Tag Archives: PTSD

Cold Spaghetti, Hyper Vigilance and #PTSD

A Grunt's delight

Eat’em cold

I developed a keen palette for eating MRE’s cold in Ranger school.  Whoof down your food while you can because you may not get a chance to eat it later.  (“You can taste it later, Ranger.”, was a favorite RI catch phrase.) While I trained in Ranger school under the stressors to mimic combat, (little sleep, malnourishment, extreme physical exertion) the lessons and habits I picked up still stay with me to this day.  I eat my food, as my family would say, like a gavone, and I prefer my food cold.  There was little time to eat in Ranger school, so heating up the meals always seemed like a waste of time.

I also developed this boy scout preparedness mind set. Map? I go nuts without one (thanks you smart phones). Knife? In all my cars… Right next to the first aid kits and flashlights.  All of this preparation is to save the precious seconds when shit hits the fan.  Combat only reinforced what I learned in Ranger school.

In Iraq my crew and I kept a tight track.  Everything was organized and ready to spring at a moments notice.

Ammo, water, food.  Check, check, check.  Batteries, Commo fill, fuel. Affirmative.

The days that reinforced the preparation are sometimes the stuff of legend.

Cold Spaghetti, Hot barrel

Spaghetti.  Spaghetti with cheese and crackers mashed into one pouch.  Cold.  Cold spaghetti, cheese and crackers mashed, into one pouch.  It was easy, it was fast and it had this horrible constipating effect. In my mind it was the perfect grunt meal.

We were in the TOC listening to Red platoon move into the new Patrol Base.  They were in the north west part of our AO and had an Iraq Army attachment assisting with the move in.

“Hey Sir, how do you eat that shit?”  My driver asked.

“What?” I replied with a mouth full of crackered cheesy spaghetti goodness.

“That cold spaghetti, how can you possible eat it like that?” he clarified.

I was just about to shovel my last bite.  I paused and looked at him and his MRE.

“That’s yours right?” pointing to his bubbling sack of food.

“Yeah.”

“And I’m done eating right?” showing him my near empty pouch.

“Yeah, So?”

“Hot food is a luxury.”

“How do you figure?” he started to say.

BOOoOoOoOm. The walls shook.  It could only be Red in trouble.  I was getting reinforcement for my warped cold food rationale.

My wife was on station and the radios lit up with the her voice reporting the contact.

I ran in to get my kit.  My driver, without hesitation and leaving his warm food behind, left to get his.

Time runs in slow motion when sh-t hits the fan.  In seconds we were out the door and on my Bradley.  Seconds later we were rolling out the gate heading towards the plume of smoke still rising from Red platoon’s last check-in.  Training and adrenaline take over.

The Kiowa’s continued circling as we raced towards Red platoon.

God, if you are up there, I can use a hand down here.  I’ll trade something for them.  Just don’t let them be hurt.

Bang bang bang!

“Sir, are they shooting at us?”, my gunner asked. “I hear the pop of gunfire.”

“No,” I replied. “I’m shooting at them.“

I emptied one clip of my Berrta as warning shots. I was reloading it and firing my M4 at anyone or any vehicle attempting to intersect our path.  The message was clear.  It was not a time to mess with this track.  I was prepared. My adrenaline was spike.

Outlaw 26 (aka my wife) called in that Red one was on the roof and reporting the contact.  A Vehicle Born Improvised Explosive Device (car bomb or VBIED) detonated at the gate to the house Red occupied. They were assessing casualties.

Shit.  Come on Big Man, help me out here…

We pulled up to the house.  The garden walls of everything close by were knocked over.  Car?  Nothing but an engine block laying near the house.  The rest was strewn debris not bigger than the size of a Coke can.

As we pulled up Red One came out and climbed up on my track.  He had the wide eyed look of shock.  I wouldn’t doubt if he was at that point.

I remember asking him if he was ok.  He said he was, but he just needed a minute.  We just took it all in for a time.

“The explosion was so loud I though someone was dead.”  He said.

It turned out that the Iraqi Army Soldier with Red Platoon saw the car pull up.  As the car crept closer the Iraqi raised his weapon, then shot.  The car bomber detonated just hoping to take anyone with him.  He didn’t.  Besides some ringing ears and maybe a concussion, everyone was fine.  Even when you prepare, sometimes things just go wrong and sometimes its better to be lucky than good.

