made the woman at the SSA office teary too?
On the drive home we started making phone calls. The courthouse was a bit rude and base legal was ... well, base legal (you military folks know what I mean).
Another week and a half and we're finally starting to make some headway. Derrick does not need to adopt his own child but we do have to go through the courts to change her name. I had to laugh this morning when our lawyer explained the barbaric process we have to go through to do it but I guess in some wierd twisted North Carolina way it makes sense. So through the hurdles we will go and hopefully by the middle of March (if not sooner) we will have our newest Cordova. :)
It's got to happen, and soon! Melanie said in no way, no how is she going to boot camp as a...
Private Johnson
(they already teased her this past weekend about that while she was at MEPS.
*& as a side note, this is clearly not the only reason for the name change)
A cautionary note to all unwed pregnant women, save the hassle- give the baby his/her daddy's last name from the get go. The Lord only know's what your future may hold.
So, most or many of you know or have heard my backwards story about Derrick and I. It wasn't until The Real Housewives of DC that I heard something that summarized us in a nutshell. One of the cast members said she and her husband "met, fell in love, got married and had a baby... just not it that order." Well that's us perfectly.
In our backwardness I decided what I thought was right all things considered. I was in CA, he was in TX and we were far from the happily married couple we are today. Not in a million years did I expect that three and a half years later we'd be on speakng terms let alone getting married. Honestly, I didn't think I would ever speak to him again (on both our accords).
September 22, 1993 Melanie was born and I decided, to be fair to her and Derrick, that I would give her my last name. Fair to her because I didn't want her growing up wondering why she was different than the rest of the family that surrounded her, and fair to Derrick because I felt like he should have a say in giving his name to someone else.
Wow has this decision bit me in the ass time and time again.
(Now mom, if you're reading this I blame you for some of the run around I've gotten and don't you worry, I'll get to why in just a second.)
In 1997 we have our whirlwind craziness (I may have a blog about it, but you'll have to scroll a good long ways to find it) which included a wedding. Shortly after that I updated my drivers license with my new last name but I probably waited 2 years before legally changing my name through social security and for whatever reason, I didn't think to switch Melanie's at the time. It wasn't until we enrolled her in school that I realized my mistake.
I attempted to do what my mother had done when she married her second husband, she changed her last name and ours to her married name. I applied for a name change using the documents she had used. An original birth certificate and my marriage license. I assumed because Derrick is her biological father AND on the birth certificate that these documents would be enough. Apparently 10 years makes tons of difference. I was told that Derrick would need to adopt her, his own daughter, in order for her to take his name. We moved from CA to NC, deployments happened and happened again then we were in Okinawa (where more deployments ensued). Family legal issues like this are hard to do from there so we choose to wait until coming back. Now we're back.
I decided since it had been another almost ten years I'd give Social Security a call and see if anything had changed. Thirty plus minutes of being transferred put on hold and finally... SCORE! All is a go. Fill out an application and bring in previously mentioned documents and presto chango, we have a Cordova!
But we don't. We made the trek- an hour each way. Waited almost an hour and hit the same roadblock we'd hit before. Apparently the gentleman we spoke to was a little confused. So with a very emotional Melanie in tow we left the SSA building. It was devastating for her (and I). We were told it was a go, even in the office they told her she would be leaving a Cordova then in the last minute the woman changed her story. Melanie was so excited and for them to tell her it isn't going to happen, it broke my heart. Is it bad that that I got a little pleasure in the fact that her emotional breakdown made the woman at the SSA office teary too?
On the drive home we started making phone calls. The courthouse was a bit rude and base legal was ... well, base legal (you military folks know what I mean).
Another week and a half and we're finally starting to make some headway. Derrick does not need to adopt his own child but we do have to go through the courts to change her name. I had to laugh this morning when our lawyer explained the barbaric process we have to go through to do it but I guess in some wierd twisted North Carolina way it makes sense. So through the hurdles we will go and hopefully by the middle of March (if not sooner) we will have our newest Cordova. :)
It's got to happen, and soon! Melanie said in no way, no how is she going to boot camp as a...
Private Johnson
(they already teased her this past weekend about that while she was at MEPS.
