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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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My son just returned from Afghanistan in Feb. He suffered

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My son just returned from Afghanistan in Feb. He suffered a concussion from an IED. He was briefly treated in Afghan and then sent back to duty. He complained of headaches, neck ache and back ache. It wasn't until he almost passed out and was dizzy while on duty that he was sent to a hospital in the field. He was kept there for approx. 2 weeks and given sleep meds and they ran tests. He was diagnosed with mild PTSD. He was returned to his unit just before returning home. He returned home....seemingly "fine." As the weeks went on he showed strong signs of agitation, full blown rages of anger, crying easily, forgetful...continued headaches and back and neck aches. He was finally sent to a doctor...they said yes he has PTSD.....it wasn't until he finally broken down in tears and had a full blown panic attack in the Dr.'s office that they finally took him seriously. In just two weeks he has been on probably eight different meds. Zoloft, Abilify, Propanol, Xanax, etc. Many of it wasn't helping....each time he went back to the doctor they prescribed even more meds. My son felt drugged. Plus he still had the anxiety, anger and night terrors. It wasn't until he collapsed unconscious out in the NC heat...he was able to call his wife before he passed out....he was located through his phone. It took several hours....the MP's found him. Taken to the hospital and rehydrated and Cat Scan was performed...found out to be normal. He was told he had a bad reaction to the meds!!!!!!!!!! Very, very long story short....he does not want to go back to the military doctor he was assigned to....he wants a civilian doctor....we need to find one quickly. He wants the help.....but doesn't want to be a guinea pig for a doctor that doesn't really listen to him. Thank you for any help you can give us.




I just found my list of all the meds. that he has been on...prescribed by the doctor.  Gabapentin 300mg, Zoloft 50mg, Quetiapine 25mg, Nortriptyline 25mg, Diclofenacsod Ec 50mg, Propranolol 60mg, Clonazepam 0.5mg, Alprazolam 0.5mg, Prazosin 1mg (with increased dosages per week), Abilify 5mg, and just recently Augmentin for a bad sinus infection. 
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.

First let me say that I can imagine how difficult this situation must be for him and for you. That you are seeking help on his behalf is a very good thing and he is fortunate to have you as a parent. I will also at the end of the posting give you a technique you can share with him that he can use to help with his anxiety from the post traumatic stress disorder (PTSD) he is suffering. It is not a cure but rather something he can use throughout the day or night to help himself in anxiety and the other parts of PTSD.

I am so sorry that your son has served his country and now is having to deal with his problem through the VA or army system. When it comes to PTSD they take the least effective approach because it is quick and just uses medications that can be dispensed. One doesn't work, throw another at the soldier. This is not often effective. Because medications only treat the anxiety and depression symptoms associated with PTSD, not the PTSD itself. Psychotherapy geared toward PTSD is needed for that. So even going to a civilian doctor will not alter this situation. He needs to see a psychologist or psychotherapist who is experienced with PTSD therapy.

Psychotherapy that is helpful is some form of Exposure Therapy. I have found EMDR can be very useful especially for traumas. It is a type of therapy specifically for PTSD originally. Here is the International Society's website:

http://www.emdria.org/

On the web you will find many opinions on EMDR both for and against. I am trained in it and have found it useful. Exposure therapy is also very helpful. HOWEVER, and this is important: I have found that you need to combine these types of therapy with a more introspective, humanistic approach. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. But many EMDR practitioners and therapist working with Exposure Therapy do not take the time to insure the emotional safety of the patient and so that's why you need someone who is more humanistic in approach.

If you don't have a good referral source, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (you can see a photo of the therapist!) look at the listing and see if they list working with PTSD and EMDR and also some form of humanistic therapy in their orientations. And make sure they have experience with soldiers or you are at least confident in them as a therapist and they share your values.

http://therapists.psychologytoday.com/rms/

So, please recommend to him to seek help and to get this treated. I wish you both the very best!

Finally, I am going to put here a protocol that is used for anxiety and PTSD type symptoms that resemble panic attacks. When I work with people who can't sleep because of PTSD, they have great anxiety that often has similar symptoms to panic. It's often that you can't breathe from it, that it's a choking feeling tells me that there's an underlying anxiety we have to address. So I want to give you this technique to help you IMMEDIATELY! while you look for the medical and psychological help. So, I want you to have this easy technique you can use right away to help you in every stage of your social anxiety: when you're thinking about going; when you're in transit; when you're about to go into the social situation. Throughout you will have this technique to help you!