We stayed out there for hours helping the local population affected by the blast and refortifying the outpost.

Then, we traded out with a different platoon and headed back to our camp.

My driver, gunner and I entered the TOC.  They sat down and opened another MRE.  Their food from hours earlier was cold.  I wasn’t hungry.

We were lucky.  We had to be more vigilant.  Could my readiness be better?  “Always.”, I though.  But at least we were ready to go today.

The Price of Ready

I think part of the price of vigilance and preparedness is the inability to let things go or relax.  It takes a great amount of effort, and drugs, to get me to relax.  Even with the help of medicine and time, it is exhausting. (As one of my friends says, “It is a multifactorial problem.”)

That day my quirks were reinforced.  I feel part of human nature is to look for and hold on to things we agree with and avoid things we don’t.  Even unreasonable or illogical acts become habits because I look for the reinforcement and then use that experience as proof I am right.  In therapy I explored a number of ways where this type of mindset can be harmful and how to use reason to separate the illogical emotional evidence and set my mind right.  High probability v low probability, using “always” and “nevers” to justify my actions plagued my mind.

Then, traumatic events would be glued to guilt or remorse for a lack of preparedness or attention to detail.  In the end, it was a lot of hard work in therapy to let go of that which I cannot control, and even some of what I can, to find peace.

I still like cold food and I still have flashlights in my cars.  But, I don’t tie it to my survival anymore.

Zombies, Worrying, and #PTSD

Nightmares and Zombies

I have a recurring nightmare that my Bradley Fighting Vehicle is swarmed by the enemy and I cannot find my rifle or shoot my weapons.  Pretty much, replace the zombies shown above with insurgents and you get the picture minus me screaming.  I wake up in a cold sweat until I realize I am home again.  The nightmare is less now than when I first returned, but I still get a panicked visit quite frequently.  In theatre there were incidents of Soldiers being ambushed from behind while on their vehicles.  I remember one report about a Soldier who was killed at close range on his track.  I think there was a stigma about being on the receiving end of these types of attacks that most of my peers related to weakness.  Worrying about your covering your “Six” is standard for me.

This past week has been a rough one because of a number of factors, some of which are beyond my control.  Unfortunately, though they are beyond my influence, they are still gnawing at my thoughts.  My dog passing and the fever pitch in the news about the debt ceiling negotiations affecting Veterans benefits have me re-running scenarios and working contingencies.  Essentially I am worrying more.

Hot Hot Heat

The weather has been brutally hot and reminiscent of my time spent in the desert.  The intense heat always puts me on high alert.  I can grab winks in the heat, but it is far from sound sleep.  (My remedy is to put attempt to put frost on my windows with my AC…)  In each deployment during OIF I and III there always seemed to be a period of time where we were transitioning to a new AO and comfortable amenities were not readily available.  (Ah, the life of an Infantryman…)  The large operations were targeted in the heat of the summer to preempt an active fall and prey on the insurgents’ laziness and unwillingness to fight in the heat. Lucky us.

In one instance I remember the heat, lack of true safety, and little sleep colliding to wreak havoc on all of us as we laid siege to a town.  We rolled forward through our sector and eventually took over a school as a forward base in searing heat.  While the school did have an air conditioner, the electricity needed to run it was limited at best. Still, we tried to rotate everyone through that room to catch their little bit of sleep in the AC.

Each night of that operation we pounded the city with artillery, close air, Abrams and Bradley fire. (I have a sweet story about a trigger happy an LT for another day…)  We were close enough to the impacts and the forward line of troops that we had to be alert all the time.  We slept whenever we could on whatever we could and trying to achieve any comfort gave way to sheer exhaustion.  The inherent danger being around falling artillery, with insurgents close by, and the constant push of mission planning and execution, I feel that this operation (and others) organizes my mind to relate the heat with anxiety and restlessness and worrying.

Trained to Worry

I was trained as a leader that in combat you do not get second chances.  Attention to detail, flawless execution, and expecting the unexpected are so highly emphasized that when I finally reached combat, I spent each phase of planning and operating ruminating on how to keep my Soldiers alive.