*& as a side note, this is clearly not the only reason for the name change)
A cautionary note to all unwed pregnant women, save the hassle- give the baby his/her daddy's last name from the get go. The Lord only know's what your future may hold.
Friday, January 28, 2011
Isn't it crazy how time just flies?
I was looking through old photos today and had to pause for a minute when I came across this picture. This is Melanie at just a few days old with my grandfather, her great grandpa Tom.
I sat and thought about how quickly our children grow. This seems like it was just yesterday but really this is her, just yesterday.
Melanie, Sgt Rowan and a small glimpse of dad back in the corner.
This was her second meeting with him and in the few hours with him, that black book, an additional big ole binder and some plastic cards she started to make up her mind.
Sgt Rowan gave her ten goal cards. All you Marines out there, you know the cards. Each card has a goal that one might wish to attain while in the Marine Corps. The game is for the potential recruit to prioritize them, then see if mom and dad can replicate their childs goals. In the few months since our last meeting Melanie has grown and matured so much it was a little easier to pick her top goals this go round.This is what Melanie wants to get out of her service in the Marine Corps:
Something tells me she'll get it all.
By the end of the night Melanie was dubbed an 'honorary poolee" in the United States Marine Corps. To Derrick and I that's just a title to give her a little more motivation. What ever it is 'honorary' will be short lived. Next week she'll sign the paperwork that will allow her to head up to MEPS in Raliegh and soon after that she'll be an official no longer honorary "poolee". One step closer to Recruit!
I know so many of you have questions about why she's chosen to enlist and how we feel about her decision but I've decided to leave the meat and potatoes of that conversation out of this blog (there will be another coming). Just know that she's thought long and hard about this and we fully support her decision. She's a smart young lady and we're very proud.
Monday, January 24, 2011
Trading Recipes
We all love to share our favorite recipes for that amazingly yummy dish. Here's a recipe that is totally low cal, high stress but the prize more than makes up for it. Many of us already know the dish but I think at times we forget how great it is/we are.
Some of the following ingredients might need a little tweaking as duty and locations change.
Recipe for a Military Spouse
1 1/2 cup Patience
1 cup Courage
3/4 cup Tolerance
Dash of Adventure
1 lb of Ability
To the above ingredients: Add 2 tablespoons elbow grease, Let stand alone for one year, Marinante frequently with salty tears, Pour off excess fat, Sprinkle ever so lightly with money, Knead dough until payday, Season with international spices. Bake 20 years or until done. Makes unlimited servings.
SERVE WITH PRIDE
~Author unknown
PS. Thanks Gretchen for sharing. :)
Some of the following ingredients might need a little tweaking as duty and locations change.
Recipe for a Military Spouse
1 1/2 cup Patience
1 cup Courage
3/4 cup Tolerance
Dash of Adventure
1 lb of Ability
To the above ingredients: Add 2 tablespoons elbow grease, Let stand alone for one year, Marinante frequently with salty tears, Pour off excess fat, Sprinkle ever so lightly with money, Knead dough until payday, Season with international spices. Bake 20 years or until done. Makes unlimited servings.
SERVE WITH PRIDE
~Author unknown
PS. Thanks Gretchen for sharing. :)
Tuesday, January 18, 2011
Life is about compromise
So is love. Compromise, compassion and communication. That's what I've learned through the years. And the one constant certainty as we are preparing for our first retirement. What we'll do and where we end up...
More on this at a later date.
More on this at a later date.
Saturday, January 1, 2011
MD in May or stay?
That is the question.
Looking back to my high school graduation I remember there being all this hype, but for what? A bunch of home schooled kids to walk the stage of the high school none of us attended among our "peers" though strangers to one and other. Then to top it, the cassette (really, I am not that old) that was supposed to play the graduation march was never rewound from the previous year so when they hit play it was at end which left us without music for any part of the ceremony. Aside from knowing that busting my butt working as my teacher and the student, pushing to graduate almost a year and a half early was over and physically receiving my diploma the ceremony was a bust.
So now,16 years later (wow,I just realized how long it's been) I am at nearly the same place. With my university based in Maryland, my professors scattered across the world and me for 90% of my schooling it was online in Japan. I don't know the campus, have never physically met an instructor, administrator or a huge majority of my fellow classmates for that matter, so do I make the 6-7 hour trek to a place I've never been to be among people I do not know for one little ceremony?
