Ptsd

[N.E.wguy]

This question came to me today. Feel free to answer with your opinions.

Anonymous-
"I am at a loss. My husband is waiting on a diagnosis of PTSD and in the mean time was told to try marriage counseling for us so we can learn to communicate better with each other. He hasn't set anything up to actually go yet though, and I doubt he will. I have anxiety issues myself and I feel like the kids only hear us yelling. We never have a good day. He yells at the kids to the point where I don't want them around him at all. He ignores them when he's not yelling at them. I feel so bad for my kids. He just acts like he doesn't like them at all. They are his stepkids and now we are pregnant. I am scared he will treat our baby differently. I can handle when he is mean and yells at me, because I know that just comes with being a PTSD spouse, but my kids are different. How can I take care of my kids and my husband? I feel like I have to choose between them constantly. I desperately want to make this work, but I am working alone and my kids are not getting the life they deserve. I was hoping you have seen a situation similar to mine and could give me some advice? How can I help my kids grow up happy in a PTSD home? They are constantly having to play alone in their rooms so he won't be able to yell at them. They know not to jump on him or yell around him, he yells at them for asking simple questions. They want his love and attention so badly. What can I do in all of this? What should I do?"
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7 people like this.

Noelle Blihgsne Without knowing the age of the kids, I'd at least start by explaining that daddy has hurt his heart and isn't the same person he used to be. He's trying to get some help, the doctors won't be able to cure him, but they will make him feel better. And that they can help daddy by showing him love when he seems to need it, but other times by playing quietly in their rooms. Maybe make him a card or sign that tells him they still love him.
May 29 at 12:24pm · Like · 2

DwayneandMisty Taylor This sounds like my life
May 29 at 12:25pm via mobile · Like · 2

Alicia Sternenberg You have to be the one who takes the first step to setting up counseling. At home, try laying in bed together and talking at night.(Nights are best for us, kids are asleep) This helps my husband and I immensely. I'll set it up as a date if I have to. Be willing to listen and hopefully he can do the same. I hope you can find a way with communicating that works for you both
May 29 at 12:40pm via mobile · Like · 1

Tonya Butler He won't treat your child any differently, he isn't intentionally treating your children like this. My husband is the same way to our 3 children and they're the loves of his life. It's the nature of the beast so to speak. The VA has a new couples Counseling for PTSD it's 16 weeks long just the preparation for the program made such a huge difference for us. You will learn soo much about your husband, more than you think you know now. With my input I think my husband became a little more aware or how he was affecting the kids and I and he's really started to make strides in removing himself before he looses control or he can tell me when he is having a hard time w the kids. Counseling will help!!!
May 29 at 1:04pm via mobile · Like · 2

Cathy Sheridan Ive tried a million things but the most enlightening thing for me has been

Reading the postings on this page its one of the best things I have ever done. Both sides presented

I'm diagnosed PTSD. (Due to DV)

I love bush walks. Being in amongst trees is probably one of the least stressful things I can do
Perhaps as a family you can do this

Breathing slow it down
Tell yourself to stay calm
Say to yourself don't yell
Use I statements. "I feel ......
Keep your voice even - don't keep raising the level
Punching bags are good or a run, walk
Gardening
Meditation Yoga Tai chi Callanetics my favourite
Something slow try or fast what ever the situation needs

Sometimes it's takes a few goes of trying something before you notice a difference. Other times it doesn't seem to work just put the idea aside and try something else, you can always try it again later

I have a friend and times I call her and ask just to say the words
"Don't worry about it, it will be ok" for some reason it works. She does say it slowly, and our call last a minute nothing else is discussed ( she knows I will more than likely explain later)

Make sure the kids have a good understanding behaviour. Suitable to their ages

Find someone who specialises in PTSD if you are able to see a phycologist who treats patients using the Cognitive behavioural therapy method (CBT)

These are some if the things that help me.
May 29 at 1:38pm via mobile · Like

Kelly Lea I have PTSD & without knowing age of children I really can't say exactly ~
I am 54 with no children but have animals & it breaks my heart because I can see what my PTSD does to them ~
There is so much guilt & shame with PTSD & the acting out with triggers that goes with it & that's part of the anger ( in the lashing out ) to KNOW we are hurting causing distress on those we love ~
I can't even imagine if I had children in the mix ~
The noise of young children would add to my anxiety right now ~
so again without knowing the ages ~ off the cuff here ~ my suggestion would be if at all possible away from the kids ~
Ask your husband in text email or talking or even leaving a message on his phone IF it's a good time to ask him something of a serious nature concerning the kids ~ IF he says it's not a good time then ask him to please let you know when it will be & let him know you understand it could take a day ~ a week ~ but that you would like to ask something to be of help to make all less stressful for him & the household ~
IF he is ok to talk ~ I would as the above said wait until children are asleep ~ house quiet ~ what he would like that he sees might help ~ IF he isn't a talker tell him he can think on it & just send you a text of what he needs ~ for his peace of mind ~
I need major major space to myself & maybe that is what he might need ~ just space ~
The space thing is also tricky because in the space the PTSD person doesn't want to feel abandoned either ~ even if they are screaming get out get out ~

 

[N.E.wguy]

Kelly Lea O YES ~ after reading the other post above ~ I personally do bikram yoga 90 minutes in 105 degrees ~ I work to do it daily ~ it makes a HUGE difference ~ my man begs me to go ~because he sees such a difference in me after ~ he cannot go because he has heat issues but if you can find a bikram yoga class that in itself will change your mans life ~ IF he can go & IF not You go & it will help EVERYTHING ~ promise ~
If the bikram is not of interest ~ a gentle YIN yoga class ~ restorative yoga will also be of benefit & if you have Fios ~ go to Veria ~ they have classes on tv ~ you can do at home ~ or get a DVD ~
I see the pain in my mans eyes when I'm triggered ~ he became my trigger & reactivated my PTSD that was in remission only a day ~ but what a awesome day that day was ~
my man didn't mean to do it ~ trigger in me my ptsd but he betrayed my trust & trust is also a major need when one has PTSD ~
my point in mentioning my man becoming my trigger is to explain why my triggers are now a lash out at him~ he was my safe place & without family & isolated from friends from years of abuse in a DV marriage that I'm in midst of divorce now ~ I needed a safe place & with his betrayal he became intertwined with all my abusers ~ so it has been the hardest thing I have ever gone thru ~ being broken from a DV situation ~ then meeting him to find he had been betraying me since hello ~ it was devastating & because of his having a large family & my only social life is fb ~ I have not been able to talk to anybody of my pain until I found this site all because I don't want to hurt his name ~ I have held all in for the last year when I came to the knowledge of his betrayal ~
I stay because number one I'm broken ~ number two he is getting help for his issues & he loves me ~ this I know 100 % ~ I love him too but know I'm not healthy & know if I was ~ I probably would have ended our relationship for what he was doing ~
But since I'm not well & since he is a good man that had/ has a problem ~ I stay ~ I have no other choice right now ~
He is so kind ~ he says even IF I decide I do not want this relationship he is willing to stick by me & take care of me until I'm able to get well~
Just felt i needed to clarify why I rage say unkind things to him at times ~ he is my trigger because he broke trust & I will not KNOW until in better place what we are ~ but for now I have someone who is willing to do what ever it takes to get me well ~
I am going to a clinic in Lewisville Texas soon that specializes in PTSD ~ learned of it on Dr Phil ~ think it is called P&P ~
Again sorry for my ramble ~ writing is my soothing balm ~ even if I write all over the place ~ Plz forgive me ~ blessings ~
May 29 at 2:22pm via mobile · Like · 1

A Spouse's Story PTSD Reply from another anonymous... " - I am so sorry to hear that you have to go through this. I also am in a similar situation. It has been tearing me apart because I also feel like I have to choose between my husband (who is their step parent) whom I love dearly and my precious children. He and I both have PTSD and its a constant struggle and lots of arguments. I can only tell you what I do, not everyone can do the same. It has to come from within and only you know how far you can push your husband. Whenever my husband yells and scolds the kids for things that they should not be scolded or yelled at for, I defend them on the spot. I dont want them to think that they are the ones in the wrong. He is the one with the problem and needs to learn to deal with it. In my situation I had too,its something that needs to be fought for every single day. They (husbands) need to learn that they can help their situation with training. yes, training.. sounds nuts because we are adults, but PTSD sets us back. We have to learn to love, care, patience, rationalizing and so many other things all over again. Counseling is good, but the right one is vital. They truly have to want it, or counseling wont help. make that first step towards counseling but like I said only you know how far you can push your husband. I pray that you find the strength and solution to your needs. "
May 29 at 4:51pm · Like · 1

Kelly Lea I'm so sorry but I have to disagree with the last post ~
I think it is vital that children have a unified front PERIOD ~
This I feel will cause more confusion ~ I'm a stickler on what I say ~ because my own parents never had a unified front & it messes up the entire dynamic in my opinion ~ it turns kids against one parent as they can't know when they are at fault or not ~ they are children ~ it teaches them to not respect the parent that is being scolded by the other or vise versa ~
If a therapist ever said this was ok ~ I would find a new therapist ~
I feel it would be better to separate or get a duplex & live next door to one another & have play dates when all are feeling well rather than be disrespectful to one of the parents in front of the children ~
As a child should not be scolded in front of others neither should an adult ~ these are all private matters and this is just my opinion & I may make ppl mad but I'm passionate of this ~ ALL even those out of control with PTSD deserve respect PERIOD ~
May 29 at 5:30pm via mobile · Like · 2

Drew Beardmore This will sound a little strange even so Try finding a good life coach who is skilled up in NLP (Nuro-linguistic programming) ask the coach to do some work with your anxiety and his anger strategies you will find that this will help to change the triggers and how you actually do it. I am studying it here with the hope to be able to help some of my Military Brothers who struggle with it
May 29 at 6:09pm · Like · 2

 

[N.E.wguy]

Sometimes in life with PTSD, things are going to get rough. It is going to seem or feel like your life is falling apart. Relationships are going to get rocky.

But I will gladly be the first to tell you that relationships can survive PTSD. It will take more work and effort then normal, learning how to communicate so you know where each other is standing and what you both are feeling, it takes truly accepting that PTSD is real, and planting your feet in concrete that you are not going to let PTSD destroy your family.

