Drug Problems

18 12 2008

Before I write anything else, I have to thank BabyJesusHorse for agreeing to participate.  His knowledge and experience are invaluable to those of us who’ll seek compensation for service-connected injuries and illnesses.  He’s a good writer, a very kind man, and he cares about his uniformed brothers and sisters.  His participation also ups the intelligence quotient quite a lot.

Drug problems.  I’m not referring to my depency on narcotics.  Though I’m sure I’ve referred to my depency sometime earlier, and will no doubt again sometime later.  No, this post is about problems obtaining medications prescribed to WTU soldiers.

The problem is simple to describe: We’re given two week supplies of narcotics (usually prescribed for accute or chronic pain and or insomnia), but often cannot, due to limited staffing and man-hours, get follow up appointments, procedurally necessary for refills, before our drugs run out.  Meaning some, myself included, have gone without pain medication for days.  Some go through withdrawal.  When I asked them why they endure this suffering quietly, I’m given an indoctrinated/enculcated response.

I’m not given to taking that route.  The first time it happened I complained to my case manager.  My meds were refilled by phone (which apparently isn’t supposed to happen).  The next time it happened, I took the prescribed amount from the leftover smaller doses I had lying around (for example, instead of one 40 mg Oxycontin, I took one 20 mg and two 10 mg), and brought the problem to the attention of my platoon leader.  He assured me this problem is going to be addressed.  I believe him.

I’ll keep you all abreast.



Just Who is Navin Johnson?

18 12 2008

The esteemed and talented creator of this public diary has paid me the ultimate compliment by allowing me to share my thoughts with you.  I’m sure Jimison’s regular readers are wondering just what the hell a “Baby Jesus Horse” is and why Jimison hath given me space from which “to blog.”

I will try and be succinct and readable and do Jimison proud, though I have to admit publicly and to myself that I have not the rhetorical skills nor the intellect of my very dear friend. But I’ll give it a whirl nevertheless, because although my experiences are very different than what Jimison has endured, our crippling back and leg pain are similar in scope as well as intensity. He found me in a forum dedicated to assisting veterans who had questions about VA functions and such. We now see each other on a fairly regular basis because not only is Jimison a well-educated and thoughtful person, he is very personable and truly gives a shit about the world in general and those around him in particular. Plus, he gets to spend most weekends in a real house with my wife and children and ya gotta know that that beats barracks life any day ‘o the week.

My back problems began in 1988, though I had some muscular-type injuries prior to the audible “POP” that occurred while I was doing some black ops for 8th Army J-2, specifically moving office furniture because I was too impatient to wait for a dolly. Yep, earned my beret that day.  Well, that “POP” has since been identified on x-rays as a “node, probably old fracture” of a vertebral body in the lumbar (lower) spine. Not only did that injury–along with a severe ankle sprain and fracture from 1984 incurred doing PT at the Defense Language Institute-SF– become more severe, especially since the Army MD’s could not diagnose my symptoms (see ‘Feres Doctrine’), I was discharged on disability and dropped into the VA’s House of Mirrors in December 1991.

But I digress. I got a B.A. in Econ and History, started working for the VA in July 1996 as an “adjudicator” (a misnomer if there ever was one). I responded to veterans claims by telling them what to do, what VA needed, and assembled the evidence necessary to rating the claim fairly. Interestingly and much to my surprise, I found that I could–at least in my own little corner of the VA universe–make positive things happen to help veterans and their surviving spouses. Mind you, it was always an uphill struggle because many, but not all, of my coworkers were EXACTLY what people think of when they picture “government bureaucrat”.  The most egregious examples were all in management.

Surely, this comes as no surprise to many who have had the pleasure of trying to get someone on a 1-800 line to act as if they gave a rat’s ass about your concern. I know of a case where a phone contact person put a “difficult” claimant on hold and then went home for lunch. I ain’t lying! This person’s spouse is now a GS-14 and former vice-director of the Appeals Division in Washington, D.C.  Funny anecdote: the now GS-14 tried to convince me one day that “just because something is mandatory doesn’t mean you have to do it.” There are others who do care that they are at least doing a good job but who aren’t terribly smart, but very very few can be described as “advocates” for veterans. FWIW, by the time I was retired due to disability, I had been a rating specialist, a very good one too, for 7 years.

