Canadian Veterans Advocacy

Tuesday, July 31, 2012

New announcement: Negotiator Appointed to Service Income Security Insurance Plan Class Action Suit

Negotiator Appointed to Service Income Security Insurance Plan Class Action Suit

July 31, 2012

Negotiator Appointed to Service Income Security Insurance Plan Class Action Suit
OTTAWA, ONTARIO--(Marketwire - July 31, 2012) - The Government of Canada today announced the appointment of Professor Stephen J. Toope, President and Vice-Chancellor of the University of British Columbia (UBC), as federal representative in negotiations to resolve the Manuge class action, regarding the long term disability benefits to former members of the Canadian Forces (CF).

"The well-being of both our serving and retired members is important for our government," said the Honourable Peter MacKay, Minister of National Defence. "This appointment further underlines our intent to work towards a positive resolution in this matter."

Prior to joining UBC, Professor Toope was President of the Pierre Elliott Trudeau Foundation, a position he held from 2002 to 2006. From 1994 to 1999, Professor Toope served as the dean of McGill University's Faculty of Law. Previously, he served as Law Clerk to the Right Honourable Chief Justice Dickson of the Supreme Court of Canada from 1986 to 1987. He continues to conduct research on many aspects of international law and is currently working on issues of human rights and culture, and the origins of international obligation in international society.

If a settlement of the class action is reached between the parties, it will need to be approved by the Federal Court.

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: CVA Homeless veterans announcement

sorry for the resent UPDATED

CVA Homeless veterans announcement

During the past couple of days, there has been an opportunity to personally engage Minister Blaney and members of his staff about the current issues confronting the veterans community and one of the issues addressed was the homeless veterans issue.

The CVA strives for a comprehensive, nation wide standard/policy on this issue and believes various organizations, VAC and the VAC stakeholders addressing this issue can be united, a mechanism capable sharing resources when necessary can be implemented to overcome geographical remoteness or lack of suitable funding for the outreach elements. VETS Canada is a prime example, an organization strong on outreach potential but lacking in financial resources required to effectively deal with the situation. The Legion, conversely, is flush with Poppy Fund moneys, funds which, under the circumstances, be directly to resolving critical issues of homelessness, addiction, substance abuse, mental health or physical impairments Canada's sons and daughters have experienced as a consequence of their service to Queen and country.

I have proposed to Minister Blaney that a HOMELESS VETERANS SUMMIT be conducted this fall, an opportunity for the government to bring forth the primary outreach organizations and VAC stakeholders active on this front together in an effort to seek consensus on an effective approach and the creation of a mechanism capable of pooling resources, intelligence, social resources, rehab elements...

We believe it is the governments responsibility to exercise this leadership on this issue and that it is our, the veterans and VAC stakeholders duty, to ensure the programs are effective. Accordingly, I am pleased to note there were additional tele conversations this afternoon with Minister Blaney's chief of staff and policy director in relationship to the pilot program announced below.

I would note that while Jim Lowther and VETS Canada is regrettably not not included in this initiative, the organizations participating are extremely credible and worthy of our support. I have been assured that should this project be successful, the program will be expanded to include VETS Canada and Maritime Canada. I would encourage those willing to donate to a charitable organization to consider VETS Canada as they will not benefit, at least at this time, from the nearly four million dollars in mission specific funding announced this afternoon in Calgary

This is a very good start and on this front, I would be remiss in my duty as the president of a NONPARTISAN Advocacy were I not to extend the Advocacy's appreciation to the government for this initiative. The bottom line is that over FIFTY homeless veterans in Victoria, Calgary, London and Toronto will be provided accommodation and the necessary support elements to leave the street behind forever.

Michael L Blais CD
President, Canadian Veterans Advocacy

FYI...

Here are some of the important facts for this project:

Pilot sites, providing accommodations to 56 Veterans are:

– Cockrell House - Veterans Housing Society, Victoria, British Columbia – accommodate 11 Veterans
– Calgary Homeless Foundation, Calgary, Alberta – accommodate 15 Veterans
– Mainstay Housing, Toronto, Ontario – accommodate 20 Veterans
– Unity Project for Relief of Homelessness, London, Ontario – accommodate 10 Veterans

HRSDC will fund up to $1.98 million to:

– Fund four community non-profit organizations to implement pilot at each site
– Provide evaluation after the 2 year mandate

VAC in-kind contribution of up to $1.85 million and will include:

o Dedicated case management support for Veterans at local sites
o Mental health professional expertise and services for Veterans from the Operational Stress Injuries Clinics

Community Organizations will provide:

o Site support
o Site manager
o Primary Case Worker
o Accommodation
o Meals
o Necessities of daily living
o Transportation
Homelessness Partnering Strategy

www.hrsdc.gc.ca

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: CVA Homeless veterans announcement

CVA Homeless veterans announcement.

During the past couple of days, there has been an opportunity to personally engage Minister Blaney and members of his staff about the current issues confronting the veterans community and one of the issues addressed was the homeless veterans issue.

The CVA strives for a comprehensive, nation wide standard/policy on this issue and believes various organizations, VAC and the VAC stakeholders addressing this issue can be united, a mechanism capable sharing resources when necessary can be implemented to overcome geographical remoteness or lack of suitable funding for the outreach elements. VETS Canada is a prime example, an organization strong on outreach potential but lacking in financial resources required to effectively deal with the situation. The Legion, conversely, is flush with Poppy Fund moneys, funds which, under the circumstances, be directly to resolving critical issues of homelessness, addiction, subs...Continue Reading

Homelessness Partnering Strategy
www.hrsdc.gc.ca

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Regards,
The Canadian Veterans Advocacy Team.

Tuesday, July 24, 2012

New announcement: Dear PTSD: Letter From A Military Wife To The Condition Destroying Her Family

Dear PTSD: Letter From A Military Wife To The Condition Destroying Her Family

Read more: http://www.businessinsider.com/dear-ptsd-letter-from-a-military-wife-2012-7#ixzz1zlvO53nt



*Editor's note: Post Traumatic Stress Disorder (PTSD) affects untold numbers of American servicemembers and veterans. What is easy to overlook is the toll taken on their family members. BI Military & Defense is starting a series of letters written by Battling BARE members, a group of women married to PTSD sufferers hoping to give light to life with someone suffering from PTSD. We believe these letters offer a stark and unique insight into a growing American epidemic.

This first letter is from the Heather Goble a Navy spouse of nine years.

Dear PTSD,

Before you came into my life, I had heard rumors. Back then, no one really spoke about you unless it was in hushed whispers. No one knew for sure what you looked like- but I heard you did unspeakable things... that you crept into bed with husbands and seduced them away from their unsuspecting wives. I also heard that you drank. A lot. I heard sometimes you could be two places at once- physically in one place but mentally elsewhere. It was also said that you were a liar, home wrecker, careless and violent... that sometimes you would take your mounting anger out on walls or whatever or whomever happened to get in your way. You left shattered picture frames and broken memories in your wake. There have been songs written about you... yet they don't even begin to do justice to just how evil you are. In fact, there has been talk of you being a murderer. I can't say that I'm surprised. I wouldn't put it past you. I believed those rumors and I certainly never invited you into my life.

But you came anyway.

And you were relentless.

It was four and a half years ago when you crept into our lives- an unwelcome guest. I'm not sure if you were in his med (medical) bag on the plane or if you quietly crept in through an open window one night making him awake in a state of panic... but once you came, no matter how much I begged and pleaded, you just kept finding ways back into our life. Persistent. I still can't believe the cops were never called when you would be banging down the door just to prove you were still there, still providing him the thrilling "alive" feeling I couldn't... At first you were just a nuisance... doing stupid things like ruining our sleep and tracking your sandy footprints all over our home, leaving shattered glasses, like a disrespectful child never cleaning up after yourself... leaving your mark to let us know you were still there...then you started turning up and interfering with his job. Distracting. Leaving us on edge...but you proved to be a stealth, well-trained machine... incognito even. We knew you were there but no one else admitted to seeing you- some might say you were a ghost of sorts. Eventually, we thought maybe they were right- that maybe you weren't there to stay.... So we tried so many times to go on pretending we had moved on... but you are like the ex we avoided yet managed to bump into on the fourth of July at the fireworks, causing him to hide under the nearest table so you don't see him and have to wax nostalgia about all of your memories. Those trips down memory lane were always too much to handle anyway.