I know the fact is not every relationship will survive, however if you truly love someone, you can get past what PTSD can bring or did bring, and you can heal and form a stronger relationship then you ever thought possible. But you have to try!

I won't tell you PTSD is just going to go away and a fairy tale story magically appear... that won't happen, this is real life. However I will tell you there are many ways of coping with it and making things better then where you have been or are standing now. But you have to put your all into it. BOTH of you!

When you both give it your all, you might be shocked at how much better things can become, instead of that dark rock bottom place you have been.

There were several times over the years that I thought I couldn't do this anymore, thought it might be best to walk away, but when it came down to it and I looked in the mirror, I realized he is a part of me. I couldn't walk away, he's worth more then that, WE are worth more then that.

So I planted my feet and decided the only way for us to make it through this was facing the battle and learning what weapons/tools to use to fight it. You know what? It's worked.

Every day I come here, I share things, and I rarely post something without some type of meaning behind it. I've been there, I live beside PTSD every day, and I share the tools with you that can help no matter which side of the fence of PTSD you are standing on. PTSD and life with it is by no means new to me. I won't tell you it's always easy, it's not, those ups and downs are going to come. But I can tell you, our marriage survives through it, we have and are raising wonderful well balanced children through it, and we do make it from one day to the next. I won't accept anything less.

But I can't make you use what I share, that one has to be up to you. You are the one that chooses your and your family's future. You are the one that decides if the fight is worth it. You are the one that can make a change for the better. But you have to choose to.

I will tell you, even through the worst PTSD can bring, it is possible for things to get better. But the first thing you have to do is stop holding things against each other, accept PTSD is what you are battling, and take a stand to battle it together! Craig and I, and our family are living proof it can be done! If we can do it, so can you!

* If you have already left, it does not have to be the end!

If you have already chosen to and walked out that door, have taken breathing room, really think about if that's what you truly want. If it's not, if there is any ray of hope, walk back through that door and stand tall that you two are going to work together to make life better through this.

* Communication.

Place the anger, hate, and hurt of the past to the side and start new today. I know you won't forget whatever has happened, but you can get past it. Learn to really talk as well as listen so you can work together.

* Set rules.

Learn each others lines or boundaries. They have to be spoken, even write them down if it helps. But you have to know where each other stands in order to move forward and heal whatever has already happened.

* Get professional help.

Many times having a third party to help you find a level ground is needed, you are both worth trying, reach for additional help if you can't find that level ground to stand on. Get one on one help also. Therapy can help keep both of you balanced and moving forward.

* Take care of yourself.

BOTH of you have to do this! Make sure you use the coping skills. Make sure you take "me" time when needed. Use self-help therapy, whatever works for you to help keep you balanced.

* Physical and/or Verbal Abuse.

These are things that can change! No one purposely hurts the one they love. In many cases you can get past these. Coping skills, learning about PTSD and what comes with it, communication, and everything else you can use to your advantage can help correct these things. Work together to get past any abuse that may be going on. Do it for yourself and do it for your family.

* Safety Protocol.

Rather there is any type of abuse in your home or not, having safety guidelines is a must in any home. Especially if you have children. We all know what PTSD is capable of bringing, have safety in place of what to do in any certain situation, it goes back to it's better to be safe then sorry. Knowing ahead of time if you are faced with such and such then this is how it will be handled, and everyone understanding that, can save a lot of issues from happening or knowing how to handle them if they do arise.

* Education.

Learn! There is no tool more powerful or that can help both of you more then both of you learning what you are faced with. As you learn you will also learn solutions and ways of dealing with or coping with what PTSD can bring. You learn how to handle situations without over reacting. You learn to find a balance which helps you move forward.

* Stop fighting each other.

You have a larger beast to battle then each other! Fighting and arguing just breaks down your relationship, don't let it!

Through everything, keep in mind you chose to be with the one you are with for a reason, don't lose sight of that! Both of you do what you need to in order to make it through life with PTSD. PTSD is not just going away, so make a plan and take action to make life the best it can be with it. Life might not be a fairy tale story all of the time, but it doesn't mean life has to be bad either. Don't give up on each other! Work together, help each other, support each other, and let go of the past and start new today... it can make all of the difference in the world!

~Bec
"A Spouse's Story...PTSD"

 

[N.E.wguy]

PTSD vs Outside Negative Influence

This is huge! Anyone that has PTSD probably has heard their doctor say "Try to avoid additional stress." Or something along those lines. Keeping a calm, stable environment is pretty important when it comes to PTSD and coping with it.

Hard one to do isn't it? I mean, this is real life which comes with stressful situations.

There are many situations in life where it is just not possible. Sometimes you are put in a position where you have to face it and handle it accordingly. Lay the facts on the table and do what you have to in order to get the situation handled/solved and move on. Don't hold on to negative situations... when you do they are just going to eat at you and bring you down, flair up your PTSD symptoms, as well as depression if you also suffer from it. Don't let them run your life.

Work with the facts.

What can you do right now this minute?

If there is nothing you can do right now this minute then try not to dwell on it. When the time comes to handle it, then be prepared for it but don't allow it to run your life every second of every day. Pace yourself and don't get ahead of yourself with the what if's and but's. When you allow this to happen, many times your mind thought process will leave from the facts at hand and everything will start to consume you and your life. Don't allow this to happen!

Then there are others who like to push your buttons so to speak... which is nothing less then cruel! Especially when they know there is a disability at hand.

But I hate to say this happens oh too often. Some people are going to try to break you, weigh you down, try to put you in a worse condition then you are already battling... normally for their own personal gain or due to their own issues in life. A bully, that's really all they are. Someone who is not happy with their own life so they pick on someone else.

Don't let them! Life already has enough that comes with it without you allowing other people to get at you. When these times come, and sooner or later they will come, focus on who you are and don't let their words or actions tear you down. You are better then that and obviously a better person then they are!

So what do you do?

* Stick with the facts of the situation.

* Don't let the "what could happen" weight you down.

* Handle things accordingly as they come and don't let them consume you and your life.

* Don't allow negative people to over rule who you really are or cause you to question yourself.

* Use coping skills in stressful situations.

* Make a plan of action for situations you know are coming. Set a pace and timeline for you to do things to prepare for it so it does not consume your life every second of every day.

* Don't allow a situation to take over your time you need to focus on yourself and take care of yourself.

* Talk to someone close to you or your doctor when stressful things are weighing on you. Just talking to someone can help.

* Seek professional help in situations where a professional can take added stress off of you rather it is a financial adviser, a lawyer, a doctor, or even a housekeeper or lawn maintenance person.

* Avoid negative people if you have to.

Life can be stressful, and adding PTSD to it is at times difficult. Do what you know is best in or for your situation and most of all for YOU! You spend a lot of time and energy being the best you can be with living life with PTSD, don't allow additional things damage how far you have come!

~Bec
"A Spouse's Story...PTSD"

 

[N.E.wguy]

Okay let’s hit this page running this morning. I’m seeing HUGE issues going on in the PTSD world right now, and I believe there are some simple things we can do to prevent them! On BOTH sides of the fence.[/font][/COLOR][/LEFT]

Let’s face the facts. Relationships are falling apart! With PTSD being involved there are extra steps that have to happen in relationships to make sure they survive. These things take extra self-control that is beyond normal. It takes stepping out of the box as I say it and looking back in. Putting yourself in someone else’s shoes even for a brief moment to take a look at where you stand, what you are doing, and what you could do to make things better. And that goes for everyone.

Having PTSD or living beside it does not bring the “normal” relationship! And you can’t expect it to! I’ll be honest, as a child majority of us had our heads filled with fairy tale stories of the happily ever after and the house with the white picket fence, children running around happy, and a dog named Spot. It’s a mind set that every little girl grows up believing in, it’s every boy’s vision of being the knight in shining armor. Think about it, many will agree.

But the fact is, none of those visions of what life is suppose to be like include sickness of any sort, and especially not PTSD. So you have to reset your thoughts. It’s called the facts of life. I’m not saying you can’t have a happy life or be that knight, what I’m saying is you have to reach that type of life in a different way. It’s not just handed to you, you can’t just expect it to happen.

With any relationship it takes work! Then you mix PTSD, as well as other disabilities or illnesses with it and that happy life and relationship are not going to just fall into your hands.

Let me touch on these separately…

Spouse/SO:

Look at yourself. Look at how you act, how you respond to things. Are you keeping in mind that PTSD is real and does exist? Be honest with yourself.

I know that living with a partner that has PTSD can get lonely. That’s a fact about it. But at the same time you can’t rely on someone else to make you happy all of the time. It goes back to doing things for yourself to bring happiness. If you don’t know how to make yourself happy, how would you be happy in a relationship? Especially mixed with PTSD.

This goes back to one of the things I do for myself, I buy myself flowers once a month, or something that I want for myself that will bring me a different sense of happy. This month and last I didn’t buy flowers, I put time into gardening and my pond. And don’t get me wrong, many budgets are tight and buying things for yourself isn’t always the answer, you can do something for yourself, whatever it might be that brings a smile to your face. Something that you can see that reminds you that you did it for yourself.

Self-help therapy! A huge key to living a balanced life when living with PTSD. No, it doesn’t take the loneliness away, but it helps you keep your self esteem which is extremely important and easily lost with everything that goes on.

Look at how you treat your partner. Many times I hear “but look at how I’m being treated!”

Well, the truth is, if you don’t like the way you are being treated, then don’t treat them that way because you are hurting or feelings are hurt. Two wrongs don’t make a right… at all!

Sometimes when a person with PTSD sees their partner smile, laugh, still live life, it doesn’t mean you are going on with life without them, it means you have a chance to lift them up from those dark places PTSD brings them to.

As long as they are seeing you sad or upset, even angry what do you think is going to be the response? I can answer this, they are going to feel like a burden, that you deserve a better life, that they are just bringing you down, that you would be better off without them and it fuels the PTSD anger. That’s not quite the outcome or response you want now is it. NO!

Your feelings are going to show rather you want them to or not, but you can work on making yourself feel better which in turn leads to them not worrying as much. You always have to keep in mind PTSD consumes them, and they can’t help this, it’s a part of what comes with PTSD.

Oh I hear you saying it now! “But he doesn’t want me to be happy! He doesn’t want me to feel good because he can’t!”