I’m proud to say that I was, and still am, an advocate for veterans and their spouses. I try and volunteer when possible with the state agency. Don’t get me wrong: there are lotsa buttwipes out there who submit false claims, phony doctor’s records, and falsified DD-214’s that create a huge, as in GINORMOUS (it’s really a word) backlogs for the VA. But most people are not aware that VA does not make its own rules; instead, Congress writes the laws and Courts often change those same laws that sometimes cause the ENTIRE benefits side of VA screech to a halt in order to ensure ALL current claimants awaiting a decision get to read another paragraph and have another 60-120 days to respond.

CAVEAT: Believe you me, I ain’t about to defend all the VA’s inefficiencies on court cases and fraudulent claims, because the vast majority of those claiming benefits are law-abiding, honorably discharged veterans’ who served their country and deserve better than what they are receiving, case closed.

That being said, many of those who scream the loudest (and I’m not employing hyperbole) are the conservato-libertarian types who want to abolish most guvment  services as a drain on society. Anecdotally, and I’ve told Jimison about this, some of the most disputatious and foul-mouthed callers into the 1-800 line hail from estates in Palm Beach, FL. I’m talking about multi-millionaires like retired CEO’s of Fortune 500 companies and famous entertainers. And they have called, red-faced and out of breath because the additional $22 cost-of-living increase didn’t make it into their check.

Call me crazy, but the Truth, as the Greeks and Confucius instructed us so many hundreds and hundreds of years ago, is usually somewhere in the middle. Which brings me to the title of my introductory missive as well as my nom de plume. Navin Johnson was the name of the character played by Steve Martin in The Jerk. At one point in the movie, Navin, who came from desperately humble beginnings, looks into a TV camera during an interview and asks out loud and in the 3rd person, “Just who is Navin Johnson?” when a breaking news story butts in that results in his losing all his earthly possessions.

The moral of the story, as my addled brain inferred anyway, was never to take oneself too seriously because once it’s all said and done, the only things that truly matter are the unconditional love and affection of another person/family or adored pet, and the location of the GODDAMNED REMOTE!!! But seriously, we’re all Navin Johnson in one way or another. He lost all his possessions and his fame, but his loss forced his family and wife to find him because they cared for him regardless of the trappings.

Which brings us to “Baby Jesus Horse.”  This term came to my attention several years ago during some nasty and contentious and very public melees over the veracity of the Theory of Evolution and whether Intelligent Design should be taught along with Evolution if not outright supplant it from the curriculum.

As I sat transfixed, watching the TV interview and stuffing my face as any good American, the “curator” of a “museum” dedicated to the principles of Creationism (capitalized just in case) posited that a certain collection of bones were not “dinosaurs” that roamed the Earth 165 to 300 or so million years ago; no, those were the bones of an animal that flourished since the time of Creation (there’s that capital “C” again–one can never be too sure) until the Era of  Jesus, from about 6,000 B.C. to 32(?) A.D. and the animal was being called a “Jesus Horse” by the museum’s resident Creationist.

I awoke, several hours later and in a hospital room, very confused about how and why I was there. The treating physician, who took actual science-based medical courses for 8 or so years, kept checking my arms and toes for track marks, convinced that I was a junkie. He then referred me for a psych evaluation, but I beg you NOT to tell Tom Cruise and his Macadamian Space Army or whatever they’re called…ok, you got me. Everything in this paragraph is NOT true. But, everything in the previous one was true!

Most Internet avatars or fake names are designed (wink wink) to either make someone overly cute, strong, sexual, or powerful. So I defy anyone to find something more, you know, all of those qualities (except sexual) than a BabyJesusHorse. So I am the Steed of ID, but do not call me SID.

Currently, I volunteer my time and talents to assisting veterans or Active Duty “close to getting out” getting their cases in order and explaining as well as I can how the VA system operates. My back pain severely limits what I can do and the meds, as beneficial as they are, make me stoopider than I actually am. But I am willing to help anyone with a VA-related question including gathering secondary or tertiary evidence that independently corroborates a stressor for the purposes of establishing service connection for PTSD. The stressor could be a landmine, sniper fire, rape, fire aboard ship, etc.