What if x happens?  How would Y impact our next move?  If the enemy does Z, what do we do? It was constant and ever changing with these fluid and dangerous battlefields.  Overlay those thoughts with maintaining my own personal safety (Is this a safe enough position?  If I am attacked now, what are my first moves?  See zombie picture above.), and the result over time is ingrained hyper vigilance.  Again, the fear in my dream is that I cannot react to the threats and the vigilance is for naught.

It is well documented that this mindset is hard to turn off when a Soldier returns home.  In some way we are essentially turned into an efficient worry wort or super prepared boy scout in combat.  The Army calls it “risk mitigation” and it is important for being in combat.

However, the strain of survival and the burden of keeping my Soldiers safe became such a way of life that it was hard to remember what safe and calm felt like.  I was more comfortable pissed off and on edge.  Then, when an acute trauma was intertwined with the perpetual anxiety, some whacky stuff started to seep into my everyday thoughts. (I currently get into these fits where I work through detailed plans for responding to a Nuclear attack on Manhattan and getting off Long Island.  Normal?  Not so much.)  But, when you combine super anxiety with anger and depression you have some real fun between your ears.

How the Cognitive Processing Helps

As I have completed and continued Cognitive Processing therapy, I am able to unwind the anger from the depression and guilt from the anxiety.  Though being able to separate the feelings doesn’t stop their onset, knowing what I am facing and applying techniques to “combat” the onslaught of impulsive and irrational feelings give me a fighting chance to fend it off.

The first line of defense for me is getting rest and taking the time to unwind and think.  This blog helps because I can logically revisit my thoughts and organize a plan for staying rational.  My plan for the heat is pretty simple: stay out of it. :)  But, when that is not possible I am ensuring my medications are current and I have adjusted my diet and added fish oil to my regiment.  Keeping a tight calendar and preparing myself mentally and physically is where I can get my edge.

This past week the calendar was very fluid and I paid for it by the end of the week.  This coming week I am booking up again, but at least I have visibility.

My Mom has a poster hanging in the kitchen that reads “Don’t let the worries of tomorrow drain the energy of today.”  It is good advice and takes a lot of work to achieve.

If I ever start thinking about Zombie attacks, I will really have to check myself out.  Though as I quickly think about it, I don’t think the scenario is much different from the nuclear fallout… I may just carry more blunt objects.

Managing Meds- the early days of #PTSD & how the Red Sox saved my life

As I have said once before, getting my sleep under control was the first place I started. As such, the first medications I came in contact with were sleep meds.

Here is a brief story of how I knew that there was really something was seriously wrong and the start of my prescribed sleep pills.

A Book in a Pile

I was near the end of my second tour and had been awake for three days. I was back at the Forward Operating Base (FOB) taking care of supply and maintenance paperwork. In an effort to fall asleep each night, I picked through the stacks of donated books and read whatever I felt was worth reading. The pickings were slim since they were mostly books libraries were going to throw away anyway. One book I came upon was the “Best American Sports Writing of 2005.” When I saw this one I snatched it up because at least it was about sports and I recognized the editor: NY sports writer Mike Lupica.

I started with a story about Eli Manning and his stats during rookie camp compared to his brother. (I’m so glad that story turned out to have merit.) Then I came to Tom Verducci’s article Sportsmen of the Year. The article chronicled the Red Sox faithful who had waited so long for a championship. As I sat and read about the elderly who died happy and had their headstones engraved with their allegiance to the Red Sox I began to cry. Uncontrollably. The emotions were too much for me to bear. I thought about my soldiers who were dead and how they would never experience the joy of being a fan of anything again. I envied the elderly who reached that ripe old age. I thought about how there were times I secretly wished I was dead so I wouldn’t have to suffer worrying about me or my own Soldiers dying or getting hurt. At least if I died over there it would be with my brothers in arms and honorable.

When I was done crying I knew that I needed help. I thought to myself, “What the hell is wrong with you? You hate the Red Sox.” The combination of that mess of thoughts was a epiphany for me and I consider it my defining moment to seek help for what I knew in my heart was PTSD.

Seeking Help in Mosul

The next morning I scheduled a flight to Mosul to see psychiatric services.

Helicopter flights ran frequently from Tal’ Afar to Mosul and I hopped in with a group of Soldiers who were also struggling. Our unit had seen some serious fighting and a few of the guys were quietly getting help in theatre. They had seen the psychiatrist and were already on sleep meds. This was their follow up and my first appointment though we were all skeptical of our path forward with doctors in theater.