Well guess what, sure you are absolutely right. This does happen. But how about adding something simple to this? How about “I’m trying to be happy and accomplish things because it will help US be happy”. It will help take the burden off of their shoulders of bringing you down too. It’s hard for one with PTSD, normally they have lost most everything to this and in reality many times can have jealousy that you can succeed in something but they can’t. It takes time for you to get through to them that things you do are to help both of you. You have to be able to stand on your own two feet so both of you can be better. I’m already hearing the “but” in this, don’t worry, the PTSD side of this is coming also. It takes working together, not against each other!

Being in a relationship with PTSD is hard, extremely hard… but it’s not impossible! You as the spouse have to remember that it’s PTSD NOT your partner! Come on, would you have ever been with them in the first place if all they were was “bad”? Absolutely not! You saw something in them, something that you loved. That something is still there, it’s just harder to see, but it’s there. Think of the good things, find a way that brings those good things back to life… it’s possible. “Look for the good” I say it on here all of the time, there’s a reason for it.

Stop being at war with your partner and start working together to find solutions, they are there, you just have to find them!

The one with PTSD:

Nope, not leaving you out of this. We know you still love and care about your partner, it’s just hard to show it much of the time. PTSD takes so much time and energy just to feel some sense of normal.

I know you are a good person! If you weren’t your partner would not be there for you! They found the good in you that they love and attracted them to you in the first place.

It’s time to start unmasking that good so they still see it. I know this is one of the most difficult things you will ever do. PTSD does not like the good and hides it so to speak. I truly believe that PTSD affects “the best of the best” and I will keep saying that until you believe it again yourself!

PTSD breaks you down, it brings you to your knees, and it’s a battle that is very tiring on the mind and the body. I understand that completely, BUT, yes there’s that word you hate hearing me say. But YOU are still there! YOU can override some simple things so that good part in you shines through. I know it’s not easy, but you CAN do it!

A partner of PTSD feeling “lonely” is the largest thing I hear, and also feel many times. I want to explain this feeling to you so you can understand it from a spouse’s view and can help change this.

You don’t have to be physically apart from each other to feel lonely. You can be in the same place even 24/7 and still feel it. It comes when you are focusing on yourself and fighting PTSD within yourself and all of the focus is on that and little on your partner. I know you don’t mean to do this, it’s hard enough coping with PTSD. But this is exactly what is happening. Then the anger of the fight comes and rolls over to your partner, no one means for this to happen but it does. Your focus remains on yourself, not because you are selfish by any means, but because you are trying to survive!

But in this surviving you are forgetting one huge, major tool you have on your side to use! Your partner! I know it seems like so much work, added stress and worry, the thoughts of I can’t please her/him. But I have something very important to help you in this, and it’s simple.

Loneliness comes from an emotional as well as physical distance, a wall put up between the two of you. And I’m saying loneliness because this seems to be the largest battle a partner has being with someone who suffers from PTSD. We all have feelings, even when there is numbness. You are human! And you do deserve feelings, you deserve happiness, and it does not matter what or where PTSD has you, there is something you can do.

As difficult as it is to take the feeling of lonely away, there are things that you can do to help prevent it. And they are rather simple but get lost in the trying to make yourself better.

Let’s start with the more easy ones, even though I know nothing that comes with PTSD is easy.

A hug. A kiss. An “I do love you and glad you are here.”. Sitting on the couch while watching a tv show and putting your arm around your partner or holding their hand. Look at them, think of why YOU chose them, there’s a good reason and it’s still there. Focus on that person for a second and think about who they are, the things you like about them, the things they do and many times do for you. Don’t let guilt that PTSD brings overlook these things, don’t think about the bad or how they would be better off without you, think about why they chose you and why you those them. It brings a sense of a happy time and place. That time and place are not lost, they are just set to the side. Use those good times to help in your relationship. No, you can’t go back, but you can move forward, and moving forward creates new senses of happy. PTSD causes you to feel stuck, things as simple as what I’ve said here can help you get unstuck… and with help from your partner.
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[N.E.wguy]

Here’s something else that seems silly and unimportant. But it plays a huge roll in all of this life with PTSD. PTSD puts you in a place where you rely on that other person, sometimes too much but might not notice that. Things like duties around the house, fixing meals, taking care of majority of things for you. It goes back to that stuck place PTSD puts you. Let’s help you get unstuck.

Simple things like picking up your clothes from the floor and putting them in the hamper. How about when you fix yourself a drink, asking your partner if they would like one. Asking what you could help with so things get done and you have more “couple time” without your partner being worn out. The little things as I call them. Just anything that could help, show you are thinking about them, shows you do care about how they feel. I know many, especially men, are use to the wife/woman doing many of these things… their role so to speak. But you have to remember, especially for those of you who are home all of the time now or most of the time, things have changed. Life with PTSD does not separate his and her roles anymore. Another mind set that many of us were raised with. You have to learn to work together on things so there is balance.

This also helps you! It helps you from being stuck, it helps you from feeling unworthy, and it will sure help your relationship. And wow… it battles PTSD on a new playing field that will be to your advantage!

Anger. Oh a huge thing that PTSD has on it’s side. When you feel that anger starting, tell your partner. Make them aware that you are feeling this way. And focus on not letting the anger control you. When both of you are aware of this feeling happening you can work together to get through it. Use your coping skills! Breathing exercises. Talking about it. Anger comes out during some of the worst times PTSD gives you and it takes a lot of self control to make it through it, but you can! Say out loud “I’m angry right now but I don’t want to take it out on you.” You might have to have a break of just quietness during this time, let your partner know that and you need this quiet time to get a grip on it because you love them and don’t want it released on them. Try this! It works! Verbal abuse is one of the most damaging things PTSD brings, and I know that none of you mean to do this, but it does happen. And when it does it really puts a wall up in a relationship, just as you use a wall to cope through things, your partner will do the same thing, it’s a defense mechanism. You both have to watch out for this, it can be dangerous to a relationship and very hard to tear down. Be open and honest with your partner, communication is a huge key that is on your side.

SO… all of this is something to really think about. None of you want to feel lonely no matter which side of the fence you are on in this. Take back your relationship, work together, you can speak honestly and calmly with the goal of making changes for the better. Avoid the fighting PTSD brings. Fighting it, for either of you, is feeding the PTSD. YOU can control this and strengthen your relationship at the same time. Try these things. Start new, start now! Work on rebuilding your relationship and letting the past hurt go so you can move forward together. And always keep in mind that when it comes to PTSD, the simple things in life are going to be the things that bring the most meaning and change for the better.

Don’t let PTSD take your relationship from you! Because it will if you allow it to. Work together, communicate, “look for the good”… it’s still there!

And to add my legal note to all of this, I’m not a doctor or in any sort of medical field. I’m simply a spouse that’s been there and these are my personal opinions and points of views. If you have an emergency situation please contact your local help hotline.

Love to you all

~Bec
“A Spouse’s Story PTSD”[/font]

 

[N.E.wguy]

PTSD vs Guilt

That is a very strong word and it carries a ton of weight with it. Guilt can come from many different reasons. But what are some of the reasons that can be related to PTSD?

You know, PTSD is hard enough for one to cope with and the struggles from day to day can be difficult, then there is guilt mixed with it.

Now, I’m not only talking about survivor’s guilt, which many with PTSD do have. That is a beast within itself already. Surviving when someone else didn’t, feeling as if you should have been the one that didn’t make it… it’s a huge weight to carry and you have to work hard to make it through those feelings every day. And to those of you that experience it, and yes my husband is one of them so I do understand what it causes. Don’t give up on yourself! I truly believe there is a reason you are here, rather it is a known reason or not to you right now.

Other common reasons guilt my develop:

* Not being able to work.

This is a tough one for many! You have a person who has worked their entire life, worked hard to succeed in what their line of work was, then they faced a disability that took it all away. They now feel like they have let themselves and others down by not being able to provide as they use to be able to do.

This was a very difficult one in our home. I had to find a way for this to be viewed differently and voice a different way of viewing it to easy that guilt. Craig is a disabled Veteran due to his military career, even though he can no longer work, he does receive financial benefits that he EARNED. To me, that IS indeed providing!

* Feeling like a burden.

This is very common. A person always took care of themselves as well as others, and now is in a position that those things are not so easy, or not as easy as they use to be. That can weigh on a person.

But let me tell you something, even if you are viewing yourself as a burden to others, you are NOT a burden to that person who loves you. You are in their life for a reason, try to remember that.

* I can’t do the things I use to do.

The old me and who I am now. An extremely hard one to grasp. The I use to do this or that and now it’s hard to even leave the house.

You are still you! Things have just changed, change is a part of life rather we like it or not. On your good days, do what you can and try not to worry about the things you can’t. I know that is way easier said then done, but try to make the best of the now. Find new things to do. You might be shocked at what you can indeed do.

* Not spending a lot of time with children.

This is the hardest one on any parent. Soccer games, school events, crowded places, lots of noise and rowdiness of children. That can be overwhelming to PTSD. You start feeling like if you don’t go or attend everything then you are letting your children down.

I’ve got news for you on this one! No matter what amount of time you spend with children, no matter what you attend or don’t attend, quality is the key. As long as when you are able to you spend quality time with a child that is the largest thing that matters. They just want you to love them and be there for them, it does not mean you have to go everywhere. Children can be the most understanding and forgiving people in this world, so don’t let something that they can overlook and get past continue to weigh on you.

* Date Night.

I personally hate this term lol! You hear it all of the time especially from your friends in the social media. It can weigh on you that you don’t go out like everyone else does, you can feel guilt because it’s something you can’t offer your loved one or not on a regular basis. You feel as if you are keeping them from the rest of the world.

There is something you can do or try. Even if you are one that your PTSD does not allow you to go out or not much, try some of these…

- Go out during off hours. It does not have to be a Friday night during dinner time outing to be a date night! Go out for lunch or during the week when things aren’t so busy. It is still going to mean just as much!

- Make special dinner plans, a movie, etc at home. There is nothing wrong with having a date night at home! Turn it into something special for the two of you, do something you two don’t normally do, oh jeez and for the ladies add that sissy romance in there lol. Even through numb feelings PTSD can cause, the motions to show you do care can still be used.

