May 20th, 2008 by Dr. Val Jones in Expert Interviews
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I met Dr. Harding at a press conference announcing the expansion of the Give an Hour initiative and really enjoyed our candid conversation about the unmet mental health needs of veterans of the war in Iraq and Afghanistan. It is sobering to know that many hundreds of thousands of soldiers are returning to the U.S. with traumatic brain injuries and post traumatic stress disorder. They volunteered to give up their lives for us, will we volunteer to care for them?
An interview with Richard K. Harding, M.D., professor and chair of the Department of Neuropsychiatry and Behavioral Science and an adjunct professor of pediatrics at the University of South Carolina School of Medicine.
Dr. Val: You mentioned that this quote means a lot to you: “One does not escape war by leaving the war zone.” Can you explain what you mean by that?
Dr. Harding: I was referring to my own experience with children rescued from Vietnam and transported to the U.S. Here, 6000 miles away and in a perfectly safe place with lots of support and food, they were still dealing with the trauma of the war zone. And I’ve seen this all along in my career, especially taking care of the National Guard folks in South Carolina. I’ve seen people become depressed and anxious and use substances to try to deal with the recurring thoughts provoked by combat experiences. They have profound changes in how they see the world. These are healthy people who were doing well in their jobs and family life. And then when they come back, they have a considerable amount of anxiety and worry and a loss of optimism about the future. In a way, the war follows them home.
Dr. Val: How do you help your patients to gain maximal recovery?
Dr. Harding: The best treatment begins with an accurate diagnosis and good access to care. There have been some major road blocks in terms of dependents trying to use TRICARE insurance, so access has been limited for family members who need services.
A good diagnostic workup by someone who knows what he’s doing is really important. Military personnel need to see a therapist who has had experience with PTSD [post-traumatic stress disorder] and other combat-related mental health issues.And they also need to get into a good treatment program that is tailored to their needs. Some people need psychotherapy, and others need psychotherapy plus medications. Some may be so severely depressed that they need to be in the hospital temporarily.
Dr. Val: There have been reports of different rates of mental health disorders in different arms of the military. For example, 50 percent of National Guard personnel report mental health issues, whereas only a third of Marines report the same. What’s that about?
Dr. Harding: Well we don’t know why, but I can speculate. If you are a trained military infantry combat soldier, you’ve been through a lot of training. You are camping out in the woods, you’ve been shot at, you’ve been through all kinds of simulations. You also belong to a tight group of individuals with whom you’ve been working for a long time, and your family has support at the military base in which you live.
That’s a lot different than a National Guard outfit composed of citizen soldiers. They’re suddenly asked to come in — not just one or two weeks out of the year — but to deploy to Afghanistan for 15 months. These people are lawyers, doctors and so forth, but they are often put on frontline assignments as soldiers. Unfortunately, they don’t have the same training and experience as the professional soldiers, so they’re more subject to emotional trauma. In addition, their families back home are scattered all over the state and don’t have the same backup and support that a family on a base would have. Spouses are often isolated when their partner is deployed.
Finally, the stigma associated with mental illness makes the military personnel less likely to get help early on because they’re worried that it will limit their opportunity for promotion.
Dr. Val: I heard that the question about mental health treatment was recently removed from the security clearance questionnaire. Is that evidence of the Army’s attempt to embrace and normalize mental health treatment?
Dr. Harding: It’s a very important symbolic victory. There is still a problem with stigma, but the Army is responding to this concern. There’s a tendency to think of mental health issues as a sign of weakness. Tough Army guys aren’t supposed to have emotional problems. They feel that they’re letting down other people if they admit to problems. You’re supposed to be able to pull yourself up by the proverbial “bootstraps.”
Dr. Val: It strikes me as somewhat adaptive, though, to choose that kind of attitude in a combat situation.