But we were wrong. And you were angry. Angry that we wished you away or that we ignored you - I'm still not sure which but you sure let us know it. Quite the elaborate production. You make quite a scene, don't you? You followed us everywhere we went. Proof of your existence began popping up everywhere but, like us, others knew of your bad reputation and hanging out with you started to get him into trouble at work... and then at home... You once left a hole in the wall at the top of the stairs...and I read the elicit text messages between the two of you... you sure were proving all the rumors true.
The last straw was when you began attacking me for trying to pull him away from your allure... your antidepressant induced numbness ... All I wanted was to go back to being a couple but everyone knows, PTSD, you're a dirty, dirty whore. You weren't ready to let go yet. You had greater plans... the ultimate sacrifice was number one on your list. You wanted his life. And you tried to take it. You probably would have won if I conceded defeat that day but, unlike you, using him for whatever thrill... I love him. So I saved his life. I'd heard you'd been violent before, or in instances like ours, cowardly, disguising yourself as miracle pills that would end the suffering you've caused. Some might say you are the snake to Adam and Eve. Even the experts trained to recognize you, they were so afraid of you and the implications of your existence that they concocted an elaborate cover up and sent us on our way. Maybe you are just bloody brilliant.

I've been reading in the news lately about how good you've gotten at tricking the military into believing you aren't real and I gotta say, I'm impressed. But I'm not buying it. At all.

I've been talking about you, PTSD, and I have about had it with you in my life. The few bruises, the tears, the fear, the insecurity, anxiety, infidelity, deceit and the broken heart.... I'm over it and I want my husband back. I bet you feel real big... that uneasy feeling you leave in the pit of my stomach never goes away anymore. Empty promises don't ease my pain. You have even stooped so low as to bring my children into your little shenanigans and that is just crossing the line. They aren't babies like they were when we first met. They're perceptive. They've witnessed our arguments. They've seen how terrible you are to me but I'm strong. I'm a fighter and when it comes to my children, I always show them that...but you're expertly trained and certainly know how to subdue your victim until they concede defeat.
This time is different, though. You have me so close to waving the white flag to protect my children... but I know once you put the pen in my hand to sign away the relationship I committed to, you will only find another home to ruin. It is for that reason that I will let you win this round. I walked away... No, I ran. In fact I fled. Hundreds of miles. Too tired to fight... but I'm regrouping. Preparing. Training. Filling my arsenal. More focused and driven than before. I'm sure you've heard the phrase that Hell hath no fury like that of a woman scorned. If you won't go quietly into the night and leave my family be, you need to know I'll never give up. And when you come at me again, I'll be prepared. This time I have a ton of women who have my back. We will tell everyone what you do. I won't let you have him. I want him back. And I don't care if you have to rot in hell but you will lose. I hope you're ready. PTSD, I hate you...


Sincerely,
Heather Goble,
-wife of HM2 FMF Justin Goble
United States Navy 2003-pending PEB
-mother
-fighter

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: Lt.-Gen. Bouchard addresses Libya-Afghan ceremony controversy

Lt.-Gen. Bouchard addresses Libya-Afghan ceremony controversy

The government’s decision to hold a major ceremony on Parliament Hill for the Canadian military personnel who served in NATO’s Libya mission created a bit of controversy because of the absence of a similar event for Afghan veterans.
During an …
Source: Lt.-Gen. Bouchard addresses Libya-Afghan ceremony controversy

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: Returning-From-a-War-Zone-A-Guide-for-Families-of-Military-Members

Returning From a War Zone: A Guide for Families of Military Members

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: Returning-From-a-War-Zone-A-Guide-for-Military-Personnel

Returning From a War Zone: A Guide for Military Personnel

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: Post-traumatiser abandonnes du Canada

Post-traumatiser abandonnes du Canada


Partie 1


Partie 2


Partie 3


Partie 4


Partie 5


Partie 6

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: CLINICAL PRACTICE GUIDELINE FOR MANAGEMENT OF PTSD

CLINICAL PRACTICE GUIDELINE FOR MANAGEMENT OF PTSD

Clinician's Guide to Medications for PTSD


Matt Jeffereys, M.D.
Overview:

Posttraumatic Stress Disorder (PTSD) has biological, psychological, and social components. Medications can be used in treatment to address the biological basis for PTSD symptoms and co-morbid Axis I diagnoses. Medications may benefit psychological and social symptoms as well. While studies suggest that cognitive behavioral therapies such as prolonged exposure (PE) and cognitive processing therapy (CPT) have greater effects in improving PTSD symptoms than medications, some people may prefer medications or may benefit from receiving a medication in addition to psychotherapy.

Placebo controlled double blind randomized controlled trials are the gold standard for pharmacotherapy. Less strongly supported evidence includes open trials and case reports. It is important for the clinician to question the level of evidence supporting the medications prescribed in PTSD treatment. There are a variety of factors influencing prescribing including marketing, patient preferences, and clinical custom which sometimes are inconsistent with the evidence base.

The evidence base is strongest for the selective serotonin reuptake inhibitors (SSRI's). The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil) (1, 2). All other medication uses are off label, though there are differing levels of evidence supporting their use. There are a number of biological changes which have been associated with PTSD, and medications can be used to modify the resultant PTSD symptoms. Veterans whose PTSD symptoms have been present for many years pose a special challenge. Studies indicate they are more refractory to the beneficial effects of medications for PTSD symptoms (3).
What core PTSD symptoms are we trying to treat?

The three main PTSD symptom clusters are listed below:
Re-experiencing:

Examples include nightmares, unwanted thoughts of the traumatic events, and flashbacks.
Avoidance:

Examples include avoiding triggers for traumatic memories including places, conversations, or other reminders. The avoidance may generalize to other previously enjoyable activities.
Hyperarousal:

Examples include sleep problems, concentration problems, irritability, increased startle response, and hypervigilance.
What are some of the biological disturbances found in PTSD?

Some of the main biological disturbances in PTSD can be conceptualized as dysregulation of the naturally occurring stress hormones in the body and increased sensitivity of the anxiety circuits in the brain. Yehuda and others have found that patients with PTSD have hypersensitivity of the hypothalamic-pituitary-adrenal axis (HPA) as compared to patients without PTSD (4). Patients have a much greater variation in their levels of adrenocorticoids than patients without PTSD. Other researchers have found differences in the anatomy of the fear center of the brain between patients with PTSD and those without. It is not known for certain whether these changes were present before the traumatic event and predisposed the person to developing PTSD or whether these changes were the result of the PTSD. One way to think of this is the fear circuitry no longer being integrated with the executive centers of the brain located in the prefrontal cortex. Even minor stresses may then set off the "fight or flight" response in patients with PTSD which leads to increased heart rate, sweating, rapid breathing, tremors, and other symptoms of hyperarousal listed above.
How do medications help regulate these responses?

The medications prescribed for treating PTSD symptoms act upon neurotransmitters related to the fear and anxiety circuitry of the brain including serotonin, norepinephrine, GABA, and dopamine among many others. There is great interest in developing newer more specific agents than are currently available to target the PTSD symptoms described earlier while minimizing potential side effects of medications. Studies show that a number of medications are helpful in minimizing the three symptom clusters of PTSD. Most of the time, medications do not entirely eliminate symptoms but provide a symptom reduction and are best used in conjunction with an ongoing program of trauma specific psychotherapy for patients such as PE or CPT.
How do we measure the effects of treatment?

There are a number of self-rating scales and structured clinical interviews to monitor the effects of treatment. Two examples include the Post-Traumatic Stress Disorders Checklist (PCL) and the Clinician Administered PTSD Scale (CAPS). The PCL military or civilian version is an example of a patient self-rating form without stressor information while the CAPS is an example of a structured clinical interview including stressor information. There is literature supportive of a strong correlation between the two measures, and the PCL has the advantage of being quick and easy to administer. Both the PCL and the CAPS will provide a quantitative measure of the patient's PTSD symptoms and response to treatment over time that will enhance the clinical assessment and interview with the patient.
What is the evidence base for the specific groups of medications used for PTSD treatment?