As mentioned before, I am a retired rating specialist from the Department of Veterans’ Affairs. Some of my duties included assistant ex-POW Coordinator for the station and helped direct the development of evidence and medical care/exams for these poor bastards who had been largely forgotten by the VA and the American public until the Jessica Lynch saga.

 I also worked as the sexual trauma development expert at a time when the VA decided, belatedly, that sexual assault victims should be approached and handled with greater care and concern given the intensely personal nature of these crimes. To its credit, VA mandated that the evidence required to successfully prosecute a claim of this nature was inherently different by recognizing two extremely important facts about sexual trauma cases: 1) most victims, and men more than women, rarely report these types of crimes, and 2) the FBI has estimated that over 98% reported sexual assaults actually occurred, meaning that people who file these claims are telling the truth in virtually every single instance.

 In fact, in the absence of clear evidence that an assault occurred, e.g., no police/MP report, no ER visit, etc., Military Sexual Trauma (MST) is the ONLY instance in which a VA examiner, upon review of military service personnel records and secondary or even tertiary evidence (like a personal diary or letter home that describes the event), can establish service-connection by linking current symptoms to the in-service MST. This is not to be confused with medical opinions and the like; in MST cases, the rating official MUST accept the conclusions of the examining official because the legal arm (the rater) does not have the training nor degree to evaluate isolated personnel records and conclude that something happened to the veteran despite the lack of “concrete” evidence.

Well, I hope to have simultaneously enlightened, humored, and entertained you sufficiently to gain a measure of trust. I also want everyone who reads Jimison to understand that he is no wilting lily or crybaby because he stubbed his toe. Unbeknown to him, the original injury to his lumbosacral spine included the fracturing of both superior and inferior facet joints at L5-S1. He had immediate loss of sensation to his feet and was soon experiencing fecal incontinence as a result. The Army and his local command did not believe the injury to be so serious when it should’ve been emergency surgery. I read the documents and after 12 years at the VA, I know what I’m seeing. Instead, he did not have surgery for 15 months and is in excruciating pain much of the day.

Now, a former combat medic who could dunk a basketball at will, has permanent and degenerative conditions that will ultimately affect his ability to walk. Had the military taken care of him from the beginning, most of the current symptoms as well as poor prognosis would not exist. So I advise those of you who believe this man to be a “girly-man” because he had to fight the military to get basic care, commit this adage to memory:

There, but for the Grace of God, go I.

If you don’t understand it, ask a trusted clergyman to help you out.

It was nice meeting all of you, especially those who are concerned that I promised to be “succinct” in the opening para chapters. It’ll get “succincter” as I grow into a Master of Bloggering.

Peace and Whatever,

BabyJesusHorse

ps-Merry Christmas and Happy Holidays to you and yours!



When He to Whom One Speaks Does Not Understand, and He Who Speaks Himself Does Not Understand, that is Metaphysics

15 12 2008

Bad pain day.  Debilitating pain day.  Slow, hobbling movements.  A lot of “Are you going to be okay brother?” as I entered the Patton Museum auditorium for our monthly town hall meeting.  I’m going to spare my readers a full report of the meeting, as much of it is irrelevant to this post.

The Chaplain spoke.  A brilliant, yet humble man.  A man whose life and all its energies are devoted to God and to us.  His words were moving and uplifting.

Next the Warrior Transition Battalion Commander spoke.  He is awesome!  His intelligence, his experience, his appearance and the way he comports himself, they all command respect.  The kind of officer one thinks of, if one served before the new millennium, when one thinks of officer.  A different breed of person.  A natural leader, differentiated from the enlisted under his command by more than a bachelors degree and completion of a 14 week course.

Yet, in spite of my admiration for him, I found myself disappointed with him today.  He spoke of certain problems and how they have been, they’re being, or they will be resolved.  But as he spoke he revealed something of his metaphysical commitments.  For those of my readership, especially my critics who don’t understand what they consider ‘big words’ and get angry at those who use them, one’s metaphysical commitments refer to what one believes is.  In this case the commander spoke to the nature of Army bureaucracy.

