The following is a transcript of the "Chat with Dr. Cantrell" from March 5th, 2009. Links to additional resources and information from the chat transcript are included to the right.
dr._cantrell
Hello everyone, who has a question for me?
lstmaloney
don't even know where to begin
dr._cantrell
just write down a question
lstmaloney
when talking to my son... are there topics i should avoid
dr._cantrell
Absolutely!
lstmaloney
what?
dr._cantrell
You let your Marine set the course so to speak, and don't ask too many questions.
mel_c
Do you have any advice for keeping acid reflux under control?
dr._cantrell
Minimize stress, this is something that sure has an affect.
wayne
I can sort of relate to lstmaloney -- i'm expecting my son to return from his first deployment soon -- and i'd like to know what to expect.
dr._cantrell
It is hard to say how each one will respond, but be sure and give them plenty of space, and don't parent them.
dr._cantrell
They have been down range and have changed significantly. They need their time to be with their buddies, or whomever they wish and this is what is so hard for parents to deal with.
lstmaloney
my son denied it for over a year before it blew up out of control I knew he had it but thought it was best for him to come forward was I wrong.
dr._cantrell
Don't ask questions and just let them open up if they choose to. The more you demand that they disclose the more they will retreat
dr._cantrell
It takes time for them to find themselves and understand how they have been effected.
dr._cantrell
It is usually around the 3 to 6 month mark that they start to get a little frustrated with themselves and others.
dr._cantrell
You may see them wanting to party more with their buddies, and stay out late or not come home. They may have more issues with anger and a bit sensitive to sounds, a lot of people. Even doing things that we take forgranted may be very challenging for them at first.
wayne
I just want to be able to do what's best -- particularly since he's only going to be home for about 2 weeks.
dr._cantrell
These two week leaves are sometimes very difficult on them. The families are all excited to see them, and they are excited on one side, but then they are not going to let their guard down and get too comfortable. They think a lot about the ones that are still down range and can't wait to get back to their buddies.
dr._cantrell
This is where expectations get a bit disappointing. Those at home have expectations of how things will be and so may the Marine, and it is not uncommon for these to be completely different than what everyone has in mind.
wayne
that's exactly what I was thinking -- and that's what's brought me here.... I don't want to have "high hopes" that can end up making my son feel uncomfortable.
lstmaloney
my son is currently being treated for PTSD...he is expecting to come home afterwards what can I or should I be expecting?
dr._cantrell
yes, it is important we just go with the flow, and not put pressure on them. They may come home and just want to eat some good home cooking and be free to do whatever they want.
dr._cantrell
As far as your son coming home after being treated for PTSD, this is wonderful that he has been getting care. Just the same types of things, just take it easy with him, and most importantly is to let all of your Marines know that you love them and you are there if they want anything, anything at all.
Green
my boyfriend is still in iraq... and i asked him when he gets home if he'd want to tell me his "war stories" and he said he would. but recently i found out that his unit "saw something distrubing" and he didnt want to talk about it over the phone, but said he'd telll me in person. i'm just wondering if he said he'd tell me when he got home because he doesn't want to tell me and is trying to avoid it
Green
and when i told him i knew, he asked me to tell him, and when i got to a certain part he told me to "stop talking abbout it"...
dr._cantrell
This is possible that he was just doing his best to not upset you. It is not appropriate for us to ask them to tell us about their combat. You have put him on the spot. This is something they feel very uncomfortable about, they wait in an anxious state to asked by a civilian questions about things that we really don't need to know.
Green
so dont ask about anything? what if I can tell he is upset?
dr._cantrell
They don't want to share some of these stories with anyone, and if they do chose to do that it is up to them to make they decision, it is not up to us to ask. You can always ask him if you feel you must to tell you funny stories.
dr._cantrell
Yes, it is best you don't ask him questions. I work with tens of thousands of our troops who are just out of the combat zone and this topic comes up in my workshops,and it something that really sets them off. They don't want to talk unless they choose to.
Green
okay. that is good to know.
dr._cantrell
If he is upset, do your best to change the topic, don't focus on that issue. Sometimes they think they are back in the warzone, so let him know where he is and give him something to hold onto, I refer to anchoring them in present time.
dr._cantrell
If they go too far off into a memory this can be a frightening experience not only for your Marine but for you as well.
dr._cantrell
is there another question
Green
okay, thank you.
joan
Our son has been back for aboutr a year from his last deployment...
joan
He is IRR for 6 months...
joan
and sleeplessness still seems to be an issue.
joan
He stays up most of the night.
dr._cantrell
Sleep is one of the major issues that they deal with. many of them do not like to close their eyes, or perhaps the night is when things happen. So they are very hyper alert and to sleep means a sense vulnerability and this increases their sleeplessness.
joan
Is this someting one can anticipate self-correcting?
dr._cantrell
yes, over time they will ease into sleeping better, but it may also take some medication to get their sleep patterns back in sync
joan
He seems to think he is getting better. He mentioned the other day he no longer takes Nytol. That was shocking to me.
dr._cantrell
Also looking at what are they doing before they go to sleep. Some of them are playing video games and this gets their adrenaline flowing
joan
aaahhhh...that seems very reasonable. I had not thought of that.