Selective Serotonin Reuptake Inhibitors (SSRI's). These medications are the only FDA approved medications for PTSD . SSRIs primarily affect the neurotransmitter serotonin which is important in regulating mood, anxiety, appetite, and sleep and other bodily functions. This class of medication has the strongest empirical evidence with well designed randomized controlled trials (RCT's) and is the preferred initial class of medications used in PTSD treatment (1, 2). Exceptions may occur for patients based upon their individual histories of side effects, response, and comorbidities. An example of an exception would be a PTSD patient with comorbid Bipolar Disorder. In this patient, there is a risk of precipitating a manic episode with the SSRI's. Each patient varies in their response and ability to tolerate a specific medication and dosage, so medications must be tailored to individual needs. Research has suggested that maximum benefit from SSRI treatment depends upon adequate dosages and duration of treatment. Treatment adherence is key to successful pharmacotherapy treatment for PTSD. Examples of the SSRI's and some typical dosage ranges are listed below:

* sertraline (Zoloft) 50 mg to 200 mg daily
* citalopram (Celexa) 20 mg to 60 mg daily
* paroxetine (Paxil) 20 to 60 mg daily
* fluoxetine (Prozac) 20 mg to 60 mg daily

Note: Only Sertraline and Paroxetine have been approved for PTSD treatment by the FDA. All other medications described in this guide are being used "off label" and may have empirical support but have not been through the FDA approval process for PTSD

Other Newer Antidepressants for PTSD. Antidepressants that work through other neurotransmitter combinations or through different mechanisms for altering serotonin neurotransmission are also helpful in PTSD. Venlafaxine acts primarily as a serotonin reuptake inhibitor at lower dosages and as a combined serotonin and norepinephrine reuptake inhibitor at higher dosages. It appears to be a first-line treatment for PTSD based upon large multi-site RCTs (6). There have been smaller RCT's with mirtazapine as well as open trials (7). Mirtazapine may be particularly helpful for treatment of insomnia in PTSD. Trazodone is also commonly used for insomnia in PTSD even though there is little empirical evidence available for its use. Nefazodone is still available in a generic form but carries a black box warning regarding liver failure, so liver function tests need to be monitored and precautions taken as recommended in the medication's prescribing information (8, 9). Examples of the newer antidepressants for PTSD and some typical dosage ranges are listed below:

* ulmirtazapine (Remeron) 7.5 mg to 45 mg daily
* venlafaxine (Effexor) 75 mg to 300 mg daily
* nefazodone (Serzone) 200 mg to 600 mg daily

All of the antidepressants described above are also effective in treating co-morbid Major Depressive Disorder (MDD) which often accompanies PTSD. While bupropion is useful in treating comorbid MDD, it has not been shown effective for PTSD in controlled trials (10). A recent trial showed superior outcomes on MDD when mirtazapine was combined initially with antidepressants vs. patients being randomized to monotherapy with fluoxetine (11). This raises important questions regarding costs, side effects, and patient preferences which merit further study.

Mood Stabilizers for PTSD. Despite some promising open label studies, recent RCT's have been negative for this group of medications in treating PTSD (12). They could be helpful in the treatment of co-morbid Bipolar Disorder and PTSD, however. For patients who have Bipolar Disorder and PTSD, these medications are useful due to the potential for antidepressants to precipitate a manic episode. Most require some regular lab work to monitor side effects. Lamotrigine does not require lab work but must be titrated slowly according to package insert directions to avoid a potentially serious rash. Examples are given below:

* Carbamazepine (Tegretol): Requires monitoring of white blood cell counts due to risk of agranulocytosis. Will self-induce its own metabolism and increase the metabolism of other medications including oral contraceptives.
* Divalproex (Depakote): Requires monitoring of liver function tests due to risk of hepatotoxicity and platelet levels due to risk of thrombocytopenia. Target dosage is 10 times the patient's weight in pounds.
* Lamotrigine (Lamictal): Requires slow titration according to the package insert due to risk of serious rash.

Atypical Antipsychotics for PTSD.While originally developed for patients with a psychotic disorder, this class of medications is being applied to patients with many other psychiatric disorders including PTSD. They act primarily on the dopaminergic and serotonergic systems and are being used in PTSD for improving hyperarousal and re-experiencing symptoms. The evidence is mixed on their use as adjunctive therapy in PTSD for patients who have residual symptoms following the use of first line agents such as SSRI's and venlafaxine (13).

There is currently one positive trial for risperidone as monotherapy. This trial studied women with PTSD related to sexual assault and domestic abuse. There are three positive trials and two negative trials of risperidone as adjunctive therapy. Many of the studies using risperidone as adjunctive therapy included veterans with combat trauma. For olanzapine, there is one negative trial as monotherapy and 1 positive trial as adjunctive therapy. There are currently no published randomized placebo controlled trials for any of the other atypical antipsychotic agents.

These medications must be used with caution and require monitoring of blood glucose levels and cholesterol levels as they may cause elevation. There is also a small risk of developing extrapyramidal side effects and tardive dyskinesia and more rare side effects such as neuroleptic malignant syndrome. These medications are also effective for comorbid psychotic and mood disorders for which they are approved. Dosages vary widely, so please refer to package insert for dosing ranges.

* Olanzapine (Zyprexa)
* Risperidone (Risperdal)

Other Medications for PTSD. There are a number of other medications that can be helpful for specific PTSD symptoms or that have been used as second line agents including the following:

* Prazosin (Minipress)
* Tricyclic Antidepressants (such as Imipramine)
* Monoamine Oxidase Inhibitors (MAOI's) (such as Phenelzine)

Prazosin has been found to be effective in RCTs in decreasing nightmares in PTSD. It blocks the noradrenergic stimulation of the alpha 1 receptor. It has not been found to be effective for PTSD symptoms other than nightmares at this time (14). The tricyclic antidepressants and MAOI's act on a number of neurotransmitters. While there are RCT's supporting their use, these medications are not used as first line agents due to their safety and side effect profiles (15, 16). The tricyclics have quinidine like effects on the heart and can cause ventricular arrhythmias especially in overdose. The MAOI's can cause potentially fatal reactions due to hypertensive crisis when taken with other medications or certain foods rich in tyramine. MAOI's can also provoke the potentially fatal serotonin syndrome when used concurrently with SSRI's.

Buspirone and beta blockers are sometimes used adjunctively in treatment of hyperarousal symptoms, though there is little empirical evidence in support of this. Buspirone acts on serotonin and might reduce anxiety in PTSD without sedation or addiction. There are some case reports supporting its use. Beta blockers block the effects of adrenalin (epinephrine) on organs such as the heart, sweat glands, and muscles. There is interest in using beta blockers to prevent PTSD, though the evidence at this time does not support this. Beta blockers reduce the peripheral manifestations of hyperarousal and may reduce aggression as well. They may be used for comorbid conditions such as performance anxiety in the context of social phobia for example.

Benzodiazepines and PTSD. Benzodiazepines act directly on the GABA system which produces a calming effect on the nervous system. This is the only potentially addictive group of medications discussed. Studies have not shown them to be useful in PTSD treatment as they do not work on the core PTSD symptoms (17, 18). There are several other concerns with the benzodiazepines including potential disinhibition, difficulty integrating the traumatic experience, preventing optimal arousal in prolonged exposure therapy, and addiction. Because of their potential for addiction and disinhibition, they must be used with great caution in PTSD. Examples are listed below:

* Lorazepam (Ativan)
* Clonazepam (Klonopin)
* Alprazolam (Xanax)

Developing new medications for PTSD:

The pathophysiological mechanism of PTSD in the nervous system is unknown, but there are several interesting areas that could lead to new drug development for the treatment or the prevention of PTSD. There are competing hypotheses about the role of glucocorticoids following trauma and their effects on the brain. It might be possible to intervene at some level in the hypothalamic-pituitary-adrenal axis or at the level of the glucocorticoid receptors in the brain to modulate the effects of stress and the development of PTSD. Neuropeptides such as Substance P and Neuropeptide Y (NPY) have been implicated in PTSD as well (19). Combat troops exposed to stress have been found to have lower levels of NPY. Perhaps altering this neuromodulator could improve the resiliency of the brain to the effects of trauma. One challenge with this research is dealing with the blood-brain barrier for introducing neuropeptides into the brain. Memantine (Namenda) is a drug of much interest in preventing neurodegeneration by protecting against glutaminergic destruction of neurons. It has been approved for use in certain neurodegenerative conditions such as Alzheimer's disease. This drug could be potentially useful in preventing hypothesized neurodegneration in the hypothalamus and memory loss in PTSD. D-cycloserine has been used in panic disorder to enhance the effects of exposure therapy (20). It is a partial agonist of the N-methyl-D-aspartate (NMDA) receptor. Current research is looking towards the possibility of one day intervening early in the course of PTSD with a combination of psychotherapy and pharmacotherapy that would prevent the development of the pathophysiology of PTSD in the brain.
Common barriers to effective medication treatment in PTSD:

There are several common barriers to effective medication treatment for PTSD which are listed below. These need to be addressed with patients in an ongoing dialogue with their prescribing clinician. Side effects need to be examined and discussed, weighing the risks and the benefits of continued medication treatment. Patient education about the side effects, necessary dosages, duration of treatment, and taking the medications consistently can improve adherence. A simple intervention of setting up a pill organizer weekly can go a long way to improve adherence.