Mosul was nicer than our FOB. It had a movie theater and a big Post Exchange (PX). There was also a large field hospital with lots of resources for all types of treatments.

Once we got settled to our room, we made our way over to the psych buildings to check in. I was still hesitant to take myself away from my unit but I thought about the Red Sox and knew I was making the right choice.

There was a Master Sergeant with the Medical Service Corps who took my information, listened to my story and told me off the record that I had PTSD and that I would have to wait until I got back home to get real treatment. (I would later learn that the doctors were forbidden from making PTSD evaluations in theatre.) The doctor saw me, prescribed Ambien and Seroquel and sent me on my way. I went to the pharmacy and picked up my drugs. I went back to my room, popped the pills and felt my brain slow down. I woke up the next morning feeling good after the first solid nights sleep in months.

The group of us went back to the Psych buildings the next morning to pick up our evaluations. I felt a tremendous amount of anger and disappointment when I got my write up because my status indicated “acute workplace stress”. I chuckle now because what else is PTSD for an Infantryman than workplace stress?

More Guilt

As we walked back to our room it began to rain. We were scheduled to return to the FOB that night but we had flexibility. We settled in and set our alarm. When my alarm went off I was still feeling good from the meds. I leaned over to the ranking NCO who came with me and asked if he wanted to leave or wait another day and get some rest. We could hear the choppers coming in, but we could also hear the rain pounding the roof of our CHU. We skipped our flight and went back to bed, not wanting to wait in the rain.

That helicopter crashed into a hillside between our FOB and Mosul killing everyone aboard.

As a result we were stuck in Mosul while an investigation was conducted. After a few days I was able to get a DNVT call back the FOB and tell my wife I was ok, more guilt still piling up. I then called my parents and confessed I was not working a desk, but fighting with my line troop. (My Mother says she always knew, but I still had lied to her to that point)

And so my dependence on medication had begun. I experienced great success early on with the Ambien and Seroquel. But, as time wore on, those meds became less and less effective. I was about to step onto the carousel of medicine. I am still not off it today, but I am working on getting off.

As for the Red Sox, I gave them some credit for saving my life for a while, and I will never forget that story and the moment of clarity it brought, but after their second World Series win in three years, I have less of a soft spot than I used to… Ok, strike that, I’m a hater again…

Crowds, a baseball game and #PTSD

I am going to a baseball game tonight. Since coming back from Iraq, I have generally not had good times at baseball games and not because I am a New York Mets fan. I don’t like crowds and in general the traffic (public trains or the LIE) gets me anxious and I don’t have panic attacks so much as angry attacks.

(I have had exceptions, I saw Endy Chavez make the catch from Row V in Shea. Even though the Metsies lost that was a magical night and I was on a hell of a lot of meds..)

In any case, tonight is an opportunity for me to succeed. I recently completed Prolonged Exposure therapy at the Northport VA. PEt has two parts: imaginal exercises and in vivo exposures.

Imaginal Exposure: To summarize in my own words, you sit with your eyes closed and talk in the first person about really crappy traumatic experiences, record it, listen to it all week, then do it over and over. With each iteration the experience uncovers more thoughtful reflection as well as a greater perspective on the traumatic events. It sucks. Like all therapies related to PTSD, it gets harder before it gets easier.

In Vivo Exposure: Then there are homework assignments for in vivo exposure. This is the fun summary: pick out a mess of things you avoid like the plague, rate them from one (in bed about to fall asleep) to one hundred (In the shit bullets flying). Then go do them.

Avoiding public transit? Go ride the subway. Don’t like war movies anymore? Watch Restrepo… Twice. Hate crowds? Go to a Ballgame!

(When my wife heard that one she rolled her eyes, but I can assure you, this is legit.)

As I was immersed in each homework assignment, I was tasked with keeping tack my feelings and mood. It is sort of like embracing the mental suck. But, as advertised, things get easier and easier.

So, tonight is another opportunity to succeed. Let’s Go Mets!

Anniversaries for a Veteran with #PTSD

Most people mark anniversaries with thoughts of joy and celebration. A card, out to dinner, a gift. You can even look at Wikipedia for traditional anniversary gifts by year. For me, and other Veterans, anniversaries carry a special weight. An alive day, the loss of a friend, the time where you treated a civilian casualty, I have them all in my mental calendar. I had deployments that overlapped during the calendar year and anniversaries from both deployments speckle my brain.

