The following is a transcript of the "Chat with Dr. Cantrell" from April 13th, 2009. Links to additional resources and information from the chat transcript are included to the right.
dr._cantrell
Am I in the right room
joan
Phew! Glad you made it in!
dr._cantrell
I understand. Well I will just wait for who ever appears.
dr._cantrell
Welcome.
joan
Welcome PTSD Mom. I am glad you found us.
PTSDMom
My computer crashed. Sorry. I have a few questions.
dr._cantrell
Yes, I had problem getting into the room.
PTSDMom
My son has PTSD and is in an inpatient program in Leavenworth, Kansas. He has the book DownRange and will use it in therapy.
PTSDMom
One of the main things I worry about is that he seems to have no hope that his condition will improve.
dr._cantrell
Wow, that is wonderful. Please give him my regards.
dr._cantrell
That is ridiculous, they will impvove but to needs to work hard.
_David_Mildadx2
ptsd i can say with diffent autority he is wrong, I had it after Vietnam and took awhile but it is better..
PTSDMom
I am sooo glad to hear that.
dr._cantrell
Yes, please don't lose hope, but you all have to work on this process.
PTSDMom
He has a great attitude and is doing everything they're asking, but he is anxious about the process of the program.
PTSDMom
They say the next part of the program is very intense and they will get into the things that happened in Iraq.
dr._cantrell
Just have him go with the flow, remember he survived Iraq and now he can survive this program.
PTSDMom
He is emotionally numb and this bothers him. Can this improve as well?
_David_Mildadx2
yes.
usme_Laura
PTSD Mom...are u the one I helped find the room?
_David_Mildadx2
it did for me.
PTSDMom
Yes.
usme_Laura
ok, just wanted to make sure u found it, good luck!
dr._cantrell
The objective with treatment is to learn what the triggers are, understand the link between the trauma and the behaviors, learn more adaptable copiing mechanisms to deal with these issues.
_David_Mildadx2
ptsd mom you and your son have resouces now for the treatment of ptsd that me and mine did not have
dr._cantrell
That makes such a difference. This is a family affair and the more you learn the better he will feel too and you will be able to understand him better.
PTSDMom
This is true and I've told my son that. He was drinking a lot to help him cope and we knew he would have to find other ways to cope, so we are very hopeful this program will teach him this.
PTSDMom
We did not realize how bad the PTSD was until he entered the program and was not drinking. They rated his severity 9 out of 10.
dr._cantrell
yes, please make sure he sticks with it, and support his effort. This is not a sign of weakness. I am so glad to hear he is getting help.
PTSDMom
I know starting a family would be stressful, but he and his wife are anxious to do so. How will this affect his PTSD?
_David_Mildadx2
dr c's book down range and the book courage after fire are the some of the best out in dealing with PTSD.
dr._cantrell
Please have them hold off, the divorce rate is already off the charts, and adding a child can be stressful and dangerous!!
PTSDMom
I got both of those for my son and he's reading "On Killing" by Dave Grossman.
_David_Mildadx2
his wife will have to really understand this condition too.
dr._cantrell
yes, indeed she will need to also participate in this process.
joan
I understand that part of it. My husband suffered from PTSD.
PTSDMom
I think we all are much better about handling and understanding the PTSD than the drinking.
dr._cantrell
But the drinking and the PTSD go hand in hand. Lets talk about this for a while.
_David_Mildadx2
i can say form expericne that if the wife does not take part in the treatment the marriage will fail.
dr._cantrell
Yes, Indeed. It can anyway, but it sure makes a diference to know that everyone is on the same page.
PTSDMom
She was attending weekly counseling sessions with him at the VA before he entered treatment and I'm sure will continue.
_David_Mildadx2
that is good news if she is attending with him.
PTSDMom
My son also says the drinking goes hand in hand with PTSD and gets frustrated at us when we get upset about the drinking.
dr._cantrell
Alcohol is so common, the troops tells me it makes it easier to socialize, sleep, forget, and let go of stuff.
PTSDMom
My son shakes quite often and the alcohol helps calm him as well as help him get to sleep.
dr._cantrell
But in reality they are dealing with their PTSD, DEPRESSION AND AXNIETY Issues. Alcohol masks these issues, and the pain associated with them, but in reality it also makes things worse.
dr._cantrell
He cannot continue on this path, it is very important that get this addressed by the doctors.
PTSDMom
That was my point to him exactly.
PTSDMom
However, I did not realize how severe his symptoms were until the drinking stopped.
dr._cantrell
His nervous system may be so activated by the adrenaline that he can't calm down, but they give them medications that help with all of this.
dr._cantrell
He must stop in order to get to the symptoms, but he also needs to be ready to face them.
