Veterans’ Health Today

Veterans’ Health Today
Summer 2005

PTSD
A Normal Reaction to Abnormal Stress

Greater understanding of the emotional and physical effects of combat-related stress has made assessment and treatment for today’s Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans more immediate and effective than that of returning Vietnam veterans thirty years ago. Today, the medical community recognizes that stress disorders, such as Post-traumatic Stress Disorder (PTSD) do affect veterans.
Public awareness of PTSD came to the forefront after the Vietnam War, although it was recognized by the medical community during World War I as shell shock. Initial treatment primarily involved peer counseling. As more was learned about PTSD, new and improved therapies to deal with the aftermath of stress have been added.

What are the symptoms?
PTSD can occur whether a veteran has been home a week, a year or ten years. Symptoms of PTSD include feelings of being unable to cope with overwhelming anger, sadness, discouragement, depression or tension; a jumpy or edgy need to be on guard; trouble falling or staying asleep; disturbing dreams about the experiences of war; feelings of isolation or distance from family and friends; and increasing substance abuse. Physical symptoms can include rapid heartbeat, headaches, muscle aches or tension. Many vets and their families feel reluctant to seek help for fear that they will be seen as weak, crazy, or a “failure.” Having PTSD means none of those things. It simply means you are having a normal human reaction to the overwhelming stress of war.

What can you do?
There are many things that veterans can do themselves to manage stress reactions. The Department of Veterans Affairs has compiled a list of simple ways to reduce stress:

Physical and mental relaxation
Exercise or sports
Taking a break when necessary
Seeing or talking with friends
Listening to music
Working on hobbies
Writing a journal or diary
Going back to work or school
Practicing your religious faith or talking with a priest, rabbi, minister, elder or practitioner of your faith.

What help is available?
Clinical treatments can include managing symptoms using relaxation techniques, exploring and changing behaviors including self judgments about reactions both when the trauma was happening and today, and talking with peers and counselors about the trauma. Taking the lead in providing education and treatment for PTSD are storefront Vet Centers (Readjustment Counseling Services). Since their inception in 1979, Vet Centers have provided psychological counseling for war-related trauma, community outreach, case management and referral activities, plus supportive social services to veterans and families. Today Vet Centers are staffed with both civilians and some combat veterans, all with an advanced degree in the counseling, psychology, social work, or nursing field.
According to Dr. Jeffrey Matloff, who directs the VA San Diego Healthcare System’s Post Traumatic Stress Clinical Team, VA hospital systems provide more than 100 specialized outpatient programs called “PTSD Clinical Teams” or PCTs for short. In addition to group and individual counseling, these programs provide medication services to veterans who suffer from either military or combat-related PTSD. Often there are separate programs to treat military sexual trauma within the VA. There are also about 16 specialized inpatient PTSD programs in the country.”
Today veterans of the war in Iraq face some new stresses, according to Karen Schoenfeld-Smith, PhD., San Diego Vet Center Team Leader. “More of the service members are deployed from a reserve or National Guard unit,” says Dr. Schoenfeld-Smith. “Often they are leaving civilian jobs where fewer of their supervisors and co-workers understand the unique stressors and adjustment difficulties of combat. Many service members are uncertain about their return to civilian jobs. There has also been higher stress due to short term deployments which were later extended, and multiple deployments.”
“Combat fundamentally changes people in how they think and react, which can impact their post-combat adjustment to the civilian world,” says Dr. Matloff. That adjustment and transition to civilian life can be difficult for both veterans and their families. Helping veterans make that transition is the goal of VA Medical Centers and Vet Centers.
If you or someone you love is experiencing the symptoms of PTSD, remember that the reaction is normal and treatable, then contact your primary care provider or Vet Center.