I would have to pull the kids out of school early on Friday so we could be there for the morning ceremony. We'd be lucky to have the rest of the afternoon and some of Sunday morning before hitting the road for our trek back home. Not to mention having to take time off work for this weekend (oh yeah, I got a job-start on Thursday).
So the question is, is it worth the craziness of a whirlwind, barely two day trip to MD just to throw on a cap and gown and pick up my degree? Thoughts and opinions please.
Looking back to my high school graduation I remember there being all this hype, but for what? A bunch of home schooled kids to walk the stage of the high school none of us attended among our "peers" though strangers to one and other. Then to top it, the cassette (really, I am not that old) that was supposed to play the graduation march was never rewound from the previous year so when they hit play it was at end which left us without music for any part of the ceremony. Aside from knowing that busting my butt working as my teacher and the student, pushing to graduate almost a year and a half early was over and physically receiving my diploma the ceremony was a bust.
So now,16 years later (wow,I just realized how long it's been) I am at nearly the same place. With my university based in Maryland, my professors scattered across the world and me for 90% of my schooling it was online in Japan. I don't know the campus, have never physically met an instructor, administrator or a huge majority of my fellow classmates for that matter, so do I make the 6-7 hour trek to a place I've never been to be among people I do not know for one little ceremony?
I would have to pull the kids out of school early on Friday so we could be there for the morning ceremony. We'd be lucky to have the rest of the afternoon and some of Sunday morning before hitting the road for our trek back home. Not to mention having to take time off work for this weekend (oh yeah, I got a job-start on Thursday).
So the question is, is it worth the craziness of a whirlwind, barely two day trip to MD just to throw on a cap and gown and pick up my degree? Thoughts and opinions please.
Sunday, August 15, 2010
I don't usually do this...
...and you don't have to read it but I'm kind of excited about this one. My first paper where I was able to use a real bookstore (thank you B&N) and a topic that is so close to me (and so many of you) personally. I guess that personal investment really paid off, I aced it!
I used several great books as references, some might seem like a bit of 'psycho babble' to the everyday reader but others are very reader friendly and focus on military families and/or their returning service member. If you'd like the titles let me know. I highly suggest them for anyone who has been stationed in/near combat zones.
**I can't imagine any of my friend/family readers would try to plagiarize my paper but for anyone who stumbles across this paper and tries, know it will be caught on any plagiarism site your professor runs it through**
Life After Deployment
Living through a combat deployment may be the most stressful situation that a service member can go through but learning to live again after returning home can be a daunting task as well. We see and hear on the news accounts of service members struggling through adjustment issues when returning home after serving an extended period in combat environments; and as recently as today a post deployment health story made headlines. Though, this particular account was of a military working dog who now suffers from post traumatic stress disorder (PTSD) after serving as a bomb sniffing dog in Iraq (Elliot, 2010). While some debate the idea that animals can suffer combat stress reactions (CSRs), this story contributes to the level of incidence of combat stress injuries that occur as result of serving in hostile environments.
Most service members returning home from combat situations will have a period of readjustment that they and/or their families notice and consider disruptive to daily life. This period of readjusting can be short lived, a couple weeks or last up to a year. While many service members that serve in combat environments return home with only minimal adjustment issues as many as 30% of Vietnam veterans have had, or currently suffer with PTSD; veterans of Operation Desert Shield/Storm had an incidence rate of about 10.1%; veterans from the Somalia and Bosnia conflicts had an 8% incidence rate, and currently with the conflict in Iraq and Afghanistan have an incidence rate between 6.2% and 12.9% (Kennedy and Zillmer, 2006). With occurrences of combat stress reactions at these levels extensive research has been, and is currently being done to identify signs and symptoms of combat stress injuries during, and after returning from a deployment, as well as ways to alleviate symptoms allowing for affected service members to transition more smoothly into non-combat environments.
While serving in theater one might be shot at or be witness to the death of a friend, fellow service member, innocent civilian men, women and/or children, and even hostile combatants. Exposure to improvised explosive devices (IEDs), mine and bomb blasts, excessive weaponry, accidents, the constant state of alertness required while in combat environments and even the unfamiliar setting and culture in the combat location can initiate war zone stress reactions also known as combat or acute stress reactions (Sloan and Friedman, 2008).