PTSDMom
His meds have increased significantly. They say the middle part of his brain is working all the time -- hopefully you know what I'm talking about.
PTSDMom
They say he was not addicted to alcohol, so I hope he will be strong enough to use the other coping tools he learns.
dr._cantrell
It has nothing to do with strength, it has to do with his tolerance level.
PTSDMom
Please explain?
dr._cantrell
He uses this so he does not have to feel, because he is not ready to remember and deal with all the emotions he has need to bury, and he may find that the alcohol pushes away some of these painful memories.
dr._cantrell
So when the alcohol does what he wants, this just serves to reinforce the need for more alcohol.
PTSDMom
That makes sense. In the next step of his therapy is to remember what he felt while in Iraq. He said some cannot do that, while others get "stuck" there. This makes him nervous, but he's anxious to move ahead.
dr._cantrell
He just has to trust those who are working with him, they will guide and support him through this process.
PTSDMom
He has two doctors who have worked with him for a couple of years and he really does trust them, although he just started talking about Iraq with them recently.
dr._cantrell
How long has he been home?
PTSDMom
He served 3 tours in Iraq and has been home since march 06. His second tour in 2004 was especially bad.
dr._cantrell
It may take some time. Just have him be patient and take it easy.
PTSDMom
Having hope is such a major factor for all of us right now.
PTSDMom
I know my son is discouraged by his condition and afraid he's disappointing his family, but we are strong and will stand by him.
dr._cantrell
This I is so vital.
dr._cantrell
Please let him know it is not a sign of weakness, and he is showing so much strength by getting help.
PTSDMom
I have told him this. One of his buddy's dad is a VN vet and encouraged all those boys to get help, and not ruin a major part of his life as he did. It made a big impact with my son. He has such high respect for all VN vets.
PTSDMom
They had indicated to my son that he may become more violent as time goes on. He has not been at all violent. Do you believe this to be true, or did he misunderstand?
dr._cantrell
There is a tremendous amount of mutual respect from the VN and OIF troops.
dr._cantrell
Have you seen him disconnect and not show much interaction with you.
PTSDMom
These are the things that are scary for him and us as well.
dr._cantrell
I understand, but denial is not effective.
PTSDMom
We've always been close and he has talked a lot with me about his experiences in Iraq. While he's in treatment he hasn't really wanted phone calls and visits have been short for the most part, but I have thought that his mind set is on his treatment and it is hard for him to think about things in the 'outside' world.
dr._cantrell
Yes, you need to honor this boundary. Do not ask him questions about his treatment, just allow him to be emersed in this process.
dr._cantrell
He must really focus and listen to his leaders, they discourage contact with the outside world so to speak so your son can really take advantage of the treatment and the entire experience.
PTSDMom
I agree and have been surprised that they allow as much freedom with visitation as they do. We are all respecting his wishes and are trying to do whatever is helpful to him.
dr._cantrell
WOW is he lucky to have you as his MOM!!!
PTSDMom
Thank you Dr. Cantrell. I have tried so hard to do the right thing and have prayed for guidance in dealing with him. I was anxious to visit with you tonight and see if there is anything else I could learn or be doing to help.
dr._cantrell
I am so glad to have you here tonight.
PTSDMom
I tend to be optimistic, sometimes to the annoyance of my son. I just really wanted to know if it were unrealistic to be hopeful that he will improve.
dr._cantrell
What else do we have to hang onto, but our Hope and Faith that things will get better.
joan
It is very realistic that he will improve!
PTSDMom
Thank you so much! I have faith that my son will continue working his hardest to be the best he can be.
dr._cantrell
Yes, he will, but like I say everyone has to be on the same page. Sometimes if you are too enthusiastic with them they do get annoyed because maybe they do not see their progress, and it is slow to them compared to how life was when he was serving Down Range. Stand Back with and support him from a distance, so he can learn to realize on his own what he has acheived.
Ramona
my son got back from his 2nd deply in Oct to Iraq, he went IRR in Feb, he isnt doing anything, he isnt looking for a job, signing up for school ...
Ramona
is this normal to just have a down time? I dont say anything to him, Im letting him get back into the world in his own time, but I am curious.
dr._cantrell
He is probably a little lost right now. It would be good for someone to talk to him. It is normal but it may be a little extended at this time, but it could be due to some of the issues he might be dealing with.
dr._cantrell
Do you have a veteran who could befriend him?