* Not being able to participate in special events/holidays.

Just do what you can and take breaks when you need to! Holidays are overwhelming! Many time just showing face can be enough or making a call to let someone know that you would love to be there but it’s just not a good day. People are either going to take time to understand or they aren’t! Don’t let them weigh on you! You do what you can at your pace and do what is best for your situation.

- Take breaks to leave crowds when you need to.
- Show face even if you can’t stay… IF you are able to make it somewhere.
- Let people know that it does matter to you, even if you can’t make it.
- Do something on another day. A holiday does not always have to be celebrated on that day, anyone that has experienced military life knows this one well! You celebrate when you can.

* Spouses!

Don’t play the guilt trip!!! You will cause a lot of damage if you do. Work with the one with PTSD and find ways to cope and handle things. A guilt trip is just going to bring anger, frustration, the guilt, and your loved one falling into a really dark place. And sure won’t bring them any closer to you! DON’T do this to them!!!

There are MANY things that can bring guilt. Guilt can eat you alive if you allow it to, don’t let it. In many of the situations there are ways around allowing it to happen or take control of you. Don’t just give up. Guilt is a very real feeling and it’s not at all easy to overcome, it will take time and a lot of hard work, but do what you can! By trying to get past some of the guilt, you might just find new things in life you enjoy or can do.

~Bec
“A Spouse’s Story…PTSD”

 

[N.E.wguy]

In going over things NOT to say to a person that suffers from PTSD, I know there are a lot of lists out there. But what about the “why” to those lists? You can tell anyone not to say certain things, but it makes more sense when you can understand why you should not say them. I have listed a FEW of them here and over time will add to this, but here is a good start.

What NOT to say to one who suffers from PTSD and Why:

* It’s in your head, just don’t think about it. Get over it.

This is one of the most uneducated phrases out there regarding PTSD. How is one suppose to not think about it? PTSD was formed from a serious trauma, this trauma repeats itself over and over in their DREAMS! Dreams are a way of the mind venting what has happened. No one has the physical ability to just get over it.

Flashbacks, this is something that happens from a trigger which could be a sight, a smell, a certain feeling of a breeze that blows bt you. These lead to flashbacks which is where the person thinks they are actually back in the place and reliving the trauma which lead to PTSD. They zone out as I say it, they are right before you physically but they are not “there”. It takes a long time and effort to learn to cope with triggers to prevent them from taking over, sometimes they are not going to be avoided.

Can you control your dreams? Nope, sure can’t. How many times have you dreamed something and woke up thinking why did I dream that? Many times I would guess. Well one who suffers from PTSD relives their trauma in their dreams, over and over again. If you can’t predict and control what you dream, how would you expect one who has PTSD to do it? You can’t. There is no such thing as getting over it or don’t think about it. Even with all of the medications, coping skills, and professional help, at times it is still going to be there.

* You don’t need medications, you’re fine. You act so normal.

How would you feel if someone told you that you are fine, you don’t need your cancer treatment, or blood presure medication? You would probably answer them in anger and tell them your life depends on those things! Ah, we hit a nerve. PTSD is no different. Those medications are what help a person be able to find a place where they can cope with PTSD. The medications are what make them seem normal to you. In reality, if you do not live with the person, most likely you are going to only see them on a good day when they are actually able to leave the house. Be thankful this person reached for help and does have those medications, or you might not see them very often at all. Many with PTSD do not leave home because they do not want others seeing the rough side of PTSD. They want to be viewed as normal, and are just like the next person, they just have a tougher battle that is there every day they have to fight to feel that normal.

* Pull yourself up by your bootstraps soldier.

Pull up your bootstraps, hummm. Actually, they DID! The fact is PTSD sets in with what I call “the best of the best”. The ones that indeed have pulled up their bootstraps one too many times, the one that stood tall and took every trauma thrown at them. A human can only take so much trauma before something is going to give, that something is called PTSD. It when you have taken so much that your mind just wants to shut it out, which turns into a battle withing yourself. It turns into nightmares or terrors, anxiety, hypervigilence, anger, lack of self esteem, and all of the other symptoms that form PTSD. Being in a position to pull those bootstraps one too many times has factually lead many to developing PTSD. Wanna pull on your bootstraps a little too hard? No, you don’t.

* Did you kill anyone?

The one question that shows no respect at all. Again, turn the question back to yourself. Many people are raised with some sort of religious upbringing, take that then be in a position to where killing someone was your job, what you have to do. Then take that and turn around ask ask that person if they killed someone. What do you think is going to happen. One of two things normally, you are either going to set them off or they are going to walk away from you and never look back. Let’s be real, if you know a person was in a position where they might have had to kill someone, do you think there is any respect in asking that question? NO! One with PTSD has a hard enough time coping with the past, don’t put it in their face. Have respect that the person in front of you put their life on the line for someone else’s. If you have the urge to see death, try joining the military or police force. It will cure that urge real fast. Life is not a video game!

* If you could go out last week, why can’t you go out now?

One of the most stressful questions to PTSD. With PTSD every single day is different. A person might be angry one day, happy the next. They might have 3 good days followed by 2 weeks of bad ones. They have a hard time making schedules and keeping them. Planning things in advance is extreme for them. If they have a day they do go out, be thankful for it! And understanding on the days they can’t make it out the front door. All it takes is one thing to trigger their PTSD and a good day can head south. They have to focus on every single aspect of their day and things around them to make it through the day, sometimes that is too much of a struggle and it mentally and physically wears them out. When they do make it out, they tend to mask PTSD with a smile, normal, they just want to fit in and feel normal. As I say it, take the good days when you can get them and be of help and support when they are bad. Anything can be rescheduled for another day, have the understanding to do so if it’s a day they can’t get out. Goes back to no expectations, never expect too much.

* I’ve been through things too, that’s life.

Sure! Everyone has been through something, very true. However, when a person has been through a life threatening trauma, sometimes more then one, and they stand strong and hold it in… that holding it in builds and begins to weigh on you. Not everyone handles trauma the same way, and it’s normally the strongest people that PTSD affects. They are normally the ones that have lived through, seen more, and also may have guilt of being the one who did survive. If you understand PTSD, this is something you would never quote to a person.

* So you are crazy.

The good ol’ crazy statement. The old reliable for those that don’t get it, don’t understand it, and are uneducated. PTSD does not mean you are crazy! PTSD means you have experienced a massive trauma that changed your life. Anyone can develop PTSD, so it’s one of those things where before you judge someone else, would you want that said to you? Again NO! PTSD converts the trauma into nightmares or terrors, flashbacks, vents in anger at times or verbally. But it by no means means a person who suffers from it is crazy. Many of them are vey educated, more understanding of life, and some of the strongest people you will ever meet.

* Man you’ve gained weight!

Really? Wow that’s great for anyone’s self esteem! Pointing out weight gain on a person that is on medications… which cause weight gain by the way… many that fight depression which keeps them from being active, and PTSD has effected their lives to where they can’t seem to be able to do the things they use to because the battle is mentally and physically draining, is disrespectful! Weight gain and self esteem are two of the most deadliest battles of PTSD and/or depression. Even if you view it as a joking manner, they are not going to! One with PTSD needs support of those they are around. Telling them they are fat or getting fat is not support by any means!

* So you are a spouse beater.

 

[N.E.wguy]

Oh my! Those are fighting words within themselves. Just because a person has PTSD does not mean they are monsters or physically abusive to anyone! Yes, one with PTSD has anger, but normally that anger is with themselves! They judge themselves that they could have done something differently for a different outcome to what they experienced, they could have tried harder, they should have been there, the list is endless. I’m not saying that physical abuse may not be a part of one’s PTSD, sometimes it is and outside help is needed to get it under control. But majority of the time it’s not. They vent anger verbally, sometimes they might throw things or punch a wall or such. But the abuse is more towards themselves then someone else. Many that I know with PTSD are actually the most caring, loving, understanding people that would do anything to help another person. Especially their spouse!

* You can’t be a good parent if you have PTSD.

This is far from the truth! And I know this first hand! One who suffers from PTSD can be a better parent then some of the parents out there. They put effort in everything they do, it’s a part of surviving PTSD, therefore place a great deal into parenting. They don’t want to do wrong, they don’t want it to effect their children, they want to be the best person they can be. So when it comes to children, children give them the sense of being needed and many that are parents put extra effort into getting professional help so they can be that good parent. That parent know there is someone relying on them… that actually makes a huge difference in coping and managing their PTSD. They might not be able to attend every school event, but I bet they will put every effort into it. Another thing to add to this, having a parent with PTSD educates children to a whole new respect for life, for others, and can very well be the generation, if taught about it, to change the stigma of PTSD and other disabilities.

* You were not in the military, you can't have PTSD.

This one of the worst battles for someone who has PTSD not related to the military. PTSD can develop from ANY trauma that severely effected your life. It is not only related to the military. It can develop from a natural disaster, sexual assault, physical assault, car accident, child abuse, home invasion, loss of a loved one close to you, major surgery, cancer patients can develop it... the list is endless.

Thank you for taking the time to read this and educate yourself. As always, with any of my postings please feel free to “share” them, there is a great need for education and it will be of help to someone.


We have talked about what NOT to say to one who has PTSD, but what are things “TO SAY” that can help?

Thing “To Say” to one with PTSD:

* “I’m always here if you want to talk”

PTSD needs support, and many times one with PTSD just wants an ear to listen. When talking with someone who has PTSD, it is important not to interrupt when they are talking. Truly listen to what they are saying. Then respond without changing the subject. Communication! A huge key.

* “I know I can’t understand exactly what you went through, but I’m trying to understand the best I can…”

No, we will never understand exactly what someone else went through with their trauma, so it is important not to say comments that are out of context. We only see “what” they are going through now as a result of the trauma, so our understanding comes from seeing the results not from the trauma itself.

* “I care about you/love you.”

PTSD is tough. Sometimes just reassuring one that you care about them can help. Sometimes they “need” to hear it. It gives the comfort that even through the rough times you are still there for them and still care no matter what you are going through.

* “Can you help me with…”

Many times when one has PTSD, we know they battle so much each day that we don’t want to add to it. So at times we stop asking them for help with even simple things. Where you think you are helping, you might actually be doing the opposite, it could be taken as “I’m not needed any more” or “they are fine without me”. Keep a balance. Ask for help if you need it or would like to have it from one with PTSD, and accept a no if they don’t feel up to it without tossing negative remarks at them. By asking let’s them know they are still needed and helps keep the balance.