Combat stress reactions can show up in the form of sleep disturbances, insomnia, restless sleep or nightmares, trembling or shaking, anger or aggression, shortness of breath, heavy chest, dizziness, pounding heart, elevated pulse or blood pressure, nausea, constipation, diarrhea, head or back aches, blurred vision, feelings that no one can relate or understand what you’ve been through or feeling like you’re either hyper vigilant (always alert) or have a delayed startle reaction. Further symptoms can include inattentiveness, memory loss, difficulty reasoning or faulty judgment, loss of hope, flashbacks, delusions or hallucinations (Kennedy and Zillmer, 2006; Slone and Friedman, 2008).
Due to the unnatural events that service members are faced with while forward deployed and the possible ramifications each could face, each branch of service has implemented a system for use during demobilization in hopes of informing service members of what to expect and/or to watch for in themselves and their comrades. During this demobilization process a post deployment heath assessment (PDHA) is conducted to determine post deployment health and to serve as a baseline for a future PDHA that will take place three to six months after returning home from deployment (Kennedy and Zillmer, 2006).
Colonel Carl Castro, PhD and colleagues created the ‘BATTLEMIND’ approach for the US Army at Walter Reed Army Institute of Research. It is utilized during their demobilization process and can be readdressed as needed through brochures, power point presentations and online. The word BATTLEMIND is an acronym that differentiates mental skills used for survival in combat situations but can be problematic if carried over in to day-to-day living. “B” stands for buddies (cohesion) vs. withdrawal; “A” is for accountability vs. controlling; the first “T” for targeted vs. inappropriate aggression; the second “T” represents tactical awareness vs. hyper vigilance; “L” is for lethally armed vs. locked and loaded; “E” stands for emotional control vs. detachment; “M” is for mission operational security vs. secretiveness; “I” represents individual responsibility vs. guilt; “N” stands for non-defensive driving (combat) vs. aggressive driving and the “D” stands for discipline and ordering vs. conflict (Sloan and Friedman, 2006).
In addition to the demobilization BATTLEMIND for service members, the Army has created a BATTLEMIND for loved ones that aims to increase resilience and smooth the integration process. For loved ones the acronym BATTLEMIND stand for Buddies (social support), Adding/subtracting from family roles, Taking control, Talking it out, Loyalty and commitment, Emotional balance, Mental health and readiness, Independence, Navigating the Army (military) system and Denial of the self (Self Sacrifice) (Sloan and Friedman, 2006). Understanding how and being able to mesh both BATTLEMINDs together can help the post deployment transition for the affected service member and his/her family alike.
Reactions to combat stress are normal and in many cases can be reduced through simple techniques and coping strategies, alone or with loved ones; though in some cases a greater intervention is required. Armstrong, Best and Domenici (2006) suggest using relaxation drills where you recall and focus on positive events that occurred while deployed. In addition to the positive thoughts, focused breathing techniques and forced flex and relaxation of muscle groups helps reverse the “fight-or-flight” response. One simple thing many service members forget is that it takes time to adjust to a post deployment mentality. In addition, service members should ease into pre-deployment routines like drinking, as it can intensify emotions or fears, or driving due to different driving styles in combat/civilian life. They are encouraged to reconnect with their social support and talk about their deployment experiences; if not with family or peers, then with a chaplain or counselor (Sloan and Friedman, 2008).
If CSRs continue for more than six to eight weeks, intensify with time, with specific circumstances or begin to interfere with personal or work life to the extent that basic functioning is hindered help from an outside source is recommended (Armstrong, Best and Domenici, 2006; Sloan and Friedman, 2008). Persistent reactions if left untreated can turn into PTSD, depression or other mental health problems (Sloan and Friedman, 2008).