* fear of possible medication side effects including sexual side effects
* feeling medication is a "crutch" and that taking it is a weakness
* fear of becoming addicted to medications
* taking the medication only occasionally when symptoms get severe
* not being sure how to take the medication
* keeping several pill bottles and not remembering when the last dosage was taken
* using "self medication" with alcohol or drugs with prescribed medications

A final word regarding medications and treatment for PTSD:

A more comprehensive discussion of pharmacotherapy can be found online in the VA/DoD PTSD Clinical Practice Guidelines. Based upon current knowledge, most prescribing clinicians view pharmacotherapy as an important adjunct to the evidenced based psychotherapies for PTSD. While there are few direct comparisons of pharmacotherapy and psychotherapy, the greatest benefits of treatment appear to come from evidenced based therapies such as CPT, PE, and patients need to be informed of the risks and benefits of the differing treatment options. When using a combined approach of medication and therapy, it is important to keep several practices in mind. If treatment is being provided by a therapist and a prescriber, it is important for the clinicians to discuss treatment response and to coordinate efforts. It is important for the prescribing clinician to have an ongoing dialogue with the patient about their medications and side effects. It is important for the patient to take an active role in his or her treatment rather than feeling they are a passive recipient of medications to alleviate their symptoms. There is emerging evidence that when given a choice, most patients will select psychotherapy treatment for their PTSD symptoms rather than medications.

Patients with anxiety disorders including PTSD may be very aware of their somatic reactions, and it is important to start low and go slow often on dosage adjustments to improve patient adherence. Be sure to ask female patients of childbearing age about contraception when prescribing medication. Be sure to ask all patients about substance abuse as well. Once mediations are started, it is crucial that the provider remember to discontinue medications which are not proving efficacious and to simplify the number and types of medications used whenever possible.
References:

1. Brady K, Pearlstein T, Asnis GM, Baker D, Rothbaum B, Sikes CR, Farfel GM. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000 Apr 12;283(14):1837-44.
2. Marshall RD, Beebe KL, Oldham M, Zaninelli R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001 Dec;158(12):1982-8.
3. Randomized, double blind comparison of sertraline and placebo for posttraumatic stress disorder in Department of Veterans Affairs setting. Friedman MJ, Marmar CR, Baker DG, Sikes CR, Farfel GM. J Clin Psychiatry. 2007 May; 68(5):711-20.
4. Yehuda R, Bierer LM. Transgenerational transmission of cortisol and PTSD risk. Prog Brain Res. 2008; 167:121-35.
5. Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D. Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010 Jun; 167(6):640-7.
6. Davidson J, Baldwin D, Stein DJ, Kuper E, Benattia I, Ahmed S, Pedersen R, Musgnung J. Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Arch Gen Psychiatry. 2006 Oct;63(10):1158-65.
7. Chung MY, Min KH, Jun YJ, Kim SS, Kim WC, Jun EM. Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder: a randomized open label trial. Hum Psychopharmacol. 2004 Oct;19(7):489-94.
8. Davis LL, Jewell ME, Ambrose S, Farley J, English B, Bartolucci A, Petty F. A placebo-controlled study of nefazodone for the treatment of chronic posttraumatic stress disorder: a preliminary study. J Clin Psychopharmacol. 2004 Jun;24(3):291-7.
9. McRae AL, Brady KT, Mellman TA, Sonne SC, Killeen TK, Timmerman MA, Bayles-Dazet W. Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depress Anxiety. 2004;19(3):190-6.
10. Becker ME, Hertzberg MA, Moore SD, Dennis MF, Bukenya DS, Beckham JC. A placebo-controlled trial of bupropion SR in the treatment of chronic posttraumatic stress disorder. J Clin Psychopharmacol. 2007 Apr; 27(2):193-7.
11. Blier P, Ward HE, Tremblay P, Laberge L, Hébert C, Bergeron R. Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010 Mar; 167(3):281-8.
12. Davis LL, Davidson JR, Ward LC, Bartolucci A, Bowden CL, Petty F. Divalproex in the treatment of posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial in a veteran population. J Clin Psychopharmacol. 2008 Feb;28(1):84-8.
13. Pae CU, Lim HK, Peindl K, Ajwani N, Serretti A, Patkar AA, Lee C. The atypical antipsychotics olanzapine and risperidone in the treatment of posttraumatic stress disorder: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Int Clin Psychopharmacol. 2008 Jan;23(1):1-8.
14. Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, Shofer J, O'Connell J, Taylor F, Gross C, Rohde K, McFall ME. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007 Apr 15;61(8):928-34.
15. Davidson J, Kudler H, Smith R, Mahorney SL, Lipper S, Hammett E, Saunders WB, Cavenar JO Jr. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry. 1990 Mar;47(3):259-66.
16. Frank JB, Kosten TR, Giller EL Jr, Dan E. A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry. 1988 Oct;145(10):1289-91.
17. Braun P, Greenberg D, Dasberg H, Lerer B. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry. 1990 Jun;51(6):236-8.
18. Gelpin E, Bonne O, Peri T, Brandes D, Shalev AY. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996 Sep;57(9):390-4.
19. Morales-Medina JC, Dumont Y, Quirion R. A possible role of neuropeptide Y in depression and stress. Brain Res. 2010 Feb 16; 1314:194-205.
20. Otto MW, Tolin DF, Simon NM, Pearlson GD, Basden S, Meunier SA, Hofmann SG, Eisenmenger K, Krystal JH, Pollack MH. Efficacy of d-cycloserine for enhancing response to cognitive-behavior therapy for panic disorder. Biol Psychiatry. 2010 Feb 15;67(4):365-70.

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Regards,
The Canadian Veterans Advocacy Team.

New announcement: The experience of the female partners of Canadian Military Vets with PTSD

The experience of the female partners of Canadian Military Veterans diagnosed with post traumatic stress disorder

Title: The experience of the female partners of Canadian Military Veterans diagnosed with post traumatic stress disorder

Author: Pickrell-Baker, Sandra

Abstract: Military members and first responders to catastrophic events directly experience the impact of trauma. This may lead to the development of posttraumatic stress disorder (PTSD), or other types of secondary stress response. PTSD often brings complications such as personality and behavioural changes. Previous research has demonstrated there is a need to be concerned with treating the primary sufferers of PTSD. However, there is also a chain reaction in the relationship dynamics of the family. The family unit themselves develop symptoms of PTSD, and manifest their own secondary traumatic stress response. The primary question for this study was: What are the lived experiences of the female partners of Canadian military veterans diagnosed with PTSD? Secondary questions addressed the relationship between the experience of the diagnosis of PTSD and daily life. Specifically, what coping strategies and supportive resources did these women utilize? This study was situated within an interpretive/constructivist framework. In this study we read about women, who while dealing with ambiguous loss, must adjust and adapt their lives around the needs of their partner, who is struggling with the symptoms of PTSD. The complications of this change in relationship led women to deself and face the difficulties of secondary traumatic stress, such as depression and hyper vigilance. There is a need for future and more in depth research into family functioning when faced with this phenomenon. Specifically, does the adjusting and adapting actually enable the veteran to stay ill and remain defined by his diagnosis? What are the long-term implications for the children who are being reared in these circumstances. How can these women be enabled to gain meaningful support in order to cope with daily life?

URI: http://hdl.handle.net/10587/1140
Date: 2012-04-19

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The Canadian Veterans Advocacy Team.

New announcement: Try Psychosocial Therapies, Prazosin for PTSD

Try Psychosocial Therapies, Prazosin for PTSD

http://www.internalmedicinenews.com/news/mental-health/single-article/try-psychosocial-therapies-prazosin-for-ptsd/c7f81f5c11.html

BOSTON ? Exposure to trauma is ephemeral, but its effects in the form of posttraumatic stress disorder can linger for decades. However, a handful of psychosocial therapies and at least one class of drugs can be effective at reducing the invisible scars of PTSD, investigators reported at a conference on the complexities and challenges of PTSD and traumatic brain injury.

Interventions such as exposure therapy, cognitive processing therapy, and eye movement desensitization and reprocessing can help PTSD sufferers direct their thoughts away from traumatic events, often with durable results, said Terence M. Keane, Ph.D., director of the behavioral science division of the National Center for Posttraumatic Stress Disorder, Boston.