Dr. Harding: Yes, it may be. Seventy-five percent of military personnel make it through without mental health problems. They show amazing resiliency when you think about it. I’d like to think that I’d have that kind of resiliency too, but I don’t know. You don’t know until you’re in the situation. When good people try to do tough things, some will inevitably fall into the injury category. What we have to do is get recovery going and the “physical therapy” in the mental sense started as early as possible to help them get back to full capacity.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Harding: Services are available, but you have to ask for them. You have to raise your hand and admit that you have difficulties and need help. It’s also important to do this early on before you leave military service because you won’t necessarily get the same amount of care once you’re back in the workforce.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 20th, 2008 by Dr. Val Jones in Expert Interviews
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I had the chance to attend a recent press conference announcing the expansion of a nationwide effort to help U.S. veterans. The American Psychiatric Foundation, the Lilly Foundation, and Give an Hour Foundation joined forces to provide free mental health care for Iraq and Afghanistan war veterans and their families.
This innovative program allows mental health professionals to donate at least one hour a week of their professional time to serve the needs of the military. Collectively, this donated time adds up to a large improvement in access to services beyond the current reach for many of our nation’s heroes.
I am also hoping that the Give an Hour Foundation will join forces with Revolution Health to provide a therapeutic online community for military personnel and families who need support.
An interview with Barbara V. Romberg, Ph.D., founder and president of the Give an Hour Foundation
Dr. Val: Tell me about the Give an Hour initiative. Who came up with the idea, what does it involve, and how is the concept being promoted?
Dr. Romberg: I grew up in the post-Vietnam era and watched my brother’s friends go to war — and they either never came back or they returned as completely different people. So about three years ago, I was watching the Iraq war unfold and I became more and more aware that people were returning home with some very significant mental health issues. I began worrying about whether there were enough mental health services available to meet their needs, and I wondered if we in the mental health community should step up to provide additional services.
The thing that really pushed me to do something about this, as a busy private practitioner, was when I was driving in Bethesda [Md.] with my 9-year-old daughter. We passed a homeless veteran on the street and she said to me, “Mom, how can we?” It was the use of the word “we” that touched me. “How can we let this happen to these men and women who serve our country?”
And I thought, I can’t let her grow up and look to me and say, “Why didn’t your profession do something?” So I said, “OK, I’ve got to do this.” And that was the beginning of the Give an Hour initiative.
The Give an Hour initiative is a national network of mental health professionals — psychiatrists, psychologists, social workers, licensed counselors and therapists — who volunteer an hour of their time per week to serve the needs of the military. Participants are collected in an online database. Military personnel can come to our website at www.giveanhour.org, and enter their ZIP code and the services they seek, and we’ll return a list of providers available in their area. If there is no one listed in the database in the search area, we offer phone support.
Dr. Val: In your opinion, how is the health care system failing Iraq and Afghanistan war veterans who need mental health services?
Dr. Romberg: I’m not sure that it’s failing so much as it’s just being overwhelmed. The Department of Defense and the VA [Veterans Administration] are working really hard, but they’re just overwhelmed. It’s our duty, honor and opportunity to step up as mental health professionals and give back to the military. Regardless of what you think of the war, it’s a wonderful opportunity for our country to heal. The work is also therapeutic for the therapist.
Dr. Val: In terms of access to mental health services, where are the largest shortcomings: 1. Access to psychiatrists? 2. Access to psychologists? 3. Access to affordable therapies? 4. Community support?
Dr. Romberg: Yes. [Laughing.] All of the above. Many of the National Guard and Army Reserves staff return to rural communities after their tours of duty. There often aren’t providers who accept TRICARE [military health care insurance] in rural communities, so access to mental health services is limited. The VA is doing a lot of good work, but there are long waits and not enough therapists for regular ongoing visits. Continuity of care really suffers.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Romberg: These men and women are put in situations that are sometimes horrific and excruciatingly stressful for long periods of time. If you put any of us into those situations, it would affect how we experience ourselves and the world. What we want to do is educate the public so that they understand this and know how to talk to their neighbors and co-workers. When people don’t understand an illness, they can become uncomfortable and fearful that they may say the wrong thing. But by normalizing mental health issues through public education efforts, we can reduce the associated stigma of mental illness.
Military personnel need to be comfortable in accessing services when they need them. For starters, they can visit the Give an Hour website. We’re also affiliated with many other Veterans Affairs associations like the Wounded Warriors program, National Military Family Association, and TAPS. These organizations can offer assistance or put people in touch with us as needed.