More information can be found at the following websites:
www.patiencepress.com
www.ncptsd.va.gov
www.ptsdalliance.org
www.sidran.org
www.trauma-pages.com

The VA’s Fight Against Obesity

Everyone knows when their belt gets too tight or they can’t fit into their favorite pants that they’re probably overweight, but when weight gain exceeds 20 percent of a person’s desirable weight, a person is considered “obese.” Obesity is defined as an increase in total fat mass and is measured by calculating height and weight in a formula called Body Mass Index (BMI). A score of 30 or more means the person is obese. According to the National Institutes of Health (NIH), over two-thirds of Americans are overweight, and one-third are obese. Most studies show an increase in mortality rate associated with obesity. Obese individuals have a 50 to 100 percent increased risk of death from all causes, compared with normal weight individuals. Most of the increased risk is due to heart disease. However, there are a host of dangerous obesity-related conditions, including Type II diabetes, high blood pressure, high cholesterol, breathing difficulties, arthritis, heartburn, and gallstones.
So, what are the causes? “There are both genetic and environmental components that contribute to obesity. In most people the environmental component, which includes excess food or calorie intake and decreased physical activity, has a stronger affect on weight control,” said Dr. Vanita Aroda, the director of the VA San Diego Weight Control Program.
If you find that you are overweight or obese, there is help! In 2004 the VA National Center for Health Promotion and Disease Prevention began developing a VA Weight Management and Physical Activity Initiative entitled Managing Overweight/Obesity in Veterans Everywhere (MOVE). While this program is still being developed, some VA Healthcare Centers are already offering this program to their patients. The MOVE program is based on diet and lifestyle intervention to improve weight in overweight and obese veterans. According to Dr. Aroda, “The program is based on 5 levels of care. The first two levels involve basic education and follow up of diet and lifestyle changes. The more advanced levels involve options for drug therapy, residential or inpatient treatment for weight control, as well as gastric bypass surgery (bariatric surgery) as an option for obesity treatment.”
In severe cases surgery is considered for obese patients. “This is an issue that varies by institution. The VA and Department of Defense are currently putting together guidelines to help the clinician. The NIH has recognized that an appropriate requirement for surgical treatment of obesity is a BMI greater than or equal to 40, or greater than or equal to 35 with obesity-associated medical conditions,” says Dr. Aroda.
Even if your specific VA healthcare center does not yet participate in the MOVE program, you can still get help. The VA provides dietitians and a variety of nutrition education classes for their patients. Nutrition is a key part of weight loss.
According to Elaine M. Kane, a Registered Dietitian at the VA Greater Los Angeles Healthcare System, “What we find is it’s your total calorie intake that really determines whether you lose weight. If you burn more calories than you eat then you’re going to lose weight. That’s the bottom line. So, we just have to find that level for each patient, either with decreasing portion sizes or increasing exercise to burn the calories. The types of food are important because we need to make better choices when reducing our calorie intake, so we prefer patients to choose high fiber foods such as fresh fruits, vegetables, and whole grains as well as to choose lean meats, fish and poultry that are lower in saturated fat and cholesterol.
At the VA Greater Los Angeles Healthcare System, the staff provides weekly nutrition education classes covering a variety of topics from how to order healthy food when eating out to converting your favorite recipes into low fat meals.
The VA is committed to your health. Take advantage of the services offered that will help you live a longer, healthier life. And remember, there is no quick fix for obesity; it’s a lifestyle change. Dr. Aroda gives the following recommendation to her patients, “Regardless of the methods available for weight loss, even with gastric bypass surgery, decreasing calorie intake and increasing general physical activity are the foundation for weight control. Try to pick one or two changes that involve your diet and activity levels that you can see yourself doing a month from now, 6 months from now, even a year from now. It comes down to making changes you can stick with for a lifetime, hence the term ‘lifestyle changes.’”
For more information:
      www.move.med.va.gov/
      www.nutrition.gov/
      www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Tips for Losing Weight and Getting Healthy

Be active!
Eat more often with smaller meals
Eat more fiber
Drink more water
Eat less salt
Eat less fat,less saturated fat, and less cholesterol

Become Active About Healthcare:
Know Your Medication

Safe, high quality health care is important for everyone. The single most important way you can help prevent medical errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results.
An important way to become more involved is to make yourself knowledgeable about the medications you’re taking. There is no such thing as a completely safe medication, they all have risks. FDA approval of a drug simply means that the benefits of the drug outweigh the known risks. Here are some specific tips for learning more about your medication.