* “Would you like to…”

This helps keep them included, even if it’s just going for a walk or watching a movie. Again, stay away from any negative remarks if the answer is no, you could follow it up with “is there anything else yo would like to do?”. You are giving input to something you would like to do with them and also backing it up with a different option of their choice. The important thing is for PTSD not to get into that stuck position too much.

* “You seem…(angry, frustrated, sad, etc) today, do you want to talk or is there anything I could help with?”

This is important. Many times one with PTSD might not realize their actions or the way they are coming across to someone else. By saying this you are pointing out how you are viewing things, you are opening the door for if they want or need to talk, and if that’s not the way they are feeling it opens communication for what they are actually feeling and keeps misunderstandings from happening or one taking it personally.

* “I am taking your medical condition to heart, keeping it in mind, can we talk about the way I am feeling about…?”

By saying things along this line before starting a serious conversation helps let the one with PTSD know you are not tossing their feeling and what they are going through to the side. You are keeping them in consideration. But you are also allowing for your feelings to be discussed on whatever topic is at hand. Communication is important, and both of you are important. This gives a decent icebreaker to prepare one with PTSD that a serious talk is needed but you also care what they think and how they feel. Do not misuse this! If you are keeping them in mind, make sure you do!

These are a few things that can help with knowing what “TO” say to one with PTSD. Words and how they are used becomes a great importance with PTSD so also think before you speak, keep communication lines open, make sure you do not just assume things, and make sure you use your ears and not just your mouth.

~Bec
“A Spouse’s Story…PTSD”

 

[N.E.wguy]

Nearly 1 in 4 stroke survivors develop PTSD, study shows
hxxp://www.usatoday.com/story/news/nation/2013/06/19/study-stroke-ptsd/2417697/
Cathy Payne, USA TODAY 5:03 p.m. EDT June 19, 2013
About one in nine stroke or mini-stroke patients have chronic PTSD more than a year later, a new study finds.
Brain stroke

PTSD may hinder recovery after a stroke or mini-stroke
Stroke is the fourth-leading cause of death in the USA
Stroke is a leading cause of serious long-term disability

A stroke may leave some survivors with post-traumatic stress disorder, which may hinder their recovery, according to a study released today.

About 23% of patients who survive a stroke or transient ischemic attack, a brief interruption of blood flow to the brain, have PTSD symptoms within a year, the study finds. About 11% have chronic PTSD, in which symptoms last three months or longer, more than a year later. The study, led by Columbia University Medical Center researchers, was published online today in the journal PLOS ONE.

"Strokes are among the most terrifying life-threatening events," says lead author Donald Edmondson.

People think about PTSD in relation to external events like war or sexual assault, says Edmondson, assistant professor of behavioral medicine at Columbia's Center for Behavioral Cardiovascular Health. "There is something different about PTSD after a stroke because the threat is inside your body," he adds.

The analysis looked at nine studies of PTSD induced by a stroke or TIA, sometimes called a mini-stroke. The studies included 1,138 stroke or TIA survivors in France, Norway, Switzerland, United Kingdom and the United States. The average age of participants was 64.5 and 47.5% were men.

PTSD can develop after an event involving physical harm or the threat of physical harm, according to the National Institute of Mental Health. Symptoms include having nightmares, avoiding reminders of the event and feeling tense. Treatments are psychotherapy, medications or a combination.

Stroke is the fourth-leading cause of death in the USA, according to the American Stroke Association. It is a leading cause of serious long-term disability.

Ralph Sacco, an American Heart Association spokesman who was not involved in the study, says Edmondson's research looks at an under-recognized condition. "This is one of the first studies that investigates what's in the literature about PTSD after a stroke or TIA," he adds. "We often think of PTSD as coming on after other kinds of stressful events — wars or other emotional events.

"A stroke or TIA can be an emotionally charged event — some strokes can be life-threatening or potentially disabling," says Sacco, chairman of neurology at the Miller School of Medicine at the University of Miami.

Edmondson says, "Our current results show that PTSD in stroke and TIA survivors may increase their risk for recurrent stroke and other cardiovascular events."

The concern is that PTSD may threaten recovery. Previous research has shown that PTSD is associated with patients not adhering to their schedule for taking medications.

Sacco recommends that stroke patients who suspect that they have PTSD symptoms get medical attention.

Edmondson says there are good PTSD treatments. "But first, physicians and patients have to be aware that this is a problem," he says. "Family members can also help. We know that social support is a good protective factor against PTSD due to any type of traumatic event."

He adds, "The next step is further research to assess whether mental health treatment can reduce stroke- or TIA-induced PTSD symptoms and help these patients regain a feeling of normalcy and calm as soon as possible after their health scare."
related stories
New study links PTSD to heart disease, other ailments11 days ago
7 tips for living a healthier life12 days ago

 

[N.E.wguy]

New study links PTSD to heart disease, other ailments
hxxp://www.usatoday.com/story/nation/2013/06/25/ptsd-linked-to-heart-disease/2456567/
3:30 p.m. EDT June 25, 2013
Vietnam veterans

U.S. Department of Veterans Affairs
Afghanistan
Southeast Asia
Iraq

More scientists worry that mental illnesses from war, such as post-traumatic stress disorder, can damage the body as much as the emotions. Some even speculate that war could cause an early aging affect.

It means the cost of war can last decades beyond the battles are fought.

An unusual study released today underscores these fears. During 13 years of research, scientists followed twins who were Vietnam-era veterans -- 340 identical and 222 fraternal -- and found that those with PTSD were more than twice as likely to develop coronary heart disease.

The findings were published today in the Journal of the American College of Cardiology.

"This study provides further evidence that PTSD may affect physical health," says Gary Gibbons, director of the National Heart, Lung and Blood Institute, part of the National Institutes of Health, which provided some funding for the research.

Scientists at the Emory University Rollins School of Public Health followed Vietnam-era veterans, about half of whom had served in Southeast Asia. By using the 562 twins, researchers were able to control for genetic or environmental influences in the development of heart disease and PTSD.

Heart disease was found among 22.6% of veterans with PTSD compared with 8.9% without the mental illness.

Studies show that about 10% to 12% of troops who served in the Iraq and Afghanistan wars suffer from PTSD, often characterized as a signature wound of those conflicts.

Scientists speculate that because the mental disorder causes high rates of anxiety, it can lead to heart-damaging higher blood pressure and heart rates.

Heart disease in this study was defined as suffering a heart attack, being hospitalized overnight with a heart-related problems or having undergone a heart operation.

Scientists with the Department of Veterans Affairs tracking veterans who served in Iraq and Afghanistan and who have been diagnosed with PTSD and mild traumatic brain injury also report finding signs of heart disease, diabetes, slowed metabolism and obesity among young veterans -- maladies more common to middle age and beyond.

 

[N.E.wguy]

Post-Traumatic Stress Disorder (PTSD)
Symptoms, Treatment and Self-Help for PTSD
PTSD & Trauma Help Center
Post-traumatic Stress Disorder

After a traumatic experience, it's normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn't fade and you feel stuck with a constant sense of danger and painful memories, you may be suffering from post-traumatic stress disorder (PTSD). It can seem like you'll never get over what happened or feel normal again. But by seeking treatment, reaching out for support, and developing new coping skills, you can overcome PTSD and move on with your life.
In This Article:

What is PTSD?
PTSD vs. normal reaction to trauma
Signs & symptoms of PTSD
PTSD symptoms in children
PTSD causes and risk factors
Getting help for PTSD
Finding a therapist for PTSD
Self-help & support for PTSD

Print this!


What is post-traumatic stress disorder (PTSD)?
Wendy’s PTSD Story

Three months ago, Wendy was in a major car accident. She sustained only minor injuries, but two friends riding in her car were killed. At first, the accident seemed like just a bad dream. Then Wendy started having nightmares about it. Now, the sights and sounds of the accident haunt her all the time.

Wendy has trouble sleeping at night, and during the day she feels irritable and on edge. She jumps whenever she hears a siren or screeching tires, and she avoids TV programs that might show a car chase or accident scene. Wendy also avoids driving whenever possible, and refuses to go anywhere near the site of the crash.

Post-traumatic stress disorder (PTSD) can develop following a traumatic event that threatens your safety or makes you feel helpless.

Most people associate PTSD with battle-scarred soldiers—and military combat is the most common cause in men—but any overwhelming life experience can trigger PTSD, especially if the event feels unpredictable and uncontrollable.

Post-traumatic stress disorder (PTSD) can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterwards, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma.

PTSD develops differently from person to person. While the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear.
Traumatic events that can lead to PTSD include:

War
Natural disasters
Car or plane crashes
Terrorist attacks
Sudden death of a loved one



Rape
Kidnapping
Assault
Sexual or physical abuse
Childhood neglect

Or any shattering event that leaves you stuck and feeling helpless and hopeless
The difference between PTSD and a normal response to trauma

The traumatic events that lead to post-traumatic stress disorder are usually so overwhelming and frightening that they would upset anyone. Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel crazy, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.

For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder (PTSD), the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse.
A normal response to trauma becomes PTSD when you become stuck

After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you come out of it. With post-traumatic stress disorder (PTSD), however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions.
Signs and symptoms of post-traumatic stress disorder (PTSD)

The symptoms of post-traumatic stress disorder (PTSD) can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:

Re-experiencing the traumatic event
Avoiding reminders of the trauma
Increased anxiety and emotional arousal

Symptoms of PTSD: Re-experiencing the traumatic event

Intrusive, upsetting memories of the event
Flashbacks (acting or feeling like the event is happening again)
Nightmares (either of the event or of other frightening things)
Feelings of intense distress when reminded of the trauma
Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)

Symptoms of PTSD: Avoidance and numbing

Avoiding activities, places, thoughts, or feelings that remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally numb
Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Symptoms of PTSD: Increased anxiety and emotional arousal

Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance (on constant “red alert&#8221
Feeling jumpy and easily startled

Other common symptoms of post-traumatic stress disorder (PTSD)

Anger and irritability
Guilt, shame, or self-blame
Substance abuse
Feelings of mistrust and betrayal



Depression and hopelessness
Suicidal thoughts and feelings
Feeling alienated and alone
Physical aches and pains

Symptoms of PTSD in children and adolescents

In children—especially those who are very young—the symptoms of PTSD can be different than the symptoms in adults. Symptoms in children include:

Fear of being separated from parent
Losing previously-acquired skills (such as toilet training)
Sleep problems and nightmares without recognizable content
Somber, compulsive play in which themes or aspects of the trauma are repeated
New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)
Acting out the trauma through play, stories, or drawings
Aches and pains with no apparent cause
Irritability and aggression

Post-traumatic stress disorder (PTSD) causes and risk factors

While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability.

Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.
Other risk factors for PTSD include:

Previous traumatic experiences, especially in early life
Family history of PTSD or depression
History of physical or sexual abuse
History of substance abuse
History of depression, anxiety, or another mental illness
High level of stress in everyday life
Lack of support after the trauma
Lack of coping skills

Getting help for post-traumatic stress disorder (PTSD)

If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.

It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, post-traumatic stress disorder (PTSD) will only get worse. You can’t escape your emotions completely—they emerge under stress or whenever you let down your guard—and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.
Why Should I Seek Help for PTSD?

Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
PTSD can be related to other health problems. PTSD symptoms can make physical health problems worse. For example, studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

 

[N.E.wguy]

Source: National Center for PTSD
Treatment for post-traumatic stress disorder (PTSD)

Treatment for PTSD relieves symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, treatment will encourage you to recall and process the emotions and sensations you felt during the original event. In addition to offering an outlet for emotions you’ve been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

In treatment for PTSD, you’ll:

Explore your thoughts and feelings about the trauma
Work through feelings of guilt, self-blame, and mistrust
Learn how to cope with and control intrusive memories
Address problems PTSD has caused in your life and relationships

Types of treatment for post-traumatic stress disorder (PTSD)

Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.

Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.
Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.

Finding a therapist for post-traumatic stress disorder (PTSD)

When looking for a therapist for post-traumatic stress disorder (PTSD), seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can start by asking your doctor if he or she can provide a referral to therapists with experience treating trauma. You may also want to ask other trauma survivors for recommendations, or call a local mental health clinic, psychiatric hospital, or counseling center.

Beyond credentials and experience, it’s important to find a PTSD therapist who makes you feel comfortable and safe, so there is no additional fear or anxiety about the treatment itself. Trust your gut; if a therapist doesn’t feel right, look for someone else. For therapy to work, you need to feel respected and understood. To find a trauma therapist, see the Resources and References section below.
Help for veterans with PTSD

If you’re a veteran suffering from PTSD or trauma, there are organizations that can help with counseling and other services. To find help in your country, see the Resources and references section below.
Self-help treatment for post-traumatic stress disorder (PTSD)

Need More Help with Depression Need More Help with PTSD?
Help guide's Bring Your Life into Balance mindfulness toolkit can help.

Recovery from post-traumatic stress disorder (PTSD) is a gradual, ongoing process. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many things you can do to cope with residual symptoms and reduce your anxiety and fear.
PTSD self-help tip 1: Reach out to others for support

Post-traumatic stress disorder (PTSD) can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. Support from other people is vital to your recovery from PTSD, so ask your close friends and family members for their help during this tough time.

Also consider joining a support group for survivors of the same type of trauma you experienced. Support groups for post-traumatic stress disorder (PTSD) can help you feel less isolated and alone. They also provide invaluable information on how to cope with symptoms and work towards recovery. If you can’t find a support group in your area, look for an online group.

PTSD self-help tip 2: Avoid alcohol and drugs
When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, they make post-traumatic stress disorder (PTSD) worse in the long run. Substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.

PTSD self-help tip 3: Challenge your sense of helplessness
Overcoming your sense of helplessness is key to overcoming post-traumatic stress disorder (PTSD). Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.

One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.
Positive ways of coping with PTSD:

Learn about trauma and PTSD
Join a PTSD support group
Practice relaxation techniques
Pursue outdoor activities
Confide in a person you trust
Spend time with positive people
Avoid alcohol and drugs
Enjoy the peace of nature

PTSD self-help tip 4: Spend time in nature
The Sierra Club in the United States offers wilderness expeditions for veterans who have served in recent wars such as Iraq and Afghanistan. Anecdotal evidence suggests that pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing may help veterans cope with PTSD symptoms and transition back into civilian life.

It’s not just veterans who can benefit from spending time outdoors. Anyone with post-traumatic stress disorder can benefit from the relaxation, seclusion, and peace that come with being in the natural world. Focusing on strenuous outdoor activities can also help challenge your sense of helplessness and help your nervous system become “unstuck” and move on from the traumatic event. Seek out local organizations that offer outdoor recreation or teambuilding opportunities.
Post-traumatic stress disorder (PTSD) and the family

If a loved one has post-traumatic stress disorder (PTSD), it’s essential that you take care of yourself and get extra support. PTSD can take a heavy toll on the family if you let it. It can be hard to understand why your loved one won’t open up to you—why he or she is less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.

Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to take care of your loved one, you first need to take care of yourself. It’s also helpful to learn all you can about post-traumatic stress disorder (PTSD). The more you know about the symptoms and treatment options, the better equipped you'll be to help your loved one and keep things in perspective.
Helping a loved one with PTSD

Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.
Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.
Don’t pressure your loved one into talking. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Never try to force your loved one to open up. Let the person know, however, that you’re there when and if he or she wants to talk.

 

[N.E.wguy]

hxxp://en.wikipedia.org/wiki/Posttraumatic_stress_disorder

hxxp://afids.org/publications/PDF/CRI/Prevention%20and%20Management%20of%20CRI%20-8-%20-%20Thoracic-abdominal.pdf

 

[GreggHead]

I didnt read the whole thread, no need to. I live in a state that has prehistoric MJ laws, I break the law almost everyday.
It helps with my back problems, as well as the aforementioned PTSD. I wasnt shot, or shot at - not that I know - but the things I saw, and you saw too, will never go away.
Did you know you can smell in your dreams? Yeah, thats freakin amazing to me.
Thanks for your research and posting. It means something to "us".

 

[N.E.wguy]

Thanks for your post GH. My brother is in Afghanistan atm Army Infantry has multiple ptsd himself from things people should not have to think about so I will not post. But knowledge is power I know I blanketed the thread but just a little a day you can make it thru it all I have yet to read some parts just getting it out there is step one to me at all costs.. People are dying this is not a joke it needs this attention NOW not later, later may very well be to late for one of us!

thanks again to all who view and SHARE!!!

Thanks you for your service~!
my life was saved by a Vietnam vet medic because he was not afraid to rip me apart, actually terrible story of how he died after saving me I will post some one it.. I owe him my life and he is no longer with us so I may as well keep his spirit alive...

 

[N.E.wguy]

One of the Saddest days of my life yearly...i was shot in dec. 96 almost not alive to save me...

hxxp://www.bu.edu/today/2008/bmc-trauma-chief-drowns-in-boating-accident-2/

BMC Trauma Chief Drowns in Boating Accident

Erwin F. Hirsch, a much-respected and well-loved physician who served as chief of trauma surgery at Boston Medical Center for 25 years, died Friday, May 23, after his dinghy capsized in the harbor off Rockport, Maine. The 72-year-old surgeon was legendary for his efforts to provide the highest quality care to all patients, regardless of their finances or personal histories, and for his seemingly inexhaustible energy and goodwill.

“Dr. Hirsch was instrumental in the development of the Boston Medical Center level one trauma center, which is one of the best of its type in the world,” said Aram Chobanian (Hon.’06), president emeritus of Boston University and dean emeritus of the BU School of Medicine. “He not only was an outstanding surgeon, but he had the organizational skills to develop an intricate and coordinated system for care for the most complicated trauma patients. He also worked internationally to develop trauma centers in other countries. He trained innumerable medical students and house officers, and his legacy will live on through them.”

Jonathan Olshaker, chief of emergency medicine at BMC and chair of the MED department of emergency medicine, said Hirsch would truly be missed. “Erwin Hirsch was an amazing man,” said Olshaker. “His dedication to his patients, residents, and students was simply unsurpassed.”

Peter Burke, BMC chief of critical care and a colleague of Hirsch’s for 10 years, said the center was very fortunate to have had the enormous experience that Hirsch brought with him. "One of his strengths was that he was able to teach the rest of us how to deliver excellent trauma care,” said Burke. “So while he is gone now, his knowledge is not.”

The Boston Globe reported that as many of his peers retired, Hirsch continued to accept as many overnight rotations as surgeons half his age, that he encouraged his staff to engage in cutting-edge research on trauma interventions, and that he told his medical students to never ignore a child’s birthday.

John Auerbach, commissioner of the Massachusetts Department of Public Health, described Hirsch as a great friend and advisor to the department for more than 25 years. Hirsch was an original member of the DPH Trauma Advisory Committee and served as its chairman until his death. “His leadership drove the development of the state’s Trauma Registry,” said Auerbach. “His efforts will improve emergency trauma care for all the residents of the commonwealth. In addition to the countless lives that he saved as a skilled surgeon, it is fitting that his legacy of service in the creation of the Registry will help save many more lives in the future." Karen Antman, dean of the School of Medicine and provost of the Medical Campus, and Elaine Ullian, president and CEO of Boston Medical Center, said both institutions are grieving the institutions’ loss. "We are shocked and saddened by this news,” wrote Antman and Ullian in a joint statement. “Dr. Hirsch served as chief of trauma surgery at BMC for more than 25 years and was professor of surgery at Boston University School of Medicine. He exemplified our mission of providing exceptional care, without exception. He was a talented surgeon whose primary focus was advancing the treatment of trauma victims. Many people are alive today because of the work of Dr. Hirsch and the trauma team at BMC. Our thoughts and sympathies are with his family.” “Dr. Hirsch is beloved by his residents and his students,” Antman added. “He is a legend. He has been saving lives for decades. If you suffered a trauma in this region, you wanted to be air-lifted to him and treated in his department.”