*See a continuation of this conference reporting here.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 20th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Blogging is a social hobby that has brought me many new friends. I suppose one could say that blogging is a modern form of “pen pals” – only more public, and with faster responses. The medical blogosphere (comprised of people who blog primarily about health topics) is small but growing rapidly. Those who have been blogging for 3 years or more have achieved a kind of patriarchal/matriarchal status within our peer group, and they can be depended upon to serve up interesting facts, commentary, and true life stories on a nearly daily basis.
Although I read about 70 medical blogs regularly, I have met only 2 of these bloggers in person. I met Ramona Bates, physicist, plastic surgery blogger, and quilter extraordinaire in Little Rock, Arkansas last year and even observed one of her surgeries in the O.R. She took me to a fried catfish bar with her hubby and I met her affable chocolate lab, Rusty – a sizeable dog who doesn’t take direction from strangers.
I have been a big fan of Dr. Rob Lamberts’ Musings of a Distractible Mind. Of all the blogs I read, his is probably the least predictable. Interspersed between insightful commentary of health IT and helpful clinical pearls, one will find diatribes about accordians, dancing-goat exposés, and warnings about mutant cucumbers. For those who arrive at his blog looking for health content, yet unaware of Dr. Rob’s tendencies, I can imagine that certain posts might leave them with a quizzical feeling.
So I wasn’t terribly surprised when Dr. Rob arrived at Revolution Health late one Friday afternoon carrying a small grocery bag containing a plastic lobster. My astute colleagues realized at once that this was the sign of a man who needed a beer – and he was immediately offered one at our in-office happy hour. I waited a few minutes for the beverage to take effect before I inquired as to the purpose of the lobster.
Dr. Rob has named his lobster “Zippy,” and plans to have him sent around to various medical bloggers to be photographed in interesting places. He has created a website for these photos, and has a strategy for raising money for brain cancer associated with Zippy’s travels. I was honored to be one of Zippy’s first stops on the blog trail and will need to find some interesting photo settings for him in DC.
Currently dear Zippy is sitting on my desk top, confirming to colleagues that I must indeed be a woman of rather ecclectic decorative office tastes. I certainly hope that Zippy will develop a cult following for his good cause.
The rest of my time with Dr. Rob was most enjoyable – I had no idea that he was a Rochesterian (i.e. from Rochester, New York) as I have a secret fondness for people from that part of the world (hey, I married one!) We had dinner at a local Inn and Dr. Rob and my hubby gleefully discussed health IT interoperability initiatives. I listened with interest, and toasted to a couple of guys trying to make healthcare better for Americans – lobsters and all.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 19th, 2008 by Dr. Val Jones in Uncategorized
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People come from all over the nation (and the world) to speak their mind about health issues in Washington, DC. I work at a DC-based online media company (Revolution Health) devoted to enhancing awareness of medical issues and empowering patients to take control of their health.
A few weeks ago I put 2 and 2 together and realized that I could practically tip a microphone out my window and get some really important and compelling health information straight from America’s most influential leaders and organizations. I began attending local meetings, and before I knew it, I was embraced as the local physician-journalist who provides press coverage for an online health audience.
I’ve gotten terrific feedback about my recent blog interviews with former Surgeon General Rich Carmona, and Governor Mike Huckabee, among others. So I figured – hey, maybe this is something I should do more often? Maybe the medical blogosphere would like to receive regular updates on the “goings on” in Washington? Someone’s gotta keep an eye on them, and why not a local “voice of reason?”
So I’ll continue interviewing my little heart out – and point my virtual microphone at groups and people who have something interesting and important to say about health issues. I hope you enjoy them!
Up Next: I just met with a group of mental health professionals (from the American Psychiatric Association and American Psychiatric Foundation) about an exciting new volunteer effort (Give an Hour) to serve the psychological needs of military personnel returning from Iraq and Afghanistan. I hope to post about this initiative today or tomorrow here on my blog.
Later this week: Dr. Val covers the Campaign for Tobacco-Free Kids update. I’ll find out what we’re doing to break the smoking cycle at the earliest stages.