Once a service member realizes either on their own, as result of a PDHA, through the demobilization process or with administrative initiative that his/her transition from combat to normal life is not progressing or if there is an intensification of combat stress reactions an intervention needs to occur. He or she should meet with their primary care physician (PCP) to discuss any physical or mental concerns and combat stress reactions that they have noticed since returning from combat. While at this appointment the service member should inform the doctor of any medications they are taking, be honest about any alcohol or illicit drug use if any, and if comfortable, discuss their wartime experiences and how they feel they are affecting them (Armstrong, Best and Domenici, 2006; Slone and Friedman, 2008). By making the initial step with a PCP, the physician can listen to the service members concerns and if he/she and/or the physician feel that symptoms suggest a diagnosis of PTSD then a Primary Care PTSD Screen (PC-PTSD) can be conducted. The PC-PTSD is a brief, problem focused survey that does not diagnose but rules out or supports that further assessments are necessary. From there, the PCP can either initiate a regular medical treatment plan or refer the service member to a psychologist, social worker or Veterans Center (Slone and Friedman, 2008).
At the initial meeting with a behavioral or mental health provider an assessment is conducted. Along with talking with the service member the counselor may give a written survey or verbally conduct an interview to assist in the diagnosis (Slone and Friedman, 2008). A diagnosis of PTSD comes with very rigid guidelines and is considered acute if the duration of symptoms is less than three months, chronic if the duration lasts three months or more or delayed onset if the symptoms begin to occur six or more months after the trauma has occurred (Grossman, 2008). In order to meet the criteria for PTSD one must have a history of exposure to one or more traumatic events that involve actual or threatened death or serious injury, or a threat to the physical integrity to oneself or others and has a response of intense fear, helplessness, or horror. In addition they must suffer from at least two symptoms (three for avoidant/numbing) from the following criterion: intrusive recollection, avoidant/numbing and hyper-arousal.
“Intrusive recollection, the traumatic event is persistently re-experienced in: Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; Recurrent distressing dreams of the event; Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated); Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and/or Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Avoidant/numbing, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: Efforts to avoid thoughts, feelings, or conversations associated with the trauma; Efforts to avoid activities, places, or people that arouse recollections of the trauma; Inability to recall an important aspect of the trauma; Markedly diminished interest or participation in significant activities; Feeling of detachment or estrangement from others; Restricted range of affect (e.g., unable to have loving feelings); Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).
Hyper-arousal, Persistent symptoms of increasing arousal (not present before the trauma): Difficulty falling or staying asleep; Irritability or outbursts of anger; Difficulty concentrating; Hyper-vigilance; Exaggerated startle response” (APA, 2000).
Once a clear diagnosis is made the road to recovery can truly begin. The mental health provider will discuss in depth what PTSD is and how it will affect the service member and his/her co workers and loved ones. From there, patient and provider work together to set short and long term goals while mapping out the intended treatment. Treatment can consists solely of talk therapies and medications but often require more in depth teamwork between the patient and provider (Slone and Friedman, 2008).
Treatment may consist of group or individual therapy. With group therapy participants create bonds with others who have experienced similar traumatic experiences and from an individual’s experiences others in the group learn techniques to apply in their lives. Individual therapy can be administered through Cognitive Behavior Therapy (CBT), Cognitive Processing Therapy (CPT) or Exposure Therapy. CBT is the most effective choice of treatment for PTSD as it works with an individual’s thoughts in order to change their emotions, thoughts and behaviors. CPT enables the patient to indentify and examine trauma related thought patterns through cognitive restructuring and encourages replacing those thoughts with balanced and accurate ones. Exposure therapy involves controlled exposure to detailed images that instigate the fear and distress caused by the initial trauma and the memories triggered by the trauma. This process can be effective in disconnecting the memory from the associated fear and/or distress (Slone and Friedman, 2008).
Many people believe a person should avoid events, locations or situations where triggers occur but avoidance like this only reinforces PTSD symptoms because the sufferer fails to learn that these situations are only triggers to uncomfortable memories but are not in any real physical danger (Armstrong, Best and Domenici, 2006). Because of this theory, providers may offer coping techniques in situation avoidance. An example of such coping would be for the service member to write a list of all triggers – people, places and situations and rank them according to the level of stress they invoke. Create another list of ways to reward yourself after tackling a trigger. On a day where you have no other commitments plan to face the least stressful situation. While doing this you might need to resort to breathing and relaxation techniques but upon completion of the challenge, reward yourself with something from your rewards list (Armstrong, Best and Domenici, 2006).