dr._cantrell
Great, this is good news. Don't be shocked, many of them will use alcohol to fall asleep, so I think Nytol is a better choice of help aids of the two
dr._cantrell
It takes time, and this is one of the things that can cause a great deal of frustration. They feel that they aren't getting along as quickly as they had anticipated.
joan
Yes. I see that.
dr._cantrell
These are all good signs. Wonderful!!
joan
I get the feeling he keeps himself reigned in a lot. He does talk a bit though. Stories come out at odd times...usually in the middle of the night.
dr._cantrell
This is wonderful if you are there for him whenever he needs to talk.
joan
His father suffered from PTSD, received treatment, and seems far better than he was. Is there any research on a genetic predisposition?
dr._cantrell
What we call this is transgenerational PTSD. As children we learn behaviors from those around us.
joan
Thank you...you are setting off quite a few lightbulbs for me.
dr._cantrell
Good that this makes you think and you can see his behaviors and normalize them.
joan
I don't want to monopolize your time. Does anyone else have questions?
dr._cantrell
Treatment does help and it gives them an avenue to learn more effective coping mechanism, understand what sets them off.
mel_c
is it normal to have extreme fatigue and body aches associated with ptsd?
dr._cantrell
This is something that we see in many people who are dealing with emotional issues. This is also found in different cultures. Some people are not comfortable with talking about their issues, and they internalize them, and the emotions come out as aches, pain, migraines, etc.
mel_c
sometimes it seems as though no matter how much i sleep i'm still tired and i feel very lethargic and as if i weigh 1000 lbs
dr._cantrell
Yes, this is very common. Sometimes what happens, is you may be having nightmares, or poor quality sleep but you can't remember having done so, and you feel lethargic and wasted, even though you feel you got plenty of sleep.
mel_c
wow! i did not know that.
mel_c
Is there medication for this?
dr._cantrell
Yes, I have many troops I see in my practice who say they are so tired, and it is because they are not reaching the deep staget of sleep.
dr._cantrell
Yes, absolutely. You can ask you doctor about some sleep meds, but there is a medication that Dr. Murray Raskins found by fluke that helps with nightmares. It is a blood pressure medication called Prazosin and for many of our veterans they sleep better and their nightmares are lessened to a great degree.
mel_c
I haven't reached a deep stage of sleep in at least 3-4 years. Can this affect my health in other ways?
dr._cantrell
Yes, it sure can. Lack of sleep affects our entire body, our cognitive process is clearly not operating effectively when we are fatigued. It also has a negative role in many of our main body functions.
mel_c
Thank you!
ls
Is sleep walking a possible side effect of this medication?
dr._cantrell
I am not an expert in sleep disorders, but I would think if they are heavily medicated and there gross motor area is activated by something that there could certainly be a relationship. With PTSD we see night terrors, and nightmares.
ls
thx my son is IMing me got to go.
mel_c
what would you suggest to someone who's motor skills have been severely impaired due to PTSD in order to get them working a little closer to normal?
dr._cantrell
I am not familiar with PTSD being related to the quality of motor skills. Could it be that there may be Traumatic Brain Injury in addition to PTSD and this could be the effect that the combination is showing?
mel_c
yes. that is correct.
dr._cantrell
Traumatic Brain Injury of course is very individual, and the effects are different for each person. When it comes to motor skills, it would be best to work with a physical therapist and retrain yourself to do repetative movements to get the muscle memory in sync again.
mel_c
ok. i will do that.
joan
Where can veterans go if they need help once they are no longer active duty?
dr._cantrell
It is a matter of retraining yourself to move again and learning to do so from perhaps a different pathway. Our brains are phenominal in that it can compensate for injuries and rewire itself to do something new.
dr._cantrell
There are sources out in the community depending on where you are located.
dr._cantrell
Many of the VA Medical Centers have Outreach centers.
joan
That is good information to get out there.
dr._cantrell
Repetition is the key in relearning a motor skill.
mel_c
also, Dr. Cantrell you were my therapist a couple of years ago when you lived in Bellingham. I will e-mail you later and let you know just how much you've helped to save my life.
dr._cantrell
Wow, I had no idea, thank you very much. Please do email me and lets chat. Thank you for persevering!!
mel_c
I will. i'll be sure to put "chat room" in the subject line.
vpm_of_josh
Hi My son is going to be deployed soon (1st deployment). One of my biggest concerns is what he will be like when he comes home.
vpm_of_josh
I have gotten your books and have started reading them.
vpm_of_josh
I have worked as a vocational counselor with the VA for years.....a little different when its now my son.
dr._cantrell
Yes, this is very difficult. My books will help you to understand, but do live for the day, and don't focus on what will be. Savor every moment in the present.
dr._cantrell
It is much more difficult when it is your own son. You know what to look our for, and having that compassion and the awareness is wonderful and will be very useful to your Marine.
vpm_of_josh
Oh. i agree. But I was wondering is there anything that I can do before he leaves that will help when he gets back.....to make sure he knows its ok to talk....or not to talk.