Much later this week: Dr. Rich Carmona gets a second visit from Dr. Val. As an unsuspecting victim of “round two,” our former Surgeon General is speaking at the Strategies to Overcome and Prevent (STOP) Obesity Alliance.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 19th, 2008 by Dr. Val Jones in Patient Interviews
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I met Patty Smith and her husband Jay at the Alzheimer’s Association gala in Washington, DC. Patty was diagnosed with early onset Alzheimer’s at the age of 51, and has devoted her life to raising awareness of her condition. She agreed to deliver a short message to the large audience, including political celebrities like Nancy Pelosi, Chris Matthews (of Hardball) and Newt Gingrich. I was able to spend some 1:1 time with Patty in a quiet press room prior to the event.
What struck me most about Patty was her courage and determination. Although her symptoms were troublesome to her (she had some difficulty concentrating, remembering details of her past, and couldn’t offer robust answers to questions) she was prepared to be vulnerable in a very public way. I was moved by Patty’s bravery, and her willingness to sacrifice personal comfort for public education. Of all the important donors and benefactors at the event, Patty was (in my opinion) the one who sacrificed the most- because she was the one who was willing to expose her frailty to us all. I became quite misty-eyed during this interview, as I witnessed a beautiful and brilliant woman slowly being robbed of her faculties (as was my own grandmother) by a relentless disease. I am honored that Patty took the time to tell me a little bit about what it felt like to be living with Alzheimer’s. My prayers are with her and her family.
Dr. Val: How were you first diagnosed?
Patty: I was working downtown on K Street for BB&T as one of their top consultants (I was 49 years old). But I slowly started missing some things and forgetting to follow through with my work. I remember being devastated when I was written up by my superior for poor performance. I decided to take some time off to figure out what was going on with my brain.
I went to see a neurologist who ordered an MRI. The MRI was normal because it was too early in the disease process to see changes. The neurologist then sent me to a psychiatrist to check me for depression. After several sessions, the psychiatrist sent me back to the neurologist saying “If this woman doesn’t have a neurological problem, I’ll eat my hat.” Then I had a PET scan which showed the Alzheimer’s disease. It took a really long time to get the diagnosis because no one thought of Alzheimer’s as a possibility for someone so young. Also there’s no history of Alzheimer’s in my family and my father is one of 17 kids.
Dr. Val: Did you undergo any genetic testing to find out if you carry a gene for Alzheimer’s?
Patty: Well, the neurologist ordered some tests on my spinal fluid, but unfortunately the person who tried to do the spinal tap missed so many times that we gave up because it was painful. [Patty’s husband adds: In the end the test results don’t make that much of a difference. You either have it or you don’t.]
Dr. Val: What is the most difficult part of being diagnosed with early onset Alzheimer’s?
Patty: The thing that frustrates me the most is that I lose my thoughts for a moment. They come back relatively quickly still. It’s hard to see it affecting my children. They’re 22 and 20. My diagnosis has been difficult for them but they’re taking it pretty well I think.
Dr. Val: If there’s one thing you’d like others to know about early onset Alzheimer’s disease, what would that be?
Patty: I’d like doctors to consider it as a possibility when they’re seeing patients with complaints like mine. It shouldn’t take years to get diagnosed. We have to break the stereotype of Alzheimer’s being exclusively a disease of the elderly. Younger people with Alzheimer’s get diagnosed with “stress” or depression, even though the symptoms are the same whether you’re 85 or 50 years old.
Also, I’d like more research funding for drug development. I’d like the FDA to move a little faster on getting the drugs out as well. I’m willing to volunteer for clinical trials, but I’m afraid that I’ll be placed in the placebo group, and I’d really like to get the drug.
Dr. Val: Are you taking any drugs now?
Patty: Yes, I’m on Aricept, Wellbutrin, and Namenda.
Dr. Val: Are you bothered by any side effects?
Patty: At the beginning we had to adjust the dosage of the Aricept because I was getting “night terrors.” I’d wake up in the middle of the night and sit bolt upright in bed and scare my husband half to death. Of course I didn’t remember any of it because I was still asleep. We cut the dosage of Aricept in half and the problem resolved.
Dr. Val: What are your plans going forward?
Patty: I’m going to continue helping the Alzheimer’s Association to raise awareness about the disease. Our healthcare system is not equipped to handle all the additional people who will be diagnosed with Alzheimer’s in the near future. We must get the message out so that we can prepare better. I’ll continue on giving speeches across the country for as long as I can do this.
*USA Today profiled Patty and Jay in an article published last year.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