Providers might also offer coping mechanisms for combating panic or unwanted images or memories. They may suggest specific exercises to do when overwhelmed and to pay attention to your “red flag” moments. At those times, the exercises and techniques provided will help calm tense conditions (Armstrong, Best and Domenici, 2006).
Once the service members understands PTSD and the role it plays in his/her life and has the strategies and coping mechanisms in place to combat stressors the only thing left is to heal and reintegrate into their military unit. Kennedy and Zillmer (2006) stated, “Combat stress reactions are normal responses to extremely abnormal conditions.” Even though symptoms may still present themselves, the natural social support within a military unit helps alleviate the perceived threat and increases the service members perception of personal health and well being as well as normalizing reactions (Kennedy and Zillmer, 2006).
Whether the CSRs are minimal and short lived or progress into PTSD or other emotional or anxiety disorders, knowing the signs and symptoms, seeking help when needed and maintaining a sense of belonging and camaraderie between the affected service member and his/her unit can make a world of difference in the recovery process.
I used several great books as references, some might seem like a bit of 'psycho babble' to the everyday reader but others are very reader friendly and focus on military families and/or their returning service member. If you'd like the titles let me know. I highly suggest them for anyone who has been stationed in/near combat zones.
**I can't imagine any of my friend/family readers would try to plagiarize my paper but for anyone who stumbles across this paper and tries, know it will be caught on any plagiarism site your professor runs it through**
Life After Deployment
Living through a combat deployment may be the most stressful situation that a service member can go through but learning to live again after returning home can be a daunting task as well. We see and hear on the news accounts of service members struggling through adjustment issues when returning home after serving an extended period in combat environments; and as recently as today a post deployment health story made headlines. Though, this particular account was of a military working dog who now suffers from post traumatic stress disorder (PTSD) after serving as a bomb sniffing dog in Iraq (Elliot, 2010). While some debate the idea that animals can suffer combat stress reactions (CSRs), this story contributes to the level of incidence of combat stress injuries that occur as result of serving in hostile environments.
Most service members returning home from combat situations will have a period of readjustment that they and/or their families notice and consider disruptive to daily life. This period of readjusting can be short lived, a couple weeks or last up to a year. While many service members that serve in combat environments return home with only minimal adjustment issues as many as 30% of Vietnam veterans have had, or currently suffer with PTSD; veterans of Operation Desert Shield/Storm had an incidence rate of about 10.1%; veterans from the Somalia and Bosnia conflicts had an 8% incidence rate, and currently with the conflict in Iraq and Afghanistan have an incidence rate between 6.2% and 12.9% (Kennedy and Zillmer, 2006). With occurrences of combat stress reactions at these levels extensive research has been, and is currently being done to identify signs and symptoms of combat stress injuries during, and after returning from a deployment, as well as ways to alleviate symptoms allowing for affected service members to transition more smoothly into non-combat environments.
While serving in theater one might be shot at or be witness to the death of a friend, fellow service member, innocent civilian men, women and/or children, and even hostile combatants. Exposure to improvised explosive devices (IEDs), mine and bomb blasts, excessive weaponry, accidents, the constant state of alertness required while in combat environments and even the unfamiliar setting and culture in the combat location can initiate war zone stress reactions also known as combat or acute stress reactions (Sloan and Friedman, 2008).
Combat stress reactions can show up in the form of sleep disturbances, insomnia, restless sleep or nightmares, trembling or shaking, anger or aggression, shortness of breath, heavy chest, dizziness, pounding heart, elevated pulse or blood pressure, nausea, constipation, diarrhea, head or back aches, blurred vision, feelings that no one can relate or understand what you’ve been through or feeling like you’re either hyper vigilant (always alert) or have a delayed startle reaction. Further symptoms can include inattentiveness, memory loss, difficulty reasoning or faulty judgment, loss of hope, flashbacks, delusions or hallucinations (Kennedy and Zillmer, 2006; Slone and Friedman, 2008).
