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Experts: Vets need more comprehensive care

When an improvised explosive device blew up in Fallujah, Iraq, in 2004, Derek McGinnis, a former Navy corpsman, lost the bottom half of one leg.

But during a session about the importance of dealing with pain management while working with veterans with traumatic brain injury and post-traumatic stress disorder, McGinnis found that no one seemed to believe him when he spoke of the great pain he felt in the remaining half of his leg months later.

Because the explosive had left bits of metal shrapnel in his leg, doctors couldn’t use an MRI to scan his thigh for other problems. Instead, they acted as if the pain were all in his head.

“It hurt not to be believed,” he told an audience of care providers May 7 at the Coalition of Iraq and Afghanistan Veterans’ conference in Washington, D.C.

That pain, which he said burned day and night, made it difficult for him to make progress in any other area of his rehabilitation. Soon, he was transferred to Brooke Army Medical Center in Texas, where a doctor diagnosed him with nerve damage and bone growth, and immediately began addressing McGinnis’ pain.

“I was hopping up and down on one leg because I was so excited that they believed me,” he said.

Since his pain was addressed, he has worked on his mental health issues and become so comfortable with a prosthetic device that he’s now a triathlete.

As organizations throughout the U.S. work to help combat veterans, the Coalition for Iraq & Afghanistan Veterans decided to bring them all together so they could share knowledge about what they’re doing and talk about what still needs to be done. CIAV is a clearinghouse of 50 agencies that seek to help veterans of the wars in Iraq and Afghanistan.

At the three-day conference, McGinnis and other veterans talked about their experiences trying to access care after returning from deployment; family members talked about their own versions of “combat stress”; and care specialists talked about what they had to offer, as well as how the different organizations could team up.

McGinnis helped show care providers why comprehensive pain care is needed beyond treatment of the injury itself. Many veterans suffer from long-term pain, such as migraines caused by TBI or back pain caused by falls from vehicles.

Others on the same panel had advice specific to working with veterans. Fred Gusman, executive director of California Transition Center for Care of Combat Veterans — The Pathway Home, talked about using terms that service members can relate to, such as “mission,” and allowing them to look at their recovery as a “rescue mission.”

They need to use “intel” to find jobs, and instead of attending “Panic and Anxiety” classes, they went to “Jumpin’ and Jittery” classes, he said.

Elizabeth Hawkins Robinson, the cofounder of ONE Freedom, talked about the importance of teaching service members ahead of time about what stress reactions they would have in combat, as well as how to “normalize” the experience by using deep breathing techniques to calm down — or to regulate their intense life experiences.

“The hallmark of trauma is helplessness,” she said. “Empowerment is a way out of that.”

If troops understand the physiology behind stress reactions before they experience them, they might be able to understand what happens to them as what’s supposed to happen in combat.

Joseph Bobrow, president of the Coming Home Project, talked about retreats that could help everyone from health workers to family members to the veterans themselves begin to recover from having or dealing with combat trauma.

And Brenda Murdough, coordinator for the Military and Veterans Initiative for the American Pain Foundation, talked about how each piece of a veteran’s needs plays into the others. For example, McGinnis, because of his pain, couldn’t work on his psychological needs. To that end, she said comprehensive pain care needs to be accessible. She added that some veterans wait 28 to 45 days for an appointment and many don’t know what’s available to them.

More information about the Coalition for Iraq & Afghanistan Veterans and the resources it can offer is on the Web.