Our Lives With Post Traumatic Stress Disorder and Traumatic Brain Injury

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PTSD affects first responders; one man’s story

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Melissa Maher, ACB, ALB:

PTSD doesn’t only effect combat veterans, it can effect first responders (fire, police, ems, etc), as well as civilians, even children.

Originally posted on KWQC-TV6:

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QUAD CITIES, Ill. (KWQC) – We hear a lot about Post Traumatic Stress Disorder in the military, for combat veterans who have been on the front lines. But first responders are on the front lines in our communities. And while statistics vary, several studies show more than 30% of firefighters and police officers may have PTSD. For some of them, a traumatic event that happened years ago can feel like it happened just yesterday.

Nearly seven years ago, many of us watched it unfold on TV. Chaos in the streets of East Moline. But today, one man is still living it. Sgt. Tom Peterson was on duty as officers tried to serve a warrant to Kelton Trice at a local park. But Trice fought them off, and took off, firing at police. Peterson found the 21-year old minutes later in an alley. “We both have our guns drawn…

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4th of July

070811_1913~01     I finally did it! After eleven long years, I finally attended a fireworks display with my kids! Guess what?! I survived not only the fireworks, but navigating the crowds with three little ones…by myself!

 

All in all, I actually enjoyed myself! The girls were able to play on the bouncy houses, get their face painted, and even stood in line for patriotically over-priced snow cones! The girls were able to get those twisted balloon things that end up being made into all kinds of things (one had an alien that rode on her shoulders, one had a sword, and one had a flower). Granted, none of the balloon characters made it home, but they were free, so I wasn’t terribly heart broken (especially since I’m allergic to the stupid things).

I had originally decided to attend because my teen invited me. I figured with her there, I’d be able to get through the fireworks. Well, she went AWOL with her friends and I only saw her once the entire evening. Thankfully, my best friend and her family showed up just minutes before the show started. Between her and Chauncey, they got me through. I purposely sat far enough away that I couldn’t hear them launching, and I enjoyed all but the absolutely largest shells. Those were the ones that I could feel the repercussion of their explosion in my chest and that would trigger me, but as I said, my service dog Chauncey (who did amazingly well with the fireworks) and my best friend saw me through.

I definitely think we will do it again next year. Perhaps I will be able to convince a couple of my fellow veterans to attend with me. Just showing up was a huge step for me and I hope I can share that with others next year.

Moral of this story: don’t be afraid to face your fears…you may be pleasantly surprised at the results. If they aren’t what you expected them to be, you will at least know that you tried. Perform an after action and see if there is anything you could do differently next time to improve the outcome!

 


Neurobiology of PTSD

Recently, I read “Neurobiology of PTSD” from Psychiatric Times (March 1, 2008) by John Medina, PhD. Below is a review (of sorts) of this article:

The search for a biological basis of Post-Traumatic Stress Disorder (PTSD), the study for the root cause is still relatively in its infancy. Psychologists are looking at the question of Nature vs. Nurture for a potential source.

There have been studies regarding whether PTSD can be explained by pre-existing conditions, thereby making it an issue of Nature (genetics) using monozygotic twins. Both showed an “alteration in hippocampal volume and morphology”. Though only one was exposed to “intensely stressful events (combat)”. Was this a pre-existing condition (nature) or a physiological change due to the stressor (nurture)?

This line of inquiry led researchers to look beyond the average member of the group and compared to the population distributions. Instead they began to focus on those animals that were at the opposite ends of the population spectrum. They began to study those who were appearing to recover much more quickly than the population from ‘fear extinction experiments’ and compared them to those at the opposite end of the distributions, the overly-reactive population. In doing so, scientists were able to identify two phenotypes within the overly-reactive population. These phenotypes are currently being researched in animals.

Some researchers are focusing on “certain regions of the mammalian genome [consisting] of short, repeated, noncoding sequences called VNTR’s (Variable Number Terminal Repeat), attempting to identify whether these variations could hold the key to how PTSD could be inherited through chromosomal sequences. One study found a VNTR variant in patients who experienced PTSD. Other studies have looked for associations between gene mutations in the glucocorticoid receptor and PTSD, others have focused serotonin receptors.

There are also arguments about how much ‘nurture’ plays a role in the development of PTSD after a traumatic event. There are questions of whether the physiological changes that have been demonstrated with PTSD are epigenetic or hereditary. Are they a physiological reaction to trauma or a pre-existing genetic mutation that predisposes a person to develop PTSD? Epigenetic studies have explored how much nuture effects development of the ability to regulate stress. Researchers have shown that environmental influences can cause “permanent alterations in hippocampal glucocorticoid receptor expression and subsequent hypothalamic-pituitary-adrenal axis”. This issue is currently the source of intensive research.

Not all studies are in agreement, however. There are theories of “methylation” and its molecular effects on genes. Hippocampal volume has also been studies; however, it is known to be able to change “as a result of environmental exposure, duration of certain illness, and even the age of the subject:. Also, it has been shown that hippocampal volume changes are not consistently shown in all age groups. While it can be present in younger patients, it is not generally associated with older patients.