Make sure that all of your providers know about every medication you are taking; this includes prescription and over-the-counter medication, including dietary supplements such as vitamins and herbs. If you are taking several medications, ask about drug interactions.
Ask questions about your medication. If you have any symptoms or side effects after you start taking a new medication, contact your doctor or pharmacist immediately.
Make sure your provider knows about any allergies or adverse reactions you have had to medication. This can help you avoid getting a medication that can harm you.
Ask for information about your medication in terms you can understand–talk to your doctor and pharmacist about the medication.
If you have any questions about the directions on your medication labels, ask your provider or pharmacist.
Ask for written information about the side effects your medication could cause and keep this information with your medication. If you know what might happen, you will be better prepared if it does. If you do experience side effects, report the problem immediately and get help before it gets worse.
When you receive a new prescription read the label carefully. Make sure it has your name on it and the correct medication name. Some medications have similar names.
Take your medication as it is prescribed and do not stop taking it without asking your doctor. Whenever you are in doubt about a medication, ask your doctor or pharmacist about it.
Avoid foods and drugs that interact negatively with your medication.
When prescribed a new medication, ask your doctor or pharmacist what you should do if you accidentally miss a dose or take more than the prescribed dosage.
Ask your doctor or pharmacist when you should begin to feel the effects of the medication.
Store your medication as directed. Sunlight and extreme temperatures can alter the potency of some medications.

Carry a list of the medications you’re taking with you in your purse or wallet. Give a copy of this list to a family member or friend in case you are incapacitated.

Before your visit with a healthcare provider:

Write down your symptoms, concerns and questions so that you don’t forget to mention them.
Think about the questions and concerns most important for you to address in this visit.
Bring a list of both prescription and non-prescription medicines with you to your appointment.
Ask a friend or relative to come with you to the visit to take notes or to give input.

During your visit:

Describe your symptoms or reasons for your primary concerns.
Let your provider know what other health care providers you have seen have told you about your condition.
Ask plenty of questions and make sure you understand the answers. If necessary repeat back to the provider, in your own words, what was said.
Discuss with your provider different available options for handling your health problems.
Ask your provider where you can get more information about your health problem.
Be open and honest with the provider.
Let your provider know if you are unwilling or unable to follow any advice.

At the end of your visit, ask:

Am I to return for another visit?
How do I get my test results?
What danger signs should I look for?
What else do I need to know?
Will you be sending me to a specialist?

VA Desert Pacific
Healthcare Network
Vet Centers

Anaheim Vet Center
859 South Harbor Boulevard
Anaheim, CA 92805-5157
714-776-0161

Corona Vet Center
800 Magnolia Ave., Suite 110
Corona, CA 92879-3123
951-734-0525

East Los Angeles Vet Center
5400 E. Olympic Boulevard, Suite 140
Commerce, CA 90022-5147
323-728-9966

Las Vegas Vet Center
1919 S. Jones Blvd., Suite A
Las Vegas, NV 89146
702-251-7873

Los Angeles Vet Center
1045 W. Redondo Beach Boulevard, Suite 150
Gardena, CA 90247-4129
310-767-1221

San Bernardino Vet Center
155 W. Hospitality Lane, Suite 140
San Bernardino, CA 92408-3315
619-294-2040

San Diego Vet Center
2900 Sixth Avenue
San Diego, CA 92103-1003
619-294-2040

Sepulveda Vet Center
9737 Haskell Avenue
Sepulveda, CA 91343-1618
818-892-9227

Ventura Vet Center
790 E. Santa Clara
Ventura, CA 93001-2964
805-585-1860

Vista Vet Center
1830 West Drive, Suites 103/104
Vista, CA 92083-6125
760-643-2070