Ramona
he lives down the road from his grandfather a Koren war vet and we have some Marine Vet friends, but also Koren War. He says he doesn't have PTSD.
dr._cantrell
Yes, he must do it on his own time, but if you are noticing that he is really disconnecting, this is not a good sign, and he may need to have someone to talk to who can help him understand what he is dealing with.
dr._cantrell
He may not! but 99% of them will have Combat Operational Stress Symptoms, this is to be expected. See they are taught.
dr._cantrell
PTSD and COS are not the norm, but in reality it is the norm, and most will be affected in some way. Sleep issues, Anger Issues, isolation, withdrawl, feeling like they just don't fit in like they did before, it is hard for them to connect to people outside of their Marine family.
dr._cantrell
The Marine Corps are now changing their perspective on this as well. I just spoke at a conference where this was presented, and they are seeing that their Marines are affected in these ways, and it does not mean that it is the end of the road.
dr._cantrell
They are normalizing and showing how people can go in and out of these issues, some days are better than others.
dr._cantrell
I would highly encourage the grandfather to just connect with your son, and bring out the Marines to help bring him out a little. He needs some support right now. Is he drinking?
Ramona
he drinks very little. He is happy just being with the family. He gladly does little projects things of that nature, he just isnt moving forward.
Ramona
"very little" meaning, I havent seen him drink so much as a beer in over 2 mos.
dr._cantrell
Well maybe it will take him a little time, but what you are decribing is wonderful that he has a supportive family and he finds solace in spending time with you.
dr._cantrell
Glad to hear he is not drinking. Maybe do something to have the vets engage with him.
Ramona
there is one thing he has a serious anger issue about, a new Marine who was kia on the last deply, he just goes ballistic when anything about him comes up. The young man wasn't in his company, but he is very vocal about this incident. It shocks me to see him just blow like that, I understand it, but itsshocking. This isnt his nature.
dr._cantrell
He might in someway blame himself for the death of this Marine. He might have had a relationship with him eventhough they were not in the same company. This is probably a severe case of survival guilt. He uses anger to push the topic and those who bring it up away. This is severe grief in action.
dr._cantrell
One day he will need to forgive himself for whatever role he had or did not have, and then he will be able to hold him in heart without all the pain that is associated with that memory right now.
dr._cantrell
This is something that is a sign that he does have some things that he is holding onto, and he does have a button, and this is one that does not need to be pushed by anyone. This is where the veterans come into play.
dr._cantrell
Many of them have had losses and can help him move through this.
Ramona
I agree, at first he was angry at the Marine "for getting dead", I knew he didnt really feel that way. I have never tried to open that can of worms with him. Today he brought him up himself and it was with a gentler voice, I didnt ask any questions, I just let him say what was on his mind.
dr._cantrell
Perfect, just to let him talk if he choses to do so. We always have to be aware of anniversaries, (times when something happened that is remembered even in a subconscious way), so he could be a little more emotional over things in general, for him it may be irritable and angry.
Ramona
oh wow I didnt even think of that, that anniversary is within a few days of now, Thank you for mentioning that.
dr._cantrell
WOW, this is amazing, this could be a difficult time for him. If he were open to it, he might want to plant a tree or something to remember his buddy. It would be great if he would be able to think of this, because if you were to mention it, you might walk into a hornets nest. He may not be ready to share this grief with anyone yet.
Ramona
he knows I took this young mans death hard, would I be out of line if I said I wanted to plant one for him?
dr._cantrell
No you could gently approach this, and ask him if he would mind if you planted a tree or a blooming bush to remember him. This would be very respectful and a kind, loving gesture of remembrance.
dr._cantrell
Is there another comment or question?
fourthwatch
My son is on first deployment to Iraq. Many of his friends pass through our doors in So Cal. I'm trying to get educated in the event I need to know all this.
dr._cantrell
Yes, it is very important that family members and those like yourself who have up close and personal contact with Marines learn as much as you can.
fourthwatch
I know you have written books. Can you make a recommendation for me on which would be best to get?
dr._cantrell
Down Range to Iraq and Back is the first one and over 500K copies of that book has been distributed to various branches of service. They have it down range, and it gives you an idea about signs to look out for and to normalize these issues. Souls Under Siege is about the transition to family, and the newest book is a great combination of all of it.
mickie
Dr. Cantrell I have a question.
joan
Will Souls Under Siege be available at the MarineParents Conference this weekend?
fourthwatch
Thank you.
dr._cantrell
Oops Once a Warrior Wired for Life is about the Transition, and Souls Under Siege, the effects of Multiple Troops deployments and how to weather the storm is the one that is newest. YES Tracy got the first box off the press.