In addition, "emerging, exciting evidence" supports the use of the alpha-adrenergic antagonist prazosin for alleviating nightmares and sleep disruptions associated with the disorder, said Dr. Thomas A. Mellman, research associate dean and professor of psychiatry at Howard University, Washington.

Impact of Trauma Exposure

In an era of multiple military deployments and widespread regional conflicts, levels of PTSD and comorbid conditions are increasingly common, noted Dr. Keane, who also is with the department of psychiatry at Boston University.





Courtesy of Tom Allen

Terence M. Keane, Ph.D.

"If there is one powerful determinant of who develops PTSD, it is exposure to trauma experiences," he said. "It overrides all of the other risk factors. It outranks everything else, including childhood upbringing."

Many of the scales that are used to assess PTSD and combat exposure were developed after the Vietnam War. The Combat Exposure Scale, published by Dr. Keane and his colleagues in 1989, is a 7-item questionnaire gauging PTSD risk by factors such as the degree of exposure to firefights, the number of casualties in the soldier?s unit, and frequency of exposure to life-threatening situations (Psychol. Assess. 1989;1:53-5).

The scale?s upper limit of the numbers of exposures to firefights is "51 or more." In contrast, U.S. soldiers were exposed to about 400 firefights during a 15-month deployment in the Korengal Valley in Afghanistan, said Dr. Keane, citing Sebastian Junger, an American journalist who was intermittently embedded with a platoon of the 173rd Airborne Brigade in 2007-2008.

"The most upsetting thing ... was the loss of their friends," Mr. Junger wrote. "They felt responsible for their deaths, convinced there was something they could have done to prevent them and a sense of guilt that they should have been killed instead."

Psychosocial Interventions

There are five evidence-based psychosocial interventions for PTSD: exposure therapy, cognitive therapy, anxiety management, cognitive reprocessing therapy, and eye movement desensitization and reprocessing (EMDR).

"It?s very clear that participating in these treatments if you have a diagnosis of PTSD actually leads to remarkable improvement not only in symptoms, but also in life functioning," Dr. Keane said.

Cognitive-behavioral treatments for chronic PTSD approach the problem from two different angles. One approach allows patients to safely confront their traumatic experience through exposure discussions that recall trauma reminders; the other is aimed at modifying the dysfunctional thought processes that underlie PTSD.

One example of the former approach is exposure therapy, in which patients confront the objects, situations, memories, and images they fear in a systematic and repetitive fashion. After an initial relaxation training session, patients relive their experiences through imagined exposures to the traumatic memory, and, when possible, with real-life exposure to the traumatic event (for example, a visit to a car accident site).

"This is a very powerful treatment that effectively reduces symptoms of PTSD and improves psychosocial functioning in virtually every domain that we have tested," Dr. Keane said.

An alternative approach is cognitive therapy, in which patients are helped to change their negative, unrealistic thinking by identifying their dysfunctional, unrealistic thoughts and beliefs ("I?m responsible for it," "It was what I was wearing," "I should never have been there"), and challenge those distortions, helping the patient to replace them with functional, realistic alternatives.

Cognitive processing therapy (CPT) combines elements of the exposure and cognitive therapy approaches. It involves cognitive restructuring focusing on safety, trust, power, esteem, and intimacy. The patient repeatedly writes out the traumatic experience and reads it in 12 weekly sessions.

EMDR has been shown in controlled studies to help patients with PTSD, with an effect comparable to that of exposure therapy in many instances, Dr. Keane said. As in the latter treatment, EMDR accesses trauma images and memories, and helps patients to evaluate the aversive qualities of those images and memories, and to generate alternative cognitive appraisals. The recall is accompanied by sets of lateral eye movements that the patient makes while focusing on her/his response.

"There has been a lot of discussions on the eye movements ? are they necessary, are they not necessary ? [and] it looks like the best data suggest that they?re not necessary," Dr. Keane said.

Pharmacologic Interventions

When it comes to drug therapies for PTSD, many have been tried and most have been found wanting, Dr. Mellman said.

Pharmacotherapy for PTSD is based on neurobiological models of PTSD involving memory and neural structure. These models link PTSD to reactivity or selective attention to trauma stimuli, fragmentary trauma narratives, verbal memory deficits, reduced hippocampal volume, and increased amgydala activation with reduced anterior cingulate activation, he said.

Proposed hormonal and neurotransmitter-related mechanisms include reduced cortisol secretion and increased sensitivity to feedback inhibition, an effect of noradrenergic activity on fear-enhanced learning, and the role of the excitatory amino acid glutamate in neuroexcitation, learning and neurotoxicity, and GABA (gamma-aminobutyric acid) in inhibition.

Some evidence supports the use of selective serotonin reuptake inhibitors (SSRIs), which have been shown in nine randomized controlled trials in primarily female civilian populations to have positive effects on the three PTSD symptom clusters (reexperiencing, avoidance, and hyperarousal). Response rates in these studies have ranged from 53% to 64% (compared with 32% to 38% for placebo), with the effects occurring both with and without comorbid depression. In one study, maintenance efficacy of up to 1 year was seen with patients on sertraline.

However, six other published randomized controlled trials failed to find a benefit for SSRIs for PTSD symptoms, compared with placebo. These studies primarily involved men, many of whom were veterans, Dr. Mellman noted.

Other agents with mixed or limited evidence to support their use in PTSD include atypical antipsychotics, benzodiazepines, MAO inhibitors, tricyclics, and anticonvulsant mood stabilizers, Dr. Mellman said.

Seven small randomized controlled trials have looked at atypicals, primarily risperidone and olanzapine, and primarily in treatment-refractory patients.

"Overall, the evidence does support adjunctive risperidone for refractory cases, and there does seem to be a benefit to sleep for the atypical class," he said.

Regarding benzodiazepines, there appears to be a lack of evidence to support either their efficacy or inefficacy, he added.

"We don?t recommend benzodiazepines as treatment for people with PTSD, but does that mean people with PTSD shouldn?t be exposed to them? I?m not sure. They do calm a person down temporarily, but [we should be] wary of continuous, chronic application," he said.

Prazosin Proves Powerful

Prazosin, originally developed as an antihypertensive agent, has been shown to have efficacy at reducing insomnia and nightmare in veterans with PTSD.

A study of 34 veterans with chronic PTSD and trauma nightmares showed that prazosin "shifted dream characteristics from those typical of trauma-related nightmares to those typical of normal dreams" (Biol. Psychiatry 2007;61:928-34).

"Prazosin also appeals to me from a theoretical standpoint because it preserves REM sleep, in contrast to many pharmacological agents that have the effect of reducing REM sleep, and there?s a particularly interesting animal model that shows that [prazosin] preserves REM sleep against the disruption of an adrenergic agonist, and this may be a model that?s relevant to PTSD," Dr. Mellman said.

Dr. Keane and Dr. Mellman presented their findings at a symposium supported by the Home Base Program, a joint project of the Red Sox Foundation and Massachusetts General Hospital, both in Boston. Neither Dr. Keane nor Dr. Mellman had relevant financial disclosures.

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The Canadian Veterans Advocacy Team.

New announcement: Disability Savings Grant and Bond - Subvention canadienne pour l’épargne-invalid

Disability Savings Grant and Bond
http://www.hrsdc.gc.ca/eng/disability_issues/disability_savings/index.shtml

Subvention canadienne pour l'épargne-invalidité
http://www.rhdcc.gc.ca/fra/condition_personnes_handicapees/epargne_handicape/index.shtml

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The Canadian Veterans Advocacy Team.

New announcement: Disability Tax Credit Certificate Canada Revenue Agency Certificat pour le crédi

Certificat pour le crédit d'impôt pour personnes handicapées - Disability Tax Credit Certificate

Federal
http://www.cra-arc.gc.ca/E/pbg/tf/t2201/README.html

Quebec
http://www.cra-arc.gc.ca/F/pbg/tf/t2201/

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The Canadian Veterans Advocacy Team.

Vacation For Vets

ENG http://Https://public.cfpsa.com/en/AboutUs/Library/MediaCentre/NewsReleases/Pages/V4V.aspx

FR https://public.cfpsa.com/fr/aboutus/library/mediacentre/newsreleases/pages/v4v.aspx

Vacations For Vets

Vacations for Vets Available to Ill or Injured CF Members

Shell Vacations Club (SVC) Canada and the Canadian Forces Personnel and Family Support Services (CFPFSS) are pleased to announce Vacations for Vets is now available to serving or former members of the Canadian Forces who have sustained an illness or injury attributable to military service in a Special Duty Area (SDA) or Special Duty Operation (SDO) and are in receipt of a Veterans Affairs Canada benefits for that illness or injury.  The program provides eligible members of the Canadian Forces, and their travelling companions, with one week of free lodging at a Shell Vacations property.