West Los Angeles Vet Center
5730 Uplander Way, Suite 100
Culver City, CA 90230-6615
310-641-0326

REACHING US IS EASY

VA Medical Centers

VA Southern Nevada
Healthcare System
P.O. Box 360001
Las Vegas, NV 89036
702-636-3000

Mike O’Callaghan
Federal Hospital
4700 Las Vegas Boulevard North
Las Vegas, NV 89191
702-653-2215

VA Loma Linda
Healthcare System
11201 Benton Street
Loma Linda, CA 92357
909-825-7084

VA Long Beach
Healthcare System
5901 East 7th Street
Long Beach, CA 90822
562-826-8000

VA San Diego
Healthcare System
3350 La Jolla Village Drive
San Diego, CA 92161
858-552-8585

VA Greater Los Angeles
Healthcare System
11301 Wilshire Boulevard
Los Angeles, CA 90073
310-478-3711

Community Clinics

Anaheim
1801 W. Romneya Drive
3rd Floor, Suite 303
Anaheim, CA 92801
714-780-5400

Antelope Valley
547 W. Lancaster Blvd.
Lancaster, CA 93534
661-729-8655

Bakersfield
1801 Westwind Drive
Bakersfield, CA 93301
661-632-1800

Cabrillo
2001 River Avenue
Long Beach, CA 90810
562-826-8414

Chula Vista
835 3rd Avenue
Chula Vista, CA 91910
619-409-1600

Corona
800 Magnolia Avenue #101
Corona, CA 92879
951-817-8820

East Los Angeles
5400 E. Olympic Boulevard #150
City of Commerce, CA 90040
323-725-7557

Escondido
815 East Pennsylvania Avenue
Escondido, CA 92025
760-466-7020

Gardena
1251 Redondo Beach Boulevard
3rd Floor
Gardena, CA 90247
310-851-4705

Henderson
2920 Green Valley Parkway,
Suite 215
Henderson, NV 89014
702-456-3825

Imperial Valley
528 G Street
Brawley, CA 92227
760-344-9085

Las Vegas - Homeless Veterans
912 West Owens Avenue
Las Vegas, NV 89106
702-636-4077

Lompoc
338 S. Dakota Avenue, Bldg. 13850
Vandenburg AFB, CA 93437
805-605-2120

Los Angeles
351 E. Temple Street
Los Angeles, CA 90012
213-253-2677

Mission Valley
8810 Rio San Diego Drive
San Diego, CA 92108
619-400-5000

Oxnard
250 W. Citrus Grove Avenue
Suite 140
Oxnard, CA 93030
805-983-6384

Palm Desert
41865 Boardwalk, Suite 103
Palm Desert, CA 92211
760-341-5570

Pahrump
2100 E. Calvada Boulevard
Pahrump, NV 89048
775-727-7535

Pasadena
420 W. Las Tunas Drive
San Gabriel, CA 91776
626-289-5973

San Luis Obispo
1288 Morro St., #200
San Luis Obispo, CA 93401
805-543-1233

Santa Ana
Bristol Medical Center
2740 S. Bristol Street
1st Floor, Suite 110
Santa Ana, CA 92704
714-825-3500

Santa Barbara
4440 Calle Real
Santa Barbara, CA 93110
805-683-1491

Sepulveda
16111 Plummer Street
Sepulveda, CA 91343
818-891-7711

South Los Angeles
3737 E. Martin Luther King Jr. Blvd.,
Suite 515
Lynwood, CA 90262
310-537-6825

Sun City
28125 Bradley Road
Suite 130
Sun City, CA 92586
951-672-1931

Upland
1238 E. Arrow Highway,
No. 100
Upland, CA 91786
909-946-5348

Victorville
12138 Industrial Boulevard
Suite 120
Victorville, CA 92392
760-951-2599

Vista
1840 West Drive
Vista, CA 92083
760-643-2000

Whittier/Santa Fe Springs
10210 Orr and Day Road
Santa Fe Springs, CA 90670
562-864-5565