Due to the unnatural events that service members are faced with while forward deployed and the possible ramifications each could face, each branch of service has implemented a system for use during demobilization in hopes of informing service members of what to expect and/or to watch for in themselves and their comrades. During this demobilization process a post deployment heath assessment (PDHA) is conducted to determine post deployment health and to serve as a baseline for a future PDHA that will take place three to six months after returning home from deployment (Kennedy and Zillmer, 2006).
Colonel Carl Castro, PhD and colleagues created the ‘BATTLEMIND’ approach for the US Army at Walter Reed Army Institute of Research. It is utilized during their demobilization process and can be readdressed as needed through brochures, power point presentations and online. The word BATTLEMIND is an acronym that differentiates mental skills used for survival in combat situations but can be problematic if carried over in to day-to-day living. “B” stands for buddies (cohesion) vs. withdrawal; “A” is for accountability vs. controlling; the first “T” for targeted vs. inappropriate aggression; the second “T” represents tactical awareness vs. hyper vigilance; “L” is for lethally armed vs. locked and loaded; “E” stands for emotional control vs. detachment; “M” is for mission operational security vs. secretiveness; “I” represents individual responsibility vs. guilt; “N” stands for non-defensive driving (combat) vs. aggressive driving and the “D” stands for discipline and ordering vs. conflict (Sloan and Friedman, 2006).
In addition to the demobilization BATTLEMIND for service members, the Army has created a BATTLEMIND for loved ones that aims to increase resilience and smooth the integration process. For loved ones the acronym BATTLEMIND stand for Buddies (social support), Adding/subtracting from family roles, Taking control, Talking it out, Loyalty and commitment, Emotional balance, Mental health and readiness, Independence, Navigating the Army (military) system and Denial of the self (Self Sacrifice) (Sloan and Friedman, 2006). Understanding how and being able to mesh both BATTLEMINDs together can help the post deployment transition for the affected service member and his/her family alike.
Reactions to combat stress are normal and in many cases can be reduced through simple techniques and coping strategies, alone or with loved ones; though in some cases a greater intervention is required. Armstrong, Best and Domenici (2006) suggest using relaxation drills where you recall and focus on positive events that occurred while deployed. In addition to the positive thoughts, focused breathing techniques and forced flex and relaxation of muscle groups helps reverse the “fight-or-flight” response. One simple thing many service members forget is that it takes time to adjust to a post deployment mentality. In addition, service members should ease into pre-deployment routines like drinking, as it can intensify emotions or fears, or driving due to different driving styles in combat/civilian life. They are encouraged to reconnect with their social support and talk about their deployment experiences; if not with family or peers, then with a chaplain or counselor (Sloan and Friedman, 2008).
If CSRs continue for more than six to eight weeks, intensify with time, with specific circumstances or begin to interfere with personal or work life to the extent that basic functioning is hindered help from an outside source is recommended (Armstrong, Best and Domenici, 2006; Sloan and Friedman, 2008). Persistent reactions if left untreated can turn into PTSD, depression or other mental health problems (Sloan and Friedman, 2008).
Once a service member realizes either on their own, as result of a PDHA, through the demobilization process or with administrative initiative that his/her transition from combat to normal life is not progressing or if there is an intensification of combat stress reactions an intervention needs to occur. He or she should meet with their primary care physician (PCP) to discuss any physical or mental concerns and combat stress reactions that they have noticed since returning from combat. While at this appointment the service member should inform the doctor of any medications they are taking, be honest about any alcohol or illicit drug use if any, and if comfortable, discuss their wartime experiences and how they feel they are affecting them (Armstrong, Best and Domenici, 2006; Slone and Friedman, 2008). By making the initial step with a PCP, the physician can listen to the service members concerns and if he/she and/or the physician feel that symptoms suggest a diagnosis of PTSD then a Primary Care PTSD Screen (PC-PTSD) can be conducted. The PC-PTSD is a brief, problem focused survey that does not diagnose but rules out or supports that further assessments are necessary. From there, the PCP can either initiate a regular medical treatment plan or refer the service member to a psychologist, social worker or Veterans Center (Slone and Friedman, 2008).