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from panic attacks or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety even if it just seems like sleeplessness, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in a panic attack is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Customer: replied 3 years ago.
Thank you for your help. I will be passing on your relaxtion exercise and the info onto to my son. He has also made an appt. with a civilian doctor.....hopefully this dr will treat and help the problem instead of just only medicating. My son needs someone to listen to him too....not just medicate....which so far has lead to almost an overdose. Thank you again for your help Dr. Mark.
Expert:  Penny Rayas, MFT replied 3 years ago.

The VA has a list of therapist that your son can see they carry his insurance from my VA. If the therapy for him is not working he needs to find a therapist who will work well with him. I have to say I agree with everything Dr. Mark said. I have seen that the problem with working with vets is that they have been trained in the military to not feel their feelings. He will have to become comfortable with feeling his pain slowly and yes meditation works very well in therapy for PTSD in combination with talk therapy. I wonder how I can help you cope with this, this is not easy for you to see.

Customer: replied 3 years ago.
Yes, you are correct...it is very difficult to watch my son go through this. He is a very proud Marine....has received The Purple Heart, the NAM Medal and other accomodations. He wants to serve his country. Since he has been home from deployment the PTSD symptoms have been very difficult on him, me as a parent and above all...his wife and two year old son. My son desperately wants to spare his son from seeing the anger outbursts, crying episodes, etc. We all feel we are walking on egg shells around him....never knowing if he is going to "explode!" He has been told he will probably be medically discharged within the year and of course, will not be deploying with his buddies again in November....which is very hard....he feels he is letting his fellow marines down...plus in some ways he feels like a failure. He feels weak because he can't "control" this "problem!" We want to say the right thing....but we aren't exactly sure what to say to help him.
Expert:  Penny Rayas, MFT replied 3 years ago.

I am so sorry that your son is experiencing such difficulties. I think you are doing your best by being a supportive loving mother. He has to be easy on himself. I have noticed from working with vets that they feel very guilty when they can't serve their country any longer. Is not a realistic guilt but one imposed by their high expectations of themselves. I would tell him that I am proud of him and that I love him no-matter what happens. War is traumatic I can't even Imagen what it feels like when your life and the life of others you love are on the line all the time, or when you see others die in frond of you. Being human means being hurt by all that. I bet he sees being angry and emotional as a weakness when it is not. Some wounds are not visible and harder to treat. I wonder if you can find a support group for yourself. I also would recommend one for your son with other vets in the VA. I think caring so much shows him that you are there for him. It is the best you can do. I wish I had a magic answer. I think encouraging him to talk about his experience is all you can do and keep loving him. As a mother I know that I want to take my kids pain away but both me and you can't do that. I think if he continues to go to treatment eventually he will get better.

Keep your faith..

 

Customer: replied 3 years ago.
FOR DR. MARK

It is very difficult to watch my son go through this. He is a very proud Marine....has received The Purple Heart, the NAM Medal and other accomodations. He wants to serve his country. Since he has been home from deployment the PTSD symptoms have been very difficult on him, me as a parent and above all...his wife and two year old son. My son desperately wants to spare his son from seeing the anger outbursts, crying episodes, etc. We all feel we are walking on egg shells around him....never knowing if he is going to "explode!" He has been told he will probably be medically discharged within the year and of course, will not be deploying with his buddies again in November....which is very hard....he feels he is letting his fellow marines down...plus in some ways he feels like a failure. He feels weak because he can't "control" this "problem!" We want to say the right thing....but we aren't exactly sure what to say to help him.
Expert:  Dr. Mark replied 3 years ago.
Hi, It's Dr. Mark. I'm not sure why Penny got involved in the discussion. She must not have known that we don't interrupt other experts' discussion's. I apologize.

My heart goes out to your son. I very much would like you to have him read this and maybe even respond:

One of the most important things about being a warrior is to know when to be unbendable and when to be flexible. When to not let the enemy penetrate the line no matter what. And when to let the enemy through so you can defeat it as it is passing and vulnerable. It is not weakness to be flexible. It is a strategy of a wise soldier.

And I want you to know that to face the terrors of the night, the flashbacks, the shaking, the loneliness, etc. in isolation is to be unbendable when you need to be flexible. Isolation is not heroic if it is avoidable.

And thank G-d that our country today is so grateful to you and your comrades that there are groups upon groups that are trying to fill a need so you are not alone and isolated. There are church congregations that want to help.

So, it is important to use all the "weapons" that you have as a soldier. And those include psychotherapy for PTSD. I wrote about that above.