Is PTSD genetic or environmental? Could it be both? The studies, while in their infancy, don’t seem to universally come to a singular answer. How do twins both show physiological changes with PTSD, though only one was exposed to trauma? That would be ‘nature’. Yet, how is it that who people can experience the same trauma but only one goes on to develop PTSD? From the things I have read, I am beginning to believe it is both. There has to be some genetic element to cause the physiological changes that have been documented to occur with PTSD. Yet, you cannot discount the influence of ‘nature’. Individuals who experience multiple traumas throughout their lives are more likely to develop PTSD than those whose lives were sheltered from trauma. Having personally experienced multiple traumas, I developed PTSD. Others who deploed with me, who experienced the same elements of combat but did not have the previous lifetime traumas, did not develop PTSD. Yet, for how little I experienced in compareson to other combat veteran, how did I develop PTSD, when others who experienced much worse and emerged apparently unscathed?


Memory Issues Related to PTSD

Brain There have been many studies related to memory issues related to Post Traumatic Stress Disorder. This particular study, a literature review by Kirstin W. Samuelson entitled: “Post-traumatic stress disorder and declarative memory functioning: a review” looks at the association between “everyday memory problems with emotionally neutral material”.

Studies have shown that many PTSD patients complain of memory problems, aside from those symptoms that are part of the diagnostic criteria (intrusive thoughts, difficulty remembering parts of the trauma, etc.). This study focuses on declarative memory – that is memories that can be consciously recalled, like facts and knowledge. This type of memory can be broken down into two aspects: semantic memory which stores factual information and episodic memory which includes specific personal experiences.

The author notes “It should be emphasized that overall, decrements in memory performance due to PTSD are subtle, […] still, the findings are clinically meaningful when they represent a change in functioning before and after trauma”. She goes on to say that “the pattern of memory deficits reveal that PTSD most significantly impacts the initial acquisition and learning phases of memory, as opposed to the retention phase”.

In plain English this is a great big “duh!” to those of us with PTSD. We deal with this every day. We forget the simple things, we give up on school because learning seems so much harder than it used to be before…before our world changed. Things that once seemed a piece of cake are now complicated and hard to remember.


A Little Tassel

We’ve been busy… Chauncey and I just finished our Associates Degree and now we’re taking the summer off to recharged fortassel university this fall! Its amazing to me…other than military schools, I have never had the pomp and circumstance commencement thing.

I will readily admit that I over did it this semester. I took 18 credit hours trying to get my degree finished. This was on top of my other life responsibilities like parenting four children and taking care of a household…and Toastmasters, of course. By the end of the semester, I had to stop attending Toastmasters to focus on my classes and everything else suffered too. Unfortunately, when you have PTSD multi-tasking becomes a lot more challenging. Remembering what is due, when, in which class, which kid has a parent-teacher meeting, take out something for dinner, write a speech, write a paper, read… yea right! I had myself so overwhelmed that I was forgetting assignments and I couldn’t read more than a paragraph at a time without forgetting everything I had just read. Needless to say, we will NOT be doing that again!

Now that we are finished with this semester, Chauncey and I are trying to regroup, recharge, and redeploy to our next mission. I am looking forward to relaxing, reading something because I *want* to, and reconnecting with my Toastmasters friends (something that I really do find relaxing, oddly enough). I will be refocusing this summer and sharing some of the research I’ve done hassleover this last semester regarding PTSD’s physiological and psychological effects.

Its amazing how much something as simple as a little tassel can mean. When you go from being terrified to interact with another human outside your house to earning a degree at age…well…we’ll just say I was one of the more mature students!

Stay tuned! I’ll be sharing lost of information very soon!

By the way…we graduated Cum Laude!


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I Survived. My fight against PTSD.

I am a 40 year old mother, wife, and disabled veteran of the US Army. It has taken me a long time to get to the point where I could share this story. This may be triggering for some, and I apologize, but it is something I need to get out of my head.

 medcorpsI was a medic in the Army, as such, while I never had to pull the trigger; I had to see the aftermath of war. It didn’t matter what side they were on out there…once they came through the doors of our hospital, we had to treat them all the same. It didn’t matter whether they were combatants, innocent bystanders or children who were caught in the crossfire, when they came through our doors, they were a patient. Period.  It’s the children who stay with me. I can still see their sweet faces, along with all the medical accoutrements that were needed for their individual medical needs. They have never aged. In my mind they are still the same now as they were then…sweet, innocent, and in need of our help. For all the varying opinions of what we were doing in Iraq and why, the one thing I can say is that I made a positive difference. I did my best to harm none and other than one altercation (with another soldier), I never laid an angry hand on another person.

 

I have friendships that have lasted till this very day. We have become sisters. We have been through so much together and have helped each other become stronger in the process. They are the reason that I will never regret my service. It is the hardest thing I have ever done, the one accomplishment of which I am the most proud….but the one thing I will never do again (even if I were physically able).