The Globe reported that Hirsch, who lived in Marblehead, Mass., was in a dinghy in Rockport Harbor with Kevin Wilkins, a 46-year-old resident of Salem, Mass., when the boat capsized and both men were thrown into 48-degree water. After clinging to a moored boat for more than a half hour, Wilkins was pulled from the water and treated for hypothermia. Wilkins alerted rescuers to the disappearance of Hirsch, who was pulled from the water and given CPR. Hirsch was pronounced dead at Penobscot Bay Medical Center in Rockport.

Suresh Agarwal, a trauma surgeon at BMC, told the Globe that the opportunity to work with Hirsch was the reason he came to Boston Medical Center. “He was a father, a friend, a role model, and someone I aspire to be like,” said Agarwal. “He is a true giant in American trauma surgery.”



-----
Dr. Erwin F. Hirsch – Fifth Year Anniversary
May 23, 2013

Boston Trauma
At Boston Medical Center, the Trauma Service and the Emergency Department have a longstanding legacy of providing comprehensive emergency and trauma care to the critically ill and injured. We are the largest and busiest provider of trauma and emergency services in New England and the longest verified Level I Trauma Center in New England

This Memorial Day Weekend marks the fifth anniversary of Dr. Erwin F. Hirsch’s untimely passing. It doesn’t feel like five years to me because in so many ways his influence is still with us. Those that had the opportunity to work with him still feel his presence in our daily activities and especially in the extraordinary events around the recent Marathon bombings. We find ourselves thinking, what would Dr. Hirsch do? What would he think about this? And I hope I don’t disappoint him and the high standards he holds for everyone.

People often remark about how much things have changed (some for the better, some not), since his death and would he have been able to alter or affect these changes were he still with us. That will always be the subject of debate, but one thing is certain; change is inevitable and that includes the people around us. What we must do is manage change by learning from the past, staying engaged in the present and not losing sight of our mission going forward in the future. Keeping the patient at the center of the plan and striving for exceptional care every day, I believe would both honor his legacy and make him proud of the work we are all doing in his absence.

If we can continue to remind one another of these simple goals, everything else will be a “Piece of Cake”.

Joseph Blansfield, NP, Trauma Program Manager, Boston Medical Center

 

[N.E.wguy]

From the Metro staff at The Boston Globe
hxxp://www.boston.com/news/local/breaking_news/2008/05/dr_edwin_hirsch.html

Dr. Erwin Hirsch, renowned trauma surgeon, 72

May 27, 2008

Hirsch at Boston Medical Center in 2006.

By Bryan Marquard, Globe Staff

Nearly 20 years ago, when Elaine Ullian was head of Faulkner Hospital, she got an inkling of the high regard with which Dr. Erwin Hirsch was held across the country.

"I was recruiting a surgeon and he said, 'It will be fun to come to Boston because the best trauma leader in the world is Erwin Hirsch and I'll get to see him,'" Ullian, now president and CEO of Boston Medical Center, said today. "Erwin had rock star quality in the trauma community -- he really was a rock star. And he would be very amused to hear me say he was a rock star. He would giggle."

Drawing lessons from a life that spanned three continents and vast changes in the medical field, Dr. Hirsch spent more than three decades turning Boston City Hospital and its successor, Boston Medical Center, into the city's premier trauma center, all the while training physicians who used the knowledge he shared in careers throughout the country.

Dr. Hirsch, who was 72 when he drowned Friday in a boating accident in Rockport, Maine, "was iconic," Ullian said. "I cannot think of anybody at this medical center who was held in the same esteem that Erwin Hirsch was."

"He had an impact not only at the Boston Medical Center, but also on how trauma is practiced in the city and in the state as well -- and in the country, it would not be unfair to say," said Dr. Peter A. Burke, chief of surgical critical care at Boston Medical Center. "He had a national reputation as a person with an enormous amount of experience. Trauma, unlike other specialties, is something that requires experience because no trauma is alike and you're always dealing with the unknown, really."

Beginning in the early 1970s, when he was an assistant professor of surgery at Tufts University School of Medicine and had a clinical position at Boston City Hospital, Dr. Hirsch began building the trauma program that would become his legacy. Appointed assistant chief of surgery at the hospital in 1977, he worked with Dr. Lenworth Jacobs to secure for the hospital a Level 1 trauma center designation.

"First and foremost he was for the patient and it didn't matter to him who that patient was -- rich person, poor person, whatever," said Jacobs, a professor of surgery at the University of Connecticut and director of the trauma program at Hartford Hospital. "He was going to take good care of that person, that was his defining moment. This might sound a little trite, but with trauma, you get to know your patients very, very well and Erwin was a people person. He would really go out of his way to make sure his patients got anything they needed to get better."

In the early 1980s, Dr. Hirsch worked behind the scenes to create Boston MedFlight, a nonprofit financially backed by several of the city's hospitals that uses helicopters, a small jet, and ground vehicles to transport patients. He served on its board of directors since the service was created.

"My crew will tell you he's the father of MedFlight, and they say it with reverence," said Suzanne Wedel, medical director and CEO of Boston MedFlight.

"He also was one of the earliest people to welcome women into surgery," she said. "Even when women in surgery were an unusual breed, there were many women in surgery at Boston City Hospital and Boston Medical Center."

Dr. Hirsch, who became chief of trauma surgery at Boston Medical Center, was also a professor of surgery at Boston University School of Medicine for more than two decades.

"Trauma is a social issue as much as a medical one," he told the Globe in 1984. "The reasons [this society] sees so much of it are obvious. We drive too fast and drink too much. We batter our children and stab strangers on the street. We glamorize violence on television, then permit every Tom, ****, and Harry to own a gun."

Born in Mannheim, Germany, Erwin Federico Hirsch was the oldest of three sons and left the country with his family in 1939 after his father was released from a Nazi concentration camp, according to information from his family. In Buenos Aires, where the family settled during World War II, he was a member of the Argentine national rugby team and in 1959 graduated from the medical school at the University of Buenos Aires.

Immigrating to the United States, Dr. Hirsch trained as a surgeon at Washington Hospital Center in the nation's capital and at University of Maryland Hospital's shock trauma unit.

He volunteered for the Navy during the Vietnam War, served as a surgeon in Da Nang, then remained in the Naval Reserves and was stationed briefly in the Persian Gulf during Operation Desert Storm. While in Vietnam, his family said, he learned to sail, a pastime he continued to pursue after returning home.

"He was a citizen of the world, he really was, and he had a wonderful sense of humor -- his eyes always sparkled," Ullian said. "He just was full of life and he loved his family. He just adored his wife and his two daughters. I used to tease him: Here he was such a strong personality, and how fitting it was that he was surrounded by three equally strong women."

Dr. Hirsch leaves his wife, Susan, of Marblehead; two daughters, Christina Townsend of New York City and Kathleen of South Boston; and two brothers, Carlos of Sao Paulo, Brazil, and Cristobal of Buenos Aires.

 

[N.E.wguy]

hxxp://www.goarmyreservedocs.com/a-T_TraumaSystem.html

TRAUMA SYSTEM DEVELOPMENT IN A THEATER OF WAR: EXPERIENCES FROM OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM.
Brian J. Eastridge, MD, Donald Jenkins, MD, Stephen Flaherty, MD, Henry Schiller, MD, and John B. Holcomb, MD
Source: The Journal of TRAUMA Injury, Infection, and Critical Care

Background: Medical lessons learned from Vietnam and previous military conflicts led to the development of civilian trauma systems in the United States. Operation Iraqi Freedom represents the first protracted, large-scale, armed conflict since the advent of civilian trauma systems in which to evaluate a similar paradigm on the battlefield.

Methods: Collaborative efforts between the joint military forces of the United States initiated development of a theater trauma system in May 2004. Formal implementation of the system occurred in November 2004, the collaborative effort of the three Surgeons General of the U.S. military, the United States Army Institute of Surgical Research, and the American College of Surgeons Committee on Trauma. One trauma surgeon (Trauma System Director) and a team of six trauma nurse coordinators were deployed to theater to evaluate trauma system component issues. Demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data were gathered for 4,700 injured patients using the Joint Theater Trauma Registry. Interview and survey methods were utilized to evaluate logistic aspects of the system.

Results: System implementation identified more than 30 systemic issues requiring policy development, research, education, evaluation of medical resource allocation, and alterations in clinical care. Among the issues were transfer of casualties from point of injury to the most appropriate level of care, trauma clinical practice guidelines, standard forms, prophylactic antibiotic regimens, morbidity/mortality reporting, on-line medical evacuation regulation, improved data capture for the trauma registry, and implementation of a performance improvement program.

Conclusions: The implementation of a theater trauma system demonstrated numerous opportunities to improve the outcome of soldiers wounded on the battlefield.

Key Words: Battlefield, Combat, System, Trauma, Quality improvement, War.


The development of trauma care has been a synergistic relationship between the military and civilian medical environments for the past two centuries. During the Civil War, military physicians realized the utility of prompt attention to the wounded, early debridement, and amputation to mitigate the effects of tissue injury and infection and evacuation of the casualty from the battlefield. World War I saw further advances in the concept of evacuation and the development of echelons of medical care. With World War II, blood transfusion and resuscitative fluids were widely introduced into the combat environment and surgical practice was improved to care for wounded soldiers. From his World War II experiences, Dr. Michael Debakey noted that wars have always promoted advances in trauma care because of the concentrated exposure of military hospitals to large numbers of injured people during a relatively short span of time. Furthermore, this wartime medical experience has fostered a fundamental desire to improve outcomes by improving practice. In Vietnam, more highly trained medics at the point of wounding and prompt aeromedical evacuation decreased the battlefield mortality rate even further.

In 1966, the National Academy of Sciences published “Accidental Death and Disability: The Neglected Disease of Modern Society,” noting trauma to be one of the most significant public health problems faced by the nation. Concomitant with advances on the battlefield and the conclusions of the National Academy of Sciences was the formal development of civilian trauma centers. In 1976, the American College of Surgeons produced the first iteration of injury care guidelines, the “Optimal Resources for the Care of the Injured Patient.” This concept rapidly evolved into the development of formal, integrated trauma systems. Trauma centers and trauma systems in the United States have had a remarkable impact on improving outcomes of injured patients, reducing mortality by up to 15% in mature systems.