In recognition of service to Canada, Shell Vacations Club Canada, ULC and its affiliates are offering complimentary lodgings to eligible members of the Canadian Forces, under the auspices of their Vacations for Vets program.

[b]ELIGIBILITY:[/b]
This program is reserved for serving or former members of the Canadian Forces who sustained an illness or injury attributable to military service in a SDA/SDO and are in receipt of a Veterans Affairs Canada (VAC) benefit for that illness or injury. *Limit one vacation/yr per eligible member.

[b]PROOF OF ELIGIBILITY:[/b]
Travel requests must be accompanied by a VAC confirmation letter that validates the member is in receipt of a benefit attributable to military service in a SDA/SDO. Members can contact VAC directly for this letter by calling the toll free number 1-866-522-2122 (EN)/ 1-866-522-2022 (FR). Please scan and email the application form to branco.nancy@cfpsa.com.

[b]LEAD TIME:[/b]
Please submit your vacation request 3 weeks prior to your intended travel date. Applications will be accepted starting 1 January 2012.


PERSONAL INFORMATION
RANK   
SERVICE NUMBER   
SURNAME   
GIVEN NAME   
ADDRESS
(city, province, postal code)   

TELEPHONE (h)   
TELEPONE (w)   
EMAIL    
DATE OF REQUEST   
TRAVELLERS INFORMATION

Number of Adults ________   
Number of Children _________

Please insert name and date of birth for each travelling adult   
Please insert name and date of birth for each travelling child
ADULT 1        CHILD 1   
DOB        DOB   
ADULT 2         CHILD 2    
DOB        DOB   
ADULT 3        CHILD 3    
DOB         DOB   
ADULT 4        CHILD 4   
DOB        DOB   

SITE SELECTION
Please rank your top three (3) destinations in order of preference.    
            
1st Requested Arrival/Departure Date: _________________________________
1st Resort / Property Name: _________________________________
            
2nd Requested Arrival/Departure Date: _________________________________
2nd Resort / Property Name:             _________________________________
            
3rd Requested Arrival/Departure Date: _________________________________
3rd Resort / Property Name: _________________________________
ORDER OF PREFERENCE    RESORT NAME    LOCATION    ACCOMODATIONS
     Legacy Golf Resort    Phoenix, AZ    Studio, 1BR, 2BR (Up to 8pp)
     Orange Tree Golf Resort    Scottsdale, AZ    1BR (Up to 4pp)
     Desert Rose Resort    Las Vegas, NV    1BR, 2BR (Up to 6pp)
     Little Sweden (Door County)    Fish Creek, WI    1BR, 2BR (Up to 6pp)
     Peacock Suites    Anaheim, CA    1BR, (Up to 6pp)
     Carriage Ridge, ON    Barrie, Canada    Studio, 1BR, 2BR (Up to 8pp)
     Plaza Pelicanos Puerto Vallarta    Jalisco, Mexico    Studio, 1BR, 2BR (Up to 6pp)
     Crotched Mountain Resort    Francestown, NH    Studio, 1BR, 2BR (Up to 6pp)
     Salado Creek Villas    San Antonio, TX    Studio, 1BR, 2BR (Up to 6pp)
     Waikiki Marina Resort    Honolulu, HI    Studio (Up to 4pp)
     Houla Resort at Mauna Loa Village    Kailua-Kona, HI    1BR, 2B (up to 6pp)
     Paniolo Greens Resort    Waikoloa, HI    2B (up to 6pp)
     Mountainside Lodge    Whistler, BC    Studio, Loft, 1BR (Up to 6pp)
     Whispering Woods Resort    Welches, OR    1BR, 2BR (Up to 6pp)
     Vino Bello Resort    Napa, CA    Studio, 1BR (Up to 4pp)
     The Donatello    San Francisco, CA    Studio (Up to 4pp)
     Inn at the Opera    San Francisco, CA    1BR (Up to 2pp)
     Foxhunt at Sapphire Valley    Cashiers, NC    2BR (Up to 8pp)
     Starr Pass Golf Suites    Tucson, AZ    1BR, 2BR (Up to 6pp)
     The Cliffs Club    Princeville, Kauai, HI    1BR (Up to 6pp)
     Kauai Coast Resort at the Beachboy    Kapaa, Kauai, HI    Studio, 1BR, 2BR (Up to 6pp)
     Kona Coast Resort    Kona, Big Island, HI    1BR, 2BR (Up to 6pp)
     Carriage Hills Resort    Barrie, ON     1BR, 2BR (Up to 8pp)[/color]

New announcement: Dear PTSD: Letter From A Military Wife To The Condition Destroying Her Family

Dear PTSD: Letter From A Military Wife To The Condition Destroying Her Family

Read more: http://www.businessinsider.com/dear-ptsd-letter-from-a-military-wife-2012-7#ixzz1zlvO53nt



*Editor's note: Post Traumatic Stress Disorder (PTSD) affects untold numbers of American servicemembers and veterans. What is easy to overlook is the toll taken on their family members. BI Military & Defense is starting a series of letters written by Battling BARE members, a group of women married to PTSD sufferers hoping to give light to life with someone suffering from PTSD. We believe these letters offer a stark and unique insight into a growing American epidemic.

This first letter is from the Heather Goble a Navy spouse of nine years.

Dear PTSD,

Before you came into my life, I had heard rumors. Back then, no one really spoke about you unless it was in hushed whispers. No one knew for sure what you looked like- but I heard you did unspeakable things... that you crept into bed with husbands and seduced them away from their unsuspecting wives. I also heard that you drank. A lot. I heard sometimes you could be two places at once- physically in one place but mentally elsewhere. It was also said that you were a liar, home wrecker, careless and violent... that sometimes you would take your mounting anger out on walls or whatever or whomever happened to get in your way. You left shattered picture frames and broken memories in your wake. There have been songs written about you... yet they don't even begin to do justice to just how evil you are. In fact, there has been talk of you being a murderer. I can't say that I'm surprised. I wouldn't put it past you. I believed those rumors and I certainly never invited you into my life.

But you came anyway.

And you were relentless.

It was four and a half years ago when you crept into our lives- an unwelcome guest. I'm not sure if you were in his med (medical) bag on the plane or if you quietly crept in through an open window one night making him awake in a state of panic... but once you came, no matter how much I begged and pleaded, you just kept finding ways back into our life. Persistent. I still can't believe the cops were never called when you would be banging down the door just to prove you were still there, still providing him the thrilling "alive" feeling I couldn't... At first you were just a nuisance... doing stupid things like ruining our sleep and tracking your sandy footprints all over our home, leaving shattered glasses, like a disrespectful child never cleaning up after yourself... leaving your mark to let us know you were still there...then you started turning up and interfering with his job. Distracting. Leaving us on edge...but you proved to be a stealth, well-trained machine... incognito even. We knew you were there but no one else admitted to seeing you- some might say you were a ghost of sorts. Eventually, we thought maybe they were right- that maybe you weren't there to stay.... So we tried so many times to go on pretending we had moved on... but you are like the ex we avoided yet managed to bump into on the fourth of July at the fireworks, causing him to hide under the nearest table so you don't see him and have to wax nostalgia about all of your memories. Those trips down memory lane were always too much to handle anyway.

But we were wrong. And you were angry. Angry that we wished you away or that we ignored you - I'm still not sure which but you sure let us know it. Quite the elaborate production. You make quite a scene, don't you? You followed us everywhere we went. Proof of your existence began popping up everywhere but, like us, others knew of your bad reputation and hanging out with you started to get him into trouble at work... and then at home... You once left a hole in the wall at the top of the stairs...and I read the elicit text messages between the two of you... you sure were proving all the rumors true.
The last straw was when you began attacking me for trying to pull him away from your allure... your antidepressant induced numbness ... All I wanted was to go back to being a couple but everyone knows, PTSD, you're a dirty, dirty whore. You weren't ready to let go yet. You had greater plans... the ultimate sacrifice was number one on your list. You wanted his life. And you tried to take it. You probably would have won if I conceded defeat that day but, unlike you, using him for whatever thrill... I love him. So I saved his life. I'd heard you'd been violent before, or in instances like ours, cowardly, disguising yourself as miracle pills that would end the suffering you've caused. Some might say you are the snake to Adam and Eve. Even the experts trained to recognize you, they were so afraid of you and the implications of your existence that they concocted an elaborate cover up and sent us on our way. Maybe you are just bloody brilliant.