IED blows up. Complex Ambush. Mortar attack. My subconscious seemingly sends out messages in the form of depression, extra anxiety,anger, you name it.

I kept a journal both deployments and have specific dates for many of the big events, or a span of time when a collection of events went down. To this day, my mood is affected by those “traumatic” experiences.

Last October my wife and I were chatting and trying to keep each other in check. She turned to me and bluntly asked, “What is your deal these past couple of days? You have been acting like a complete dick.” I took the hint and adjusted my attitude.

Both my deployments to Iraq were shitty for different but similar reasons. When I looked back in my second Iraq journal i figured that since it was closer in dates, those experience would be stronger. But, I could not find a date in my last deployment that matched up. Then I found my first journal and there it was: a week from hell of mortar attacks and close calls.

Now, I am not trying to blame away acting like a dick. I very often do that of my own volition. Also, I am not claiming any scientific support for this, just my own feelings. But, the longer I do this therapy and the more data points I collect, the better I am at avoiding spiraling depression or angry outbursts related to the ghosts of my past. Life often dictates other things to try and focus on, but being conscious of the past stressors is at least helpful to me in heading off destructive behavior. I try now to not let those issues impact my relationships. It’s not easy, and I’m not always successful.

With each passing anniversary, or holiday, I get better at preparing and bracing for what has yet to be anything but a roller coaster of emotions.

This year marks seven years from the end of my first deployment and five from my second. I guess I owe myself a desk and pen set and some silverware…

The one I feed the most

I read a short quip pinned to the wall in the PTSD center at the Northport VA facility. It read this:

A Native American elder once described his own inner struggles in this manner: “inside of me there are two dogs. One of the dogs is evil and mean. The other dog is good. The mean dog fights the good dog all the time.” When asked which dog wins, he reflected for a moment and replied, “The one I feed the most.”

I took a picture of it and I look at the picture/ story often. I feel it relates to one of the first lessons/ worksheets from Cognitive Processing Therapy (CPt): stuck points and absolutes.

A stuck point is really just what it sounds like, a point or thought in your brain that is immovable and ingrained… Stuck. Lots of people in this world have thick heads and are convinced of this or that, but for a Veteran with PTSD these thoughts are burned very deeply into our thought process and linked to primal survival, and it very much feels that way.

CPt starts with identifying and challenging those beliefs. In a war zone it is tough to trust anyone, especially those who are in the least bit different. Traumatic experiences seemingly affirm in extreme ways these habits of survival. Unfortunately, habits start to defy sound logic and over time feel reasonable and essential to survive.

For example, I had a few IEDs hit my vehicles in Iraq. I also saw the devastation created by suicide bombers. When I came home, driving on roads and traveling by car without a weapon to defend myself sent me to super anxious level. When I reflect about my experiences, the reaction sounds like typical and logical responses to the threats we faced in Iraq daily. The real problems came when I could not convince myself otherwise when I was home.

The stuck point I told myself was I am Never Safe when driving. Two things to examine here: one, I tied a mundane common act to my personal safety, two I used the extreme absolute of never. Because I was dealing in absolutes, my emotions and feelings were on hair triggers. Cut me off, I cut you off. Look at me wrong, I try to start a fight with you. Zero to pissed off in the blink of an eye.

These types of statements and emotions feed the evil dog. I cannot trust anyone. I am never safe driving. If I relax I will get killed. If someone dies or is hurt and I am not totally prepared, it is my fault. All of them at one point were in my rule book and I believed in them wholeheartedly. To a certain degree, all of them still are.

What I worked on with CPt was how to take those rules and make them more specific and less absolute. Some would argue I made them softer, but I don’t buy that. I can still get to angry in a heartbeat, it is now more on my terms.

Driving can sometimes be dangerous. It is not always dangerous. Now, with some quick mental preparation before I travel, it can even be a non-issue. Someday, I hope it is fun again, maybe after I starve that damn evil dog…

This is a simple example, there are many more feelings and more complicated cases dealing with relationships or trust to name a few; and, this took me a very long time to get a grip on. I still have to remind myself to live in a world with a spectrum and not absolutes. With the more complex issues, I am still working them out.

Want to read more about CPt? Visit the VA Website

or the Wikipedia Page for Cognitive Processing Therapy