However, despite the evolving successes of civilian trauma systems, Operations Desert Shield and Desert Storm in 1992 highlighted a number of issues in which the U.S. military had fallen behind the successful construct fostered by civilian systems of injury care. Inadequacies were formally noted in both preparation and delivery of trauma care in the combat environment.3,19–21 Shortly after the terrorist attacks of September 11, 2001, the United States once again had vast numbers of soldiers committed to armed conflict. At this juncture, the medical leadership of the joint forces enacted a plan to emplace a formal system of trauma care in theater to improve the care of the battlefield wounded. The goal was to develop and implement a true trauma system, modeled after the successes of civilian systems but modified to account for the realities of combat. The stated vision of the joint theater trauma system was to ensure that every soldier, marine, sailor, or airman injured on the battlefield has the optimal chance for survival and maximal potential for functional recovery. In other words, to get the right patient to the right place at the right time.

Methods
The joint military forces of the United States initiated the development of a theater trauma system in May 2004. Initial groundwork included military surgical consultant visits to theater followed by the identification of a trauma surgeon (Trauma System Director) to be placed at the theater’s medical command headquarters to introduce the concept and importance of establishing a trauma system in the theater of operations. After this preparatory phase, a collaborative effort of the Surgeons General of the U.S. military, United States Central Command, the United States Army Institute of Surgical Research, and the American College of Surgeons Committee on Trauma formally implemented the system in November 2004. A trauma system director and a team of six trauma nurse coordinators were deployed to the theater to address trauma system components and to organize the medical assets and identify discrete deficiencies within the existing medical infrastructure. A formal system performance improvement process was initiated. Injury data, including demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data, were gathered using a Joint Theater Trauma Registry (JTTR). Interview and survey methods were utilized to evaluate logistic aspects of the system.

Results
The initial charges of the system were identified as follows:

Recommend improvements to the trauma system to:
optimize placement of surgical assets within theater.
decrease the number of surgical sites within the theater.
develop triage criteria for casualty evacuation to get “the right patient to the right place at the right time.”
develop and implement trauma practice guidelines.
Review and maintain the following:
JTTR
Morbidity and mortality reports shared between institutions
Operative case reports
Develop clinical information management scheme.
Implement a system of continuous performance improvement.
Develop/write a resource for optimal care of combat casualties, “green book” utilizing the Optimal Resources Gold Book as a template.

Derived from the Resources for Optimal Care handbook, component elements of the trauma system included prevention, point of wounding/battlefield care, and acute care facilities. To be complete and successful, the system implementation also mandated placement and evaluation of infrastructure elements including trauma leadership (impact of education on medical and tactical planning, etc.; path to leaders who make the decisions); professional resources; performance improvement; morbidity and mortality information management; research and education; and advocacy.

Prevention
Since the implementation of the military trauma system, the effect of new prevention measures has been most marked in the reduced number of soldiers killed from combat wounds, with current case fatality rates of 8.8% compared with 16.5% during Vietnam23,24 (Tables 1and 2). The two primary modes of prevention are realistic and relevant predeployment training and personal protective equipment.

Numerous trauma training programs, including the Army, Air Force, and Navy Trauma Training Centers associated with nationally renowned Level I trauma centers, have evolved to train providers to treat combat injury and prepare them for the realities of medical care on the battlefield. Others courses, such as Tactical Combat Casualty Care, Emergency War Surgery, and the Joint Forces Combat Trauma Management Course, have revolutionized the way medical providers are trained for wartime deployment.

Data gathered about injury patterns has driven force protection changes in combatant training and equipment. The impact of the personal protective equipment (body armor) fielded during this conflict has been substantial. In an early interim analysis of casualties from January to July 2004, the rate of thoracic injury was 18% in patients without body armor and <5% in soldiers wearing armor. As the conflict transitioned from a maneuver war, in which most injuries were the result of gunshot wounds, to an insurgency characterized by ambushes and improvised explosive devices, wounding patterns changed from mainly small arms injuries to multiple fragment injuries. Rapid fielding initiatives led to the up armoring of military vehicles with anecdotal concomitant reports of a decrease in the number and severity of these types of injuries.

 

[N.E.wguy]

Battlefield Care
Most deaths on the battlefield are caused by total body disruption, severe brain injury, or hemorrhage. Little can be done on the battlefield for primary injury from total body disruption or severe brain injury. However, attention to hemorrhage control at the point of wounding is the focus of ongoing efforts. Responding to feedback from medics and corpsmen on the battlefield, a number of products and therapeutic devices have been fielded to the battlefield for hemorrhage control, including new hemostatic dressings and newly tested and selected tourniquets. Reports from the battlefield thus far have documented efficacy of both dressings and tourniquets in the tactical environment similar to those in the literature.

Acute Care Facilities
The onset of Operation Iraqi Freedom was marked by a rapid ground influx of combat elements that required attached medical/surgical capability to support the fast-paced tempo of the conflict. Surgical support was initially ascribed to small surgical units such as the Army forward surgical team and the Navy forward resuscitative surgical system. Subsequently, more robust hospital elements with more operating room and intensive care unit capability were established throughout Iraq. With the increased capability came an increased capacity to render higher level care to soldiers injured on the battlefield. The larger hospital units were capable of operations 24 hours a day, 7 days a week, and could provide trauma care at a standard that would be expected of a major trauma center in the United States.

Leadership
With the backing of the Central Command Surgeon and the three Surgeons General, the position of trauma system director was rapidly incorporated as a general staff position within the theater medical command. This leadership position enabled the trauma system director to rapidly implement actionable items such as data collection, implementation of standard practice guidelines, and performance improvement. A number of trauma clinical practice guidelines have now been instituted as standards of care within the theater trauma system, including deep vein thrombosis prophylaxis, prophylactic antibiotics, hypothermia prevention, and the management of specific battlefield injury patterns such as burn, vascular injury, and penetrating traumatic brain injury. To illustrate the efficacy of clinical practice guidelines in theater, the rate of hypothermia upon presentation has been decreased from 7% to <1% since inception. The leadership and administration of the combat trauma system is roughly analogous to the leadership hierarchy of the U.S. civilian trauma community. These intrinsic leadership entities within the medical system drive advances within the trauma system by direct oversight of the medical processes and advocacy, which ultimately leads to better patient care.

Professional Resources
Professional resources are a finite and precious commodity, not only for the maintenance of the trauma system, but also for the medical care of injured warriors. Evaluation of the surgical assets in theater by the trauma system made a strong case for redeploying home many of the smaller surgical units after the larger combat support hospitals were established to conserve vital surgical resources, especially in light of the ongoing nature of the conflict and the likelihood of subsequent deployments for these individuals, approximately 65% of whom are Reserve soldiers.

In the context of the trauma system, it was rapidly determined that one trauma coordinator was needed for oversight at each combat support hospital to guarantee compliance with guidelines, improve information management, and enable data collection. Predeployment training for these individuals was performed under the guidance of the trauma coordinator and staff at the Brooke Army Medical Center and Wilford Hall Medical Center, the two Level I trauma centers in the Department of Defense. These trauma site coordinators have proven invaluable to the function of the combat trauma system.

Information Management
Multiple deficiencies were noted in all aspects of the information management and casualty information flow of injured patients. This immediate concern was one of the primary issues addressed by the system. One basic problem noted early in the evaluation was the relative paucity of clinical patient information, which was transferred to the next higher level of care. In many instances, for lack of a better method, surgeons wrote brief narratives in marker directly on patients&#8217; dressings to convey clinically relevant information.

The reason for this lack of information flow was multifactorial, but included communication failures, operational tempo, casualty acuity, casualty load, etc. The goals at the system level were to improve clinical information flow, thereby minimizing the number of duplicate procedures at multiple levels of care and streamlining the continuity of care for soldiers being evacuated from the battlefield. Several strategies are currently being implemented to correct this problem, including universal serial bus memory devices and Internet-accessible electronic medical records. One particular instrument was developed in response to the trauma system demand. This tool known as the Joint Patient Tracking Application is a Web-based application that allows users to get real-time information about the status of injured troops as they make their way through the medical system.

The other aspects of information flow essential to the improved care of injured soldiers were the performance improvement project and registry data management currency. The performance improvement process was adopted at all combat support hospital sites and is being utilized to identify inadequacies in the evolving system. Registry data that was being completed at a 10% rate before the system is now being collected on >80% of casualties within the current theater of operations.

Research
Before the current conflict, much of the data on combat injury was derived from the Vietnam conflict and the Wound Data and Munitions Effectiveness Team database. Before the development of the formal combat trauma system, little data were being published about the conflict, and the data being published was largely small series and case reports. With the thought that research drives doctrine, a concerted effort was put forth to field the JTTR. This registry is a concise form developed to capture demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data along with a brief physical examination. To date, with improved registry capture as a direct result of the trauma system, the JTTR database contains >7,500 soldier injury records as well as data on other individuals injured and cared for at U.S. theater medical assets. The results being derived from this data will likely drive the course of combat trauma care for decades to come.

Ongoing joint military research efforts include the following:

Personal protective gear
Body armor extensions
Kevlar helmet revisions
Hemostasis
Battlefield tourniquets
Hemostatic dressings
Recombinant factor VIIa
Resuscitation
Hypotensive resuscitation
Hemostatic resuscitation
O2 therapeutics/hemoglobin-based oxygen carriers

Education and Advocacy
Combat injury is the most substantial healthcare issue in theater. Two-thirds of all evaluations at combat support hospitals are for injury. One goal of this system has been to educate soldiers, leaders, and medical providers and commanders with respect to the importance of maintaining the system that has been built. Coalition partners, including the British, have expressed sincere interest in broadening the system into a multinational coalition venture. The combat trauma system has become the standard of care on the battlefield.

Conclusions
The combat trauma system has improved combat casualty care to a level never seen before. However, a less tangible but nonetheless very real and practical impact of the combat trauma system is the effect it has on soldiers and families and morale. They can read in the newspaper or see on the television that combat soldiers injured on the battlefield have a greater chance than ever before of surviving their injuries and returning home. Although this marked improvement in outcomes is multifactorial, the continued evolution and development of a deployed trauma system will certainly have a lasting impact on the delivery of healthcare on the battlefield of today and the future. Full implementation of the joint theater trauma system will ensure that the credo, &#8220;Right Patient, Right Place, Right Time,&#8221; will be met and lives will continue to be saved as a consequence.