I've been reading in the news lately about how good you've gotten at tricking the military into believing you aren't real and I gotta say, I'm impressed. But I'm not buying it. At all.

I've been talking about you, PTSD, and I have about had it with you in my life. The few bruises, the tears, the fear, the insecurity, anxiety, infidelity, deceit and the broken heart.... I'm over it and I want my husband back. I bet you feel real big... that uneasy feeling you leave in the pit of my stomach never goes away anymore. Empty promises don't ease my pain. You have even stooped so low as to bring my children into your little shenanigans and that is just crossing the line. They aren't babies like they were when we first met. They're perceptive. They've witnessed our arguments. They've seen how terrible you are to me but I'm strong. I'm a fighter and when it comes to my children, I always show them that...but you're expertly trained and certainly know how to subdue your victim until they concede defeat.
This time is different, though. You have me so close to waving the white flag to protect my children... but I know once you put the pen in my hand to sign away the relationship I committed to, you will only find another home to ruin. It is for that reason that I will let you win this round. I walked away... No, I ran. In fact I fled. Hundreds of miles. Too tired to fight... but I'm regrouping. Preparing. Training. Filling my arsenal. More focused and driven than before. I'm sure you've heard the phrase that Hell hath no fury like that of a woman scorned. If you won't go quietly into the night and leave my family be, you need to know I'll never give up. And when you come at me again, I'll be prepared. This time I have a ton of women who have my back. We will tell everyone what you do. I won't let you have him. I want him back. And I don't care if you have to rot in hell but you will lose. I hope you're ready. PTSD, I hate you...


Sincerely,
Heather Goble,
-wife of HM2 FMF Justin Goble
United States Navy 2003-pending PEB
-mother
-fighter

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Regards,
The Canadian Veterans Advocacy Team.

2nd Annual Veterans Rendezvous July 7, 2012, Niagara-on-the-Lake, ON

2nd Annual Veterans Rendezvous July 7, 2012, Niagara-on-the-Lake, ON
 http://canadianveteransadvocacy.com/Board2/index.php?topic=4359.0
 2nd Annual Veterans Rendezvous July 7, 2012, Niagara-on-the-Lake, ON

Website Link: http://www.canadianveteransadvocacy.com/rendezvous2012.html

July 7, 2012, Niagara-on-the-Lake, ON
Royal Canadian Legion, Branch 124
Memorial Ride starts at 1100
Events in Niagara-on-the-Lake start at 1300

What a year it has been! Its time to relax, enjoy the summer, and celebrate our victories!

Everyone has worked hard to get the message out -- from the Second Annual Canadian Veterans National Day of Protest, the months of advocacy and occasional protest against the proposed cuts to VAC in the Federal Budget, Operation Positive Review in support of Dennis Manuge urging the government to not appeal the favourable SISIP decision, and our most recent Vigil for Veterans on the 68th anniversary of D-Day – and considering certain decisions of the government it appears they are starting to hear our united voice!

Some have questioned if we have truly made a difference, and the answer is YES! Since our incorporation in July 2011 – only one year ago – we have been able to:

    * Obtain stakeholder status with Veterans Affairs Canada

    * Help ensure the VAC budget was shielded from the 5-10% budget cuts through constant advocacy, press coverage and a protest (ultimately the budget was cut by only 1%)

    * Secure multiple private meetings with key ministers, senior public servants and related organizations including VAC (Minister Steven Blaney and Deputy Minister Suzanne Tining), VRAB (Chair John Larlee), MP Peter Stoffer (NDP Veterans Affairs Critic), MP Sean Casey (Liberal Veterans Affairs Critic), Minister of Justice Rob Nicholson, Jack Harris (NDP Defence Critic), John McKay (Liberal Defence Critic), Sen. Don Plett, and Veterans Ombudsman, Guy Parent

    * Support Dennis Manuge and help ensure the government did not appeal the favourable ruling in the SISIP claw back class action lawsuit, leading an awareness campaign including letter writing and House of Commons attendance with fellow vets. The government chose not to appeal

    * Raise awareness of the transfer of the last VAC-controlled hospital, Ste. Anne’s, to provincial control and push the federal government establish safeguards for the existing high standard of care at this facility

    * Successfully stage a Second Annual Canadian Veterans National Day of Protest as well as the recent Vigil for Veterans (in Ottawa and Vancouver) receiving extensive national media coverage raising awareness about the issues facing Canada’s modern veterans, including the proposed class action lawsuit against the Lump Sum and the New Veterans Charter

    * Secure a coveted invitation to attend the 1812 Commemorative Military Muster at Ft York with the Prince of Wales, HRH Prince Charles

    * Become a nominating partner for the QEII Diamond Jubilee, with 80 medals for which to recommend recipients


Our work is not over and we will continue to lend support to Mrs Sheila Fynes at the Military Police Complaints Commission into the suicide of her son, Cpl Stuart Langridge. We will also actively raise awareness about the Equitas Society and the proposed class action lawsuit intended to challenge the New Veterans Charter and the Lump Sum.

The Canadian Veterans Advocacy looks forward to welcoming you to Niagara-on-the-Lake to celebrate our Second Annual Veterans Rendezvous. There will be something for everyone – bands, cars and motorcycles, military vehicle displays, children's activities, BBQ and more.

Planning to Stay for the Weekend?

Niagara-on-the-Lake is truly beautiful in July and there are so many things to do! The CVA is in the process of negotiating special rates on accomodation for CF members and Veterans during the summer high season. Once the details are known, we will update the site and get the information out at our Facebook group and page. Featured Events and Attractions "War of 1812 to Afghanistan Memorial Ride" along the Niagara Parkway from Ft Erie to Ft George.

Special Musical Guests Julian Austin and MCpl Elton Adams



Fort George National Historic Site of Canada including Butler’s Barracks home to the Lincoln and Welland Regimental Museum

A Military vehicle display courtesy of The Lincoln and Welland Regiment, featuring the The Vimy Gun and WW2 vehicles

Art display including military paintings by Don Ward and stained glass by Jacques de Winters



Car and motorcycle show

Pool, playground and picnic area for kids

Visiting writers, Harry Watts, a WWII veteran and author of The Dispatch Rider, and senior defence correspondent from the Canadian Press, Murray Brewster, author of The Savage War


Queen Elizabeth II Diamond Jubilee Medal Presentation
Detailed event schedule coming soon.
 
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Veterans Rendezvous set for next Saturday

By Ray Spiteri, Niagara Falls Review

Saturday, June 30, 2012 12:51:30 EDT PM

http://www.niagarafallsreview.ca/2012/06/30/veterans-rendezvous-set-for-next-saturday


About 40 veterans and community advocates will receive Diamond Jubilee medals July 7 in Niagara-on-the-Lake. Mike Blais, founder and president of Canadian Veterans Advocacy, and director James Green, look over one of the medals to be awarded. (Ray Spiteri/Niagara Falls Review)

About 40 veterans and community advocates will be awarded Diamond Jubilee medals during an event in Niagara-on-the-Lake next Saturday.

The Canadian Veterans Advocacy is hosting its second annual Veterans Rendezvous. This year it will be held at Royal Canadian Legion Branch 124 on King St., starting at 1 p.m.

In addition to bands, cars, motorcycles, military vehicle displays, children's activities and food, about 40 people from across Canada, many of them who served for their country overseas many times, will receive the Queen Elizabeth II Jubilee Medal.

The medal honours Canadians who have made a significant contribution to their fellow countrymen, their community, or to Canada over the years.

"We're a national organization and in a sense we have to ensure that those Jubilee medals are presented on a national basis from coast to coast to coast, which we have done," said Mike Blais, founder and president of Canadian Veterans Advocacy.

"But we also must recognize that the Canadian Veterans Advocacy has its roots in Niagara, and that there were many veterans who have been very supportive on a voluntary nature over the past two years to ensure our success."

The federal government gave CVA 80 medals to hand out after a nomination process. Of the 40 that will be presented next Saturday, Blais said about half will be received by Niagara residents.

"For us, it signifies a member of an exceptional effort on behalf of Canadians, on behalf of our veterans and those who serve today," he said.

"Many have answered the call, and we've tried to pick those who have done the most."