dr._cantrell
I think if you just let him know that you are there unconditionally and if ever he needs to talk then your door is always open. Many of them get over there and they get some much into their Marine way of thinking, but when the lights are out, we know they think of their loved ones too.
vpm_of_josh
Ok
dr._cantrell
My best to you and your Marine, you must be very proud!
vpm_of_josh
I am! And thank you
dr._cantrell
You can also think of ways that he would like you to stay in contact. Some like more than others, so see what is best for the two of you
vpm_of_josh
Oh...ok. I had not really thought of that.
vpm_of_josh
Im enjoying your book PTSD Downrange. I have recommended it to others too.
dr._cantrell
Thank you very much. It is easy to read. Once a Warrior:Wired for Life has more interaction in it and looks at how to deal with adjusting to family and society and my new books Souls Under Siege: The Effects of Multiple Troops Deployment and How to Weather the Storm is coming out in about three weeks.
joan
I look forward to reading that one.
vpm_of_josh
Ill look forward to those too.
dr._cantrell
Thank you.
vpm_of_josh
Can they have reactions to things before they deploy? I've noticed that my son does not like going to "blow them up" movies like he use to. And has far less "tolerance" to people in general.
dr._cantrell
of course. Just going thru boot camp came get them going into this direction. He is preparing himself emotionally and hardening himself up a bit to make it through the long haul.
dr._cantrell
In their training they had to things that could trigger them, and he can now associate the "blow them up" movies with his fellow Marines who may have been wounded or fell as a result of such things.
allsmiles
i have a question... maybe not towards PTSD in general... but.. how do you discuss... burial?? obviously last deployment we were not married... and I would have had no control... but now we are... and i'm scared to death to even talk about it
allsmiles
do you have advice to like maybe get over it...
dr._cantrell
are you the spouse or the Marine?
allsmiles
spouse.
dr._cantrell
i want to fully understand you question so please hang on her
allsmiles
okay
allsmiles
let me try and re word
allsmiles
maybe..?
dr._cantrell
are you saying that your Marine does not want to discuss with you if something were to happen to him
allsmiles
uhmm... it's that... I.. don't want to... more or less
allsmiles
obviously... it's not an easy subject to talk about
dr._cantrell
Oh I see, he wants to have this all planned out if he were to fall in combat. You are saying that you don't want to hear of it, is this kind of what I am hearing
allsmiles
pretty much
dr._cantrell
okay this is a very important question
dr._cantrell
You Marine wants to be prepared and have his affairs in order so that you know exactly what he wants to happen. He sees this as being loving and respectful to you and then he can go in peace. This is very important to talk about.
dr._cantrell
It is required that you have all of your affairs in order, your POA selected, and contingency plans for everything and all possibilities. Do you have children?
allsmiles
no
dr._cantrell
If you feel that uncomfortable talking about it, I really think you may need to shore up your social network and talk with other spouses and how they handle this. If something were to happen to your Marine, he must know that you will be okay and that his wishes are heard and fulfilled.
dr._cantrell
If he were to be wounded, it is only right that his affairs be handled in the way that both of you set forth. This is all very important and critical to take care of in a mature and non emotional matter.
allsmiles
yes... which is my issue.
allsmiles
just seeing what I might wanna do
dr._cantrell
This is a big issue. Really think of it from his perspective, this is a reality that everyone faces when they marry someone who is a warrior. You cannot use denial and think that it is not a possiblity. You must be able to speak about all these things openly.
allsmiles
which is very true...
allsmiles
i just have had a few issues with it... emotionally.
dr._cantrell
It is a very difficult think to face and talk about, but it very very important. This is part of showing respect to your Marine. He cannot leave without his affairs in order!!
vpm_of_josh
If a marine does not bring this up, should we?
dr._cantrell
Depending on your relationship to the Marine. Spouses vs parents. Play it by ear, but in this case it sounds like he wants to get resolution so everything is as he wants it to be.
allsmiles
yes.
dr._cantrell
I think it is important to have a plan, in the case of something happening. Even if he is wounded, who does he want at his side, his parents, both parents, his spouse etc. You must find out these things, because they differ for each person.
dr._cantrell
If it is too hard to talk about have him write it out to begin with and then go over portions of the instructions and talk it out so he knows that you understand. You want him to remain mission focused while he is gone, and not worry about you and how you are handling this deployment.
allsmiles
that is a good idea
dr._cantrell
Just take it a little bit at a time, you don't need to pressure yourselves, but do it easy and slow and this will make it more productive and less emotional. Use humor as well, this does wonders to get through some difficult topics.
dr._cantrell
How long have you been with your Marine?
allsmiles
2 years
allsmiles
we have only been married 2 months
allsmiles
but even the last deployment... death was a touchy subject
allsmiles
we just avoided it
allsmiles
but i also did not have control over anything like "that"
allsmiles
furneral wise
dr._cantrell
So this is a relatively new relationship and you are newlyweds, so there many things to explore
joan
Dr. Cantrell, thank you very much for meeting with us tonight.
dr._cantrell
You are most welcome, thank you for your comments and questions.
dr._cantrell
Good night and bless you!!