And they include Support Groups for soldiers and soldiers with PTSD. The VA might have phone numbers for local groups. Google "Soldiers support group {the name of your city}" or "Soldiers PTSD support group {the name of your city}.

I very much like the online groups at Daily Strength. Here's their PTSD group. It's not just soldiers but so what?

http://www.dailystrength.org/c/Post-Traumatic-Stress-Disorder/support-group

Here's one for military families. Your folks could really use this group along with local groups but you might be interested as well:

http://www.dailystrength.org/c/Military-Families/support-group

And church groups. Talk to pastors about speaking to church groups about what's going on in the war, what it is like, what soldiers need. There are many groups online you can look at for your needs and for information to help your comrades when you talk with people here at home:

http://iavaonline.org/form
http://iava.org/
http://www.veteransforcommonsense.org/
http://soldiersangels.org/support-groups.html

There are so many others. Notice I only use groups that have a ".org" designation. That means they are non-profit.

So my point to you? The enemy today is isolation. Isolation. Please don't give in to that enemy. Get to a competent psychotherapist who is experienced with PTSD and moves through the therapy slowly and competently.

I wish you all the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5170
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Hi Dr. Mark....
I'm still trying to figure out how to maneuver through the Just Ask system. I hope this reaches you. To begin with...thank you so much for your comments and help. My son is doing much better...he is not 100%...not sure he ever will be....but he is much better. The Marines tried to get him "eligible" to return to full duty in October so he could be eligible for deployment in November. Luckily....his doctor...pyschiatrist...refused to release him. After months and months of pure emotional and mental agony my son is finally receiving the help he needs. He has built up a great relationship with his psychiatrist and has finally been able to open up about the events that happened over in Afghanistan. He was injured from an IED...severe concussion, plus other events that happened. My son is finally sharing with us the events that happened to him that have upset him so much! He is finally talking....and we are listening (very horrific things), and telling him we love him and support him. (And we tried not to act too, too horrified about the details he shared). He is on one medication..Gabapentin (sp?) and Ambien every now and then for sleep. The meds keep him on an even "keel"....he is doing much better. He is open to us as to what he needs from us...how to talk to him, etc. He still gets a bit nervous and agitated in crowded areas, doesn't like to be "surprised" and will not watch violent shows. And so much more. He is much calmer with his wife and two year old son. He is now active in parenting! We respect his need to be alone at times....he loves to go fishing. And his drinking binges and anger explosions are much, much, much better. He was fortunate to finally find a civilian doctor that was willing to get to the root of the problem and not just medicate him. He has slowly encouraged my son to face his "demons" from Afghanistan....basically relive it....it worked. Physically he has some brain damage from the effects of the IED...mild....but enough that he will be medically discharged sometime next year. His unit was just deployed again last week....my son felt ..."at odds" to say the least. He wants to be with his buddies...but realizes he is just not physically and mentally able. His wife is very supportive and realized he was going to be missing his marine buddies.....we didn't realize it at the time...but she gave him the best gift possible. (I am telling you this...because I feel it's something that could be passed along to others dealing with PTSD.) My daughter in law took my son to the local animal shelter....they picked out a rescue dog....or I should say the dog picked my son. It's amazing the change in my son....he loves his son...he loves his wife....but he has a special bond with this "lovable mutt" he named Ginger.

I can't thank you enough Dr. Mark for all of your advice and comments. On your suggestion we found an excellent psychotherapist (civillian) that helps my son immensely. And I have passed along the "breathing techniques" to him also.....it helps him to calm down when all he wants to do is explode. My son still has a ways to go....he will never be like he was....but he is doing much better....there is a light at the end of the tunnel.

Thank you so much for your advice and just letting me bend your "cyber" ear.

A very grateful Marine Mom
Expert:  Dr. Mark replied 3 years ago.
This was such a beautiful letter. And it was such a wonderful thing you did that you took the time to write it to me. It was so extremely moving to read it. I am truly deeply touched.


And I am so very happy that your son is getting the treatment he deserves for having given his all for our country. I am really glad to know about the therapeutic effect of having Ginger in his life. I am familiar with "pet assisted therapy" but had not heard of going to the pound. I've only heard of dogs who are trained to be companions for people. This very good to know.


Please convey to him our gratitude for his service to our country and that we out here feel glad he's here taking care of himself so that his child and wife will have a healthy dad and husband rather than him going back to serve again. We need healthy dads and husbands as well!


I wish you the very, very best,


Dr. Mark

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Dr. Mark is a PhD in psychology in private practice