James Green, a director of CVA and a Second World War veteran, said he's glad that some recipients will be staunch supporters of Canada's military, including long-time participants in the annual local poppy campaign.

"I think they're going to be very receptive to it," said Green. "A lot of this stuff we did before ... (but) the ordinary citizen hasn't been included. I think this is a good idea."

Blais said he hopes to see between 300 and 400 people — possibly more if they bring their families — at the event. The legion is preparing for about 500.

"We're hoping to show them a good time," he said. "The legion is right next door to Butler's Barracks. There will be access to the museum. It's within walking distance to Fort George."

ray.spiteri@sunmedia.ca

Twitter: @RaySpiteri

    * Canadian Veterans Advocacy has raised almost $10,000 for its Pennies for Veterans program, supported by Veterans Affairs Canada, designed to help veterans who are homeless or in need of assistance;
    * Money will provide clothing, meals and rooms for veterans;
    * CVA asks those who are interested to collect and bring their pennies to next Saturday's Veterans Rendezvous

CVA Web Site Details: http://www.canadianveteransadvocacy.com/rendezvous2012.html
 
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New announcement: Utah study: Heavy combat puts service members at high suicide, PTSD risk

Utah study: Heavy combat puts service members at high suicide, PTSD risk

http://www.sltrib.com/sltrib/news/54533755-78/says-suicide-combat-research.html.csp

Military » Sending a small, all-volunteer force into combat has "enormous implications," U. study says.

By kristen moulton

| The Salt Lake Tribune
First Published 5 hours ago • Updated 1 minute ago

The more severe combat a warrior experiences, the more likely he or she is to later attempt suicide, new research at the University of Utah's National Center for Veterans Studies shows.

It might seem like common sense, says David Rudd, the center's scientific director and the dean of social and behavioral sciences, but it had never before been empirically validated, he says.

"This has enormous implications," says Rudd, who will discuss his research with the Congressional Veterans Caucus in Washington on Tuesday and at the American Psychological Association conference in August.

It shows there are ramifications when a nation sends a small, all-volunteer military into combat over and over and over again, he says.

"The severity of your psychiatric injury, the severity of your symptoms is clearly, undeniably tied to the severity of your combat exposure."

Moreover, it puts to rest the notion that warriors become more resilient, more comfortable the longer they are in combat. That's a bromide sometimes used by those who dismiss combat as a cause because, after all, roughly half of suicides occur among military members who never leave the United States.

"It makes it hard to argue the case anymore that, 'Hey, people who haven't deployed are trying to kill themselves," says Rudd. "Yes, they are, but … it's a separate issue. What this paper helps articulate is there are two different populations of people."

For those in his study who saw heavy combat, the findings are stark: 93 percent qualified for a diagnosis of post traumatic stress disorder and nearly 70 percent had attempted suicide.

Rudd surveyed 244 veterans through the Student Veterans of America for his study, which he expects to publish soon.

Col. Carl Castro, who oversees the Department of Defense's research into suicide prevention and treatment, says Rudd's findings contribute to a growing body of research into the "tremendous psychological and physical burden" that combat places on service members.

(Paul Fraughton | The Salt Lake Tribune) Craig Bryan, associate director of the National Center for Veterans Studies, and M. David Rudd, scientific director for the center and dean of the College of Social and Behavioral Science at the University of Utah, are researching veterans' mental health issues.
Utah study: Heavy combat puts service members at high suicide, PTSD risk
Military » Sending a small, all-volunteer force into combat has "enormous implications," U. study says.

By kristen moulton

| The Salt Lake Tribune
First Published 5 hours ago • Updated 1 minute ago

The more severe combat a warrior experiences, the more likely he or she is to later attempt suicide, new research at the University of Utah's National Center for Veterans Studies shows.

It might seem like common sense, says David Rudd, the center's scientific director and the dean of social and behavioral sciences, but it had never before been empirically validated, he says.
Photos

* (Paul Fraughton | The Salt Lake Tribune) Craig Bryan, associate director of the National Center for Veterans Studies, and M. David Rudd, scientific director for the center and dean of the College of Social and Behavioral Science at the University of Utah, are researching veterans' mental health issues.

At a glance

More on the National Center for Veterans Studies

The center at the University of Utah has several research projects and initiatives underway. Read about them here.
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"This has enormous implications," says Rudd, who will discuss his research with the Congressional Veterans Caucus in Washington on Tuesday and at the American Psychological Association conference in August.

It shows there are ramifications when a nation sends a small, all-volunteer military into combat over and over and over again, he says.

"The severity of your psychiatric injury, the severity of your symptoms is clearly, undeniably tied to the severity of your combat exposure."

Moreover, it puts to rest the notion that warriors become more resilient, more comfortable the longer they are in combat. That's a bromide sometimes used by those who dismiss combat as a cause because, after all, roughly half of suicides occur among military members who never leave the United States.

"It makes it hard to argue the case anymore that, 'Hey, people who haven't deployed are trying to kill themselves," says Rudd. "Yes, they are, but … it's a separate issue. What this paper helps articulate is there are two different populations of people."

For those in his study who saw heavy combat, the findings are stark: 93 percent qualified for a diagnosis of post traumatic stress disorder and nearly 70 percent had attempted suicide.

Rudd surveyed 244 veterans through the Student Veterans of America for his study, which he expects to publish soon.

Col. Carl Castro, who oversees the Department of Defense's research into suicide prevention and treatment, says Rudd's findings contribute to a growing body of research into the "tremendous psychological and physical burden" that combat places on service members.
story continues below
story continues below

Says Rudd, who served as an Army psychologist during the Persian Gulf War: "I don't think there's anything more tragic than to have someone serve multiple tours in combat and survive and then kill themselves."

War's "most significant consequence" » Suicide is a key focus of the National Center for Veterans Studies, which Rudd co-founded at the U. in 2010.

Rudd and the center's new associate director, psychologist Craig Bryan, oversee projects that are teasing out causes and determining the best treatments. The research is funded by the Department of Defense, which in recent years has poured millions of dollars into the confounding issue.

It used to be that serving in the military made one less likely to commit suicide.

Several years of war in the Middle East, when units were deploying two, three, four times, changed that.

Between 1998 and 2011, a June report showed, 2,990 service men and women died by suicide. The number per year nearly doubled between 2005 and 2009, when it peaked at about 290.

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You can view the full announcement by following this link:
http://canadianveteransadvocacy.com/Board2/index.php?topic=5000.0

Regards,
The Canadian Veterans Advocacy Team.

The Canadian Veterans Advocacy - About Us

The Canadian Veterans Advocacy Inc. is an Ontario-registered not-for-profit corporation focused on improving the quality of life for Canadian Veterans.
The organization was founded in 2010 by Micheal L. Blais, CD. Mike was inspired by former PPCLI Colonel (Retired) Patrick Stogran, Canada's first Veterans Ombudsman, when he watched the colonel stand up for the rights of Canadian Veterans during an extraordinary press conference in August 2010. Not long after this momentous event, Col Stogran was informed that his tenure as Veterans Ombudsman was over.
In November 2010, Mike, along with other military, RCMP and police veterans united in the first annual Canadian Veterans National Day of Protest. Thousands of veterans representing small and large communities gathered at their federal parliamentarian’s riding offices to demand the government stand-up for Canada’s Sons and Daughters. Of primary importance was -- and is -- the restoration of the Social Contract and Sacred Trust between soldiers and the Nation they serve. The government abandoned its soldiers and this social contract in 2006 when it passed the New Veterans Charter which replaced the Life-time Disability Pension with an inadequate Lump Sum Disability Award.
The Canadian Veterans Advocacy was born of this successful day of protest; a new veterans association guided by the motto: One Veteran, One Standard.
The CVA was incorporated in July of 2011 and is an open and inclusive organization. We encourage the involvement of all veterans, regardless of the era in which you served. We also welcome the support of family and friends of veterans and of patriotic Canadians.

The Mission

We are guided by our mission statement which clearly outlines our mandate to improve the quality of life for Canadian Veterans.

The Directors

The CVA is lead by Michael L. Blais, CD, with the help of many other active veterans, Canadian patriots and our Board of Directors.

Bravo Zulu

The Canadian Veterans Advocacy recognizes the efforts of individual veterans, other veterans organizations and supportors who are working to help us achieve our goals. Bravol Zulu goes out to...

The Canadian Veterans Advocacy

The Canadian Veterans Advocacy

Web Site: http://www.canadianveteransadvocacy.com/index.html