At the initial meeting with a behavioral or mental health provider an assessment is conducted. Along with talking with the service member the counselor may give a written survey or verbally conduct an interview to assist in the diagnosis (Slone and Friedman, 2008). A diagnosis of PTSD comes with very rigid guidelines and is considered acute if the duration of symptoms is less than three months, chronic if the duration lasts three months or more or delayed onset if the symptoms begin to occur six or more months after the trauma has occurred (Grossman, 2008). In order to meet the criteria for PTSD one must have a history of exposure to one or more traumatic events that involve actual or threatened death or serious injury, or a threat to the physical integrity to oneself or others and has a response of intense fear, helplessness, or horror. In addition they must suffer from at least two symptoms (three for avoidant/numbing) from the following criterion: intrusive recollection, avoidant/numbing and hyper-arousal.
“Intrusive recollection, the traumatic event is persistently re-experienced in: Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; Recurrent distressing dreams of the event; Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated); Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and/or Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Avoidant/numbing, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: Efforts to avoid thoughts, feelings, or conversations associated with the trauma; Efforts to avoid activities, places, or people that arouse recollections of the trauma; Inability to recall an important aspect of the trauma; Markedly diminished interest or participation in significant activities; Feeling of detachment or estrangement from others; Restricted range of affect (e.g., unable to have loving feelings); Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).
Hyper-arousal, Persistent symptoms of increasing arousal (not present before the trauma): Difficulty falling or staying asleep; Irritability or outbursts of anger; Difficulty concentrating; Hyper-vigilance; Exaggerated startle response” (APA, 2000).
Once a clear diagnosis is made the road to recovery can truly begin. The mental health provider will discuss in depth what PTSD is and how it will affect the service member and his/her co workers and loved ones. From there, patient and provider work together to set short and long term goals while mapping out the intended treatment. Treatment can consists solely of talk therapies and medications but often require more in depth teamwork between the patient and provider (Slone and Friedman, 2008).
Treatment may consist of group or individual therapy. With group therapy participants create bonds with others who have experienced similar traumatic experiences and from an individual’s experiences others in the group learn techniques to apply in their lives. Individual therapy can be administered through Cognitive Behavior Therapy (CBT), Cognitive Processing Therapy (CPT) or Exposure Therapy. CBT is the most effective choice of treatment for PTSD as it works with an individual’s thoughts in order to change their emotions, thoughts and behaviors. CPT enables the patient to indentify and examine trauma related thought patterns through cognitive restructuring and encourages replacing those thoughts with balanced and accurate ones. Exposure therapy involves controlled exposure to detailed images that instigate the fear and distress caused by the initial trauma and the memories triggered by the trauma. This process can be effective in disconnecting the memory from the associated fear and/or distress (Slone and Friedman, 2008).
Many people believe a person should avoid events, locations or situations where triggers occur but avoidance like this only reinforces PTSD symptoms because the sufferer fails to learn that these situations are only triggers to uncomfortable memories but are not in any real physical danger (Armstrong, Best and Domenici, 2006). Because of this theory, providers may offer coping techniques in situation avoidance. An example of such coping would be for the service member to write a list of all triggers – people, places and situations and rank them according to the level of stress they invoke. Create another list of ways to reward yourself after tackling a trigger. On a day where you have no other commitments plan to face the least stressful situation. While doing this you might need to resort to breathing and relaxation techniques but upon completion of the challenge, reward yourself with something from your rewards list (Armstrong, Best and Domenici, 2006).
Providers might also offer coping mechanisms for combating panic or unwanted images or memories. They may suggest specific exercises to do when overwhelmed and to pay attention to your “red flag” moments. At those times, the exercises and techniques provided will help calm tense conditions (Armstrong, Best and Domenici, 2006).
Once the service members understands PTSD and the role it plays in his/her life and has the strategies and coping mechanisms in place to combat stressors the only thing left is to heal and reintegrate into their military unit. Kennedy and Zillmer (2006) stated, “Combat stress reactions are normal responses to extremely abnormal conditions.” Even though symptoms may still present themselves, the natural social support within a military unit helps alleviate the perceived threat and increases the service members perception of personal health and well being as well as normalizing reactions (Kennedy and Zillmer, 2006).
Whether the CSRs are minimal and short lived or progress into PTSD or other emotional or anxiety disorders, knowing the signs and symptoms, seeking help when needed and maintaining a sense of belonging and camaraderie between the affected service member and his/her unit can make a world of difference in the recovery process.
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