Army bureaucracy is huge, cumbersome, but will, eventually, plod towards the general direction of what’s right, wanted, needed, etc.  Most shook their heads and or made some utterance signifying agreement.  Some seemed to even find it humorously tolerable in a “Gee, isn’t is funny when Uncle Youngea drinks up the still fruit, impregnates all the pigs, and drives the riding mower into the lake?” sort of way.  Ha ha, that’s our Army. [Wink wink.  Nudge nudge.]

There’s nothing in the definition of ‘bureaucracy,’ which the Army certainly is, suggesting inefficiency, and even if there were, that wouldn’t justify the harm done.  There’s nothing funny about the state of Army medical care.  There’s little to suggest Army medicine, as a general rule or as a whole, is plodding in the right direction.  There’s nothing tolerable, humorously or otherwise, about this bureaucracy’s failings.

Real people are hurt by this type of thinking.  Real people die because most of my brothers and sisters accept that this is just the way things are.  Real families lose their sons, daughters, husbands, wives, fathers, mothers, etc., and I suspect they don’t find anything funny about it.  And real people will continue to be hurt and killed, and families will be harmed until we recognize that there’s a mighty big difference between what is and what ought to be.

It’s clear there are those who get it.  That change is needed.  That a resigned laugh at how things are isn’t going to cut it anymore.  But those are few in number, and we tend to face a lot of hostility from the rest our fraternity.



The Cost

12 12 2008

Turn on the news and you’re bound to find some demagogue treating this war in a demagogic manner.  “If not for this war, we could fund free donuts and coffee drinks of ones choosing for all.”  Etc.  Etc.  Wonderfully acted out anger regarding the costs of the current conflicts.  Costs, that if redundant programs were reduced, could at least partially be recouped.  And as politicians and pundits argue in circles, rote from their side’s talking points, something important is lost.

Yesterday my best buddy here at the Fort Knox Warrior Transition Unit was admitted for suicidal ideations.  I don’t know for certain, but if I had to guess, it’s because he feels worthless given his injuries and the limitations they impose.  No analysis or opinion in today’s post.  Just think about him for a moment today.  Think about the many like him throughout the armed forces at the front and here at home.  Pray for them.  And remember, for everything we do there’s always a cost.



Transforaminal and Facet Injections

7 12 2008

I went to the Murphy Pain Clinic last week to discuss spinal cord stimulator implantation.  I’m on plenty of soporific drugs - Oxycontin, Percocet, Flexeril, Clonopin, etc.  I may have blacked out or simply ‘lost’ that block of time.  Sometime between walking in, laughing at the nurses’ strange preoccupation with my urine, and giving the doc a parting handshake, I agreed to four more steroid injections.

Two transforaminal injections and two facet injections.  The former and the latter require fluoroscopic X-ray and contrast dye guidance, and bath the inflamed spinal nerve roots in an anesthetic/steroid solution.  While invasive, the risks associated with this procedure are minimal.  Many find their symptoms abate, if only temporarily, upon completing the series.  For those who don’t respond, this is the road to electrical relief.

I have a problem with this because a) I’ve had several failed epidural steroid injections, and b) the approach assumes inflammation is the cause of pain, and c) I have no facet joints near the offending nerve roots - though it’s likely the areas once occupied by facet joints are pseudo-arthritic.  I sense this approach is an insurance company mandate.  I also sense, given past experience, this approach will fail.  But if this is what’s required to get the stimulator, this is what I’ll do.

Most of this will happen after Christmas Exodus.  Be sure I’ll keep you all abreast of every development.



The Great Art of Life is Sensation, to Feel that We Exist, Even in Pain

1 12 2008

Bad pain day.  Rolled out of bed around a 5/10.  Three appointments spaced three hours apart.  A lot of sitting and walking.

The foci of my treatments - mental/emotional and physical - have shifted a bit.  No longer do we harbor hopes of betterment.  Managing a lost cause seems the focus now.  Recognition creates its own pain.

I’ve accepted that this is my life.  I will never bench 400 pounds again.  I will never dunk a basketball again.  I will never walk the “Arb” with my wife again.

I know this.  I’m not at peace with it.  Finding it will be the greatest challenge of my life.  Where and how does one find peace in pain?