joan
Thank you.
fourthwatch
What type of person has the greatest risk to get PTSD?
mickie
Once a Warrior is an excellent book. Thank you for that Dr.
dr._cantrell
You are most welcome. I hope you like the newest book as well. Please let me konw.
dr._cantrell
As far as the person who is most likely to be effected. There are some factors to look at such as the duration of the event, the proximity to danger, adn intensity of the events, and repetition. First off we are all so different, with different levels of resiliency, and life experiences.
dr._cantrell
These are factors that affect our way of dealing with some of life's experiences. There is no telling how one will be affected, and it is not a sign of weakness.
fourthwatch
That makes sense. One last question if I may...
fourthwatch
At one time I read the sooner you deal with a traumatic event the sooner you will heal from it... It that still true?
dr._cantrell
Yes, research does support this. If an intervention takes place early on in the process the better the outcome. However, not everyone will be exhibiting signs and symptoms early on, some of this may take some time to emerge. I say intervetions come in many forms: Talking to other veterans, a chaplain, a psychotherapist, doing activities with others who share a common experience.
dr._cantrell
I have Combat Veterans International up here in the Northwest and their are other chapters as well. But they are veterans who ride motorbikes, and they have done some incredible interventions with many OIF service members, so this is a group who helps our troops and they are combat veterans themselves.
fourthwatch
Thank you for all your insight, time, and your graciousness to help our men come home and be whole and productive members of societyl. I am off to the Marine Parents Bookstore for your books.
dr._cantrell
Thank you very much, it is my honor to be of help in any way possible.
joan
Are there additional questions for Dr. Cantrell?
mickie
Yes.
mickie
Dr., when you said the Marine Corps is changing their perspective, can you elaborate a bit?
dr._cantrell
Yes, I have seen from information I was presented that the Marine Corps are really doing a lot processing over the issues of PTSD and COS, as is the ARMY, Air Force and Navy.
dr._cantrell
They are seeing how people go in and out of levels of disruption in their lives, and it is a continuum of distress, and some days are good, and others may be more activated.
joan
That is very encouraging to hear.
dr._cantrell
YES< it is very encouraging, because it is real and they see that they must encourage their Marines to get help and this will do wonders to keep them healthy in Mind Body and Spirit
mickie
this is so important for them to recognize. I don't know how the other branches are, I've heard the Army is better but I know of too many Marines who feel they arent supported.
dr._cantrell
I have been saying this forever, so I am very encouraged to see this. Because I work very closely with the Army units, I know that they are inviting me (a Civilian) to conduct my workshops for their troops who are returning right out of the warzone, this is wonderful.
mickie
indeed!
joan
yes.
mickie
Good news on both points.
dr._cantrell
They have bigger numbers, and can see that they must do something to inspire their troops to get help and maintain their health on all levels.
dr._cantrell
Even the Air Force is on this as well, I just spent a month in Hawaii, Japan and Okinawa on the Air Bases talking to the Commanders about this process of inspiring their guys to get HELP.
mickie
And it's so important for them to not be ridiculed when they do seek help! I hope the commanders are adopting this philosophy.
dr._cantrell
We are turning a corner, but we must not let the pressure down, we must all encourage our Marines, to get help and let them know that is ok if they are not doing so great here and there, but tomorrow is a new day and they must be actively involved in the process to embrace all aspects of themselves.
joan
indeed.
mickie
Thank you Dr. I look forward to seeing you in San Diego next week and hearing your presentation again.
dr._cantrell
YES, they must NOT EVER BE ridiculed for getting help. It is up to all of us to not tolerate this to be the standard of care. We must keep them accountable for the well being of our men and women in uniform!!
mickie
Absolutely.
joan
Thank you for joining us this evening, Dr. Cantrell.
dr._cantrell
Our Service Members deserve the Best there is!!
joan
Indeed they do!
dr._cantrell
Thank you very much See you in San Diego!!
joan
PTSDMom...thank you for all you brought to chat this evening.
PTSDMom
Thank you so much Dr. Cantrell for listening and answering my questions.
dr._cantrell
Thank you very much, it is all of you and what you bring that makes it so rich!!
dr._cantrell
You are most welcome. My Best to you and your Son!
sa818
Dr Cantrell I have spoke to you before about my son and want to Thank you for he finally has come around and things are going well.
dr._cantrell
So glad to hear this, thank you for letting me know.
sa818
it took time and patience on my part and also your books are wonderful.
dr._cantrell
Thank you, this makes me tearful with joy!!
dr._cantrell
Good night all and take good care of yourselves and our Marines!!!