 

The reason I would never serve again is simple…the culture which permeates throughout the entire military complex is one in which women are objects. If we are lucky, we are seen as “one of the guys”. We are told from day one that we are not “females”, we are “Soldiers/Marines/etc.”. This should have been my first clue, but I was too proud that I was continuing the family tradition of service. During my first enlistment, I had an NCO who would verbally berate me, wrote me up for the slightest infraction, and literally made my life hell. Within thirty minutes of arriving to work, this man would have me in tears. One day, I finally worked up the courage (or was pissed off enough) to ask him outright, “Why do you hate me so much?”  His reply was “Because you’re a female in that uniform!”. Needless to say, as soon as that day’s ass-chewing was over, I asked to take a break and instead of getting something to eat, I went straight to the Chief Wardmaster’s office and told them everything that had been happening. He was immediately escorted from the ward and received a 72 hour psych discharge. I had incidents with other male NCO’s but none as severe as this and all were seemingly karmic-ly returned to the perpetrator.

 

Unfortunately, my commander in the National Guard who was a problem as well. At first he was a little too friendly…when the level of friendliness was not reciprocated, his demeanor changed. By the time it was all said and done, I had the sworn statements of my entire squad, platoon sergeant, and several other members of my platoon stating that the commander had been singling me out for punitive reasons. I took all of these to the Battalion Commander. Since this was a very new unit, I was (in my opinion) nice enough to ask for an Honorable Discharge from the National Guard in exchange for not pressing Sexual Harassment charges against him. It was granted.

 

MSTAfter 9/11, I reenlisted in the US Army. I was stationed at Ft. Campbell, Ky. in the 86th Combat Support Hospital. Four months after I went back to active duty I was sexually assaulted by another NCO (not in my unit). I had met him online and had talked for several months. During an ice storm, he had even crashed in my barracks room and was a PERFECT gentleman (he even folded up his blankets after sleeping on the floor and left without waking me up). The night of the assault (Friday), I had been the designated driver for some new members of the unit. I ran into him at the club and he was obviously intoxicated. After ensuring that he was not driving, he said he had nowhere to crash. I told him if he couldn’t find anywhere safe to stay, he was welcome to crash in my room again. Thinking he would be the same gentleman who I had helped before, I foolishly left my door unlocked.

I was still recovering from a pretty bad case of bronchitis and had taken some medication with Codine and fallen asleep. When I awoke, he was on top of me. Every time I protested, he would bite me. Eventually, he pinned my arms above my head with the pillow over my face. I was too petrified to scream anyway. I did not want everyone else in the barracks to know what was happening to me. I was ashamed and mortified. I don’t remember most of the rape. I do remember that when he was finished, he rolled over and fell asleep. I don’t know how long it was before I attempted to move. I was terrified. Eventually I was able to get out of my bed, but instead of going and telling someone, or simply calling the police myself, I fell asleep in the corner of my room on the floor.

On Monday I tried to go to work, teaching a combat lifesavers course. I couldn’t concentrate on what I was doing; I couldn’t focus on cidthe material I had known like the back of my hand. At lunch, I told one of the other soldiers that I was going to go talk to our platoon sergeant. He could tell something was terribly wrong, and eventually I told him I was raped. My platoon sergeant was a good man who always had my best interests in mind…the real definition of a leader. By regulations, he had to report the assault. I spent the next several hours at the ER and then at the CID office being interrogated. Yes, interrogated…as if I were the one who did something wrong. The next day, I was brought back to the CID offices and interrogated again. By the time it was all said and done, it was beyond obvious that they were not going to prosecute my rapist. Exhausted, exasperated, and defeated I uttered the words that I knew would make the interrogations end. I told them “Fine, he didn’t rape me. Can I go home now?” I was allowed to go. I was so humiliated that I couldn’t even look my platoon sergeant in the face. The way I was treated by the CID agents (male and female) made me feel far worse than my rapist

The next day my unit informed me that I was to report to JAG…CID wanted me prosecuted for attempting to make a “false sworn statement”. Thankfully, the JAG lawyer listened to my story and was immediately swayed to not only choose not to pursue charges against me, but to fight on my behalf. She was a bull dog! She went up her chain of command, which then went DOWN the CID chain of command. The soldier who raped me said it was consensual…but he was married. JAG wanted him charged with adultery (there are still regulations against adultery in the Uniform Code of Military Justice). However, CID and his unit did nothing. He wasn’t punished in any way. Needless to say, it shattered my faith in the military justice system. I tried attending the rape survivors group on base. Of the seven other women there, six were assaulted on base and every single one of them had the same exact experience with CID. None of our attackers were prosecuted.

I have since been through countless hours of “therapy”, numerous medications, diagnosed with PTSD, and now have a service dog. I have recently returned to college and I’m slowly gaining my life back, though it will never be the same. I still distrust authority, being questioned by them causes immediate flashbacks, and I still have intimacy issues. I am working on them, as best as I can.

Someday, I’ll share more about my life…but for now…this is something I’ve never shared publically. This is my fight against PTSD. Getting it out of my head and productively written out is a step for me. I am still proud to have served in the United States Army; I know I did good things that changed lives, even if I will never know the full outcome of those changes. But I will never forgive those in power who prey on the victims while rapists walk free in their ranks.


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