Healing With Hope

Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain – and yet she was still not sleeping, afraid to be in crowds, unmotivated to clean up enough to look for a job and had days when she couldn't get out of bed because her back pain was so severe. She came to the Samaritan Center for Counseling and Pastoral Care in Austin, Texas after her mother saw a story on the evening news about the Center's Hope for Heroes program and its reduced-fee integrative wellness services for veterans. During her first visit, through tears, she said the center was her "last hope."

Ella began a course of twice weekly acupuncture treatments, weekly counseling and EMDR (Eye Movement Desensitization and Reprocessing) sessions and weekly massage therapy. She received a thorough diet and nutrition evaluation and a plan to balance her blood sugar and reduce inflammation.

This intensive program lasted for six weeks. Mid-way through the treatments she stopped taking the Hydrocodone, Ambien and Linzess and began to reduce her psychotropic medications. She continued to improve with the introduction of herbal formulas. By the end of the series of treatments, her pain was gone. She was sleeping through the night and waking feeling rested and motivated and was actively seeking employment.

When she said goodbye because she was moving to another city, the tears in her eyes were of gratitude.

"I have my life back," she said.

The Evolution of Hope for Heroes

The Samaritan Center founded Hope for Heroes (H4H) in 2007 to meet the growing demand for quality confidential mental health services for veterans and their families. At the time of its inception, H4H was strictly a counseling program.

Three years later, AOMA Graduate School of Integrative Medicine graduate and former Navy Corpsman Sean Hanna wanted to find a way to make alternative healing therapies available to service members, vets and their families. A combat veteran himself, he was all too familiar with the unique needs and challenges veterans face in adjusting to civilian life and navigating the Veteran Affairs healthcare system. He knew his fellow vets needed options for healing; his mission was to make those options as accessible and affordable as possible.

In 2010, Hanna met with Samaritan Center Executive Director Nancy Blaich about making Hope for Heroes an integrative medicine program complete with acupuncture, herbal and nutrition therapies, massage and Tai Chi. The two worked to secure a grant from Texas Resources for Iraq and Afghanistan Deployment (TRIAD), and Hope for Heroes became the comprehensive program it is today.

"Hope for Heroes fills an important gap in services for service members, veterans and their families," explains Hanna. "By offering integrative medicine services, as well as fully incorporating families into treatment, we holistically work with our clients and provide treatment and support unlike anywhere else to which they have access."

Post-Traumatic Stress Disorder: More Than a Label

The U.S. Department of Veterans Affairs estimates 20 percent of veterans of the Iraq and Afghanistan wars (Operations Iraqi and Enduring Freedom, or OIF/OEF), 10 percent of Gulf War veterans and a staggering 30 percent of Vietnam veterans struggle with the symptoms of post-traumatic stress disorder, or PTSD.

Other forms of physical trauma, as well as the military sexual trauma Ella experienced, can exacerbate PTSD symptoms. According to the Department of Veterans Affairs 2012 Suicide Data Report, as many as 22 veterans per day commit suicide. The VA created initiatives to expand mental health services in response to these troubling statistics, but demand continues to out pace supply. Organizations outside of the VA must step up to the plate.

In 2011, 383 military patients had visited the Samaritan Center; by 2013, that number jumped nearly 50 percent to 565. From 2011 to 2013, the number of clients who sought acupuncture and other integrative medicine services – almost all veterans or service members – increased by 76 percent. To say that "acupuncture excels at treating post-traumatic stress disorder," however, is to ignore the complex and highly individual experience of both acupuncture and PTSD. Throw Traumatic Brain Injury (TBI) and physical trauma into the mix and things get even more complicated. Not everyone's experience of "stress" is the same. This includes post-traumatic stress, which is why TCM really excels at treating individuals presenting with the many possible symptoms of PTSD.

Those who have an official PTSD diagnosis from their VA doctors come to Hope for Heroes seeking relief from anxiety, depression, hypervigilance, anger, forgetfulness, insomnia, chronic pain and irritable bowel syndrome. Many struggle with hypertension, diabetes, migraines and addiction. The majority are on several medications – primarily psychotropics, painkillers, sleep aids and drugs to lower blood pressure.

Some patients report having short tempers and feel extremely irritable and aggressive without much provocation. Some vets complain of poor memory or a frustrating inability to focus. Others lay awake at night listening for suspicious sounds, and still others find themselves crying uncontrollably. Some have urgent bowel movements and struggle with nausea and vomiting while others suffer from palpitations and have debilitating panic attacks. Many combat veterans deal with all or a combination of these symptoms almost daily.

While it makes sense theoretically that a Heart-Kidney disharmony would be at play in "PTSD" – or what we as acupuncture practitioners and students have come to understand is PTSD - it is not always the predominant pathology. Spleen qi deficiency (or even sinking), dampness, Heart qi or blood deficiency (as well as Heart blood stagnation), Liver and Gall Bladder damp-heat, Gall Bladder qi deficiency, Liver qi stagnation, Liver yang rising – all of these are potential differentiations of a PTSD diagnosis. Again, TBI, physical injury and chronic pain further complicate the picture.

The deep psychosocial impact and complex, highly individualized manifestation of trauma in the body give the eight extraordinary vessels a special place in the treatment of combat-related stress. Nearly every patient receives an extraordinary vessel pulse diagnosis, which begins and guides much of each treatment. There is great potential for further research and documentation of the application of extraordinary vessel treatments to trauma-related stress conditions.

Combined Therapies Most Effective

TCM is becoming an essential part of the healing process for veterans who come to the center because, as in any population, its diagnostic paradigm allows for an acupuncture and herbal medicine treatment approach that is tailored to each individual. Some patients only receive acupuncture and nutrition or herbal therapies, while others choose to do combinations of acupuncture and talk therapy, acupuncture and biofeedback or neurofeedback or acupuncture and Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based psychotherapy for treatment of trauma.

Outcomes at the center are 20 percent better than the national average, due in large part to the integrative medicine program. The majority of veterans who receive acupuncture in conjunction with counseling, biofeedback, EMDR, or other modalities report feeling less aggravated or overwhelmed by previously upsetting circumstances. Patients report a reduction in chronic pain, better sleep and improvements in relationships with spouses and family members. Acupuncture frequently plays an integral role in abstention and recovery from addiction for many patients as well.

A large number of patients who receive acupuncture before talk therapy report heightened focus and an ability to get more out of their sessions while many others who receive acupuncture after talk therapy – and especially EMDR – report it helps them calm down and process traumatic subject matter brought up in their sessions.

Working With Veterans

Military cultural competency is critical when it comes to working with the military veteran and service member populations. Military families and care givers are another group of individuals who stand to benefit from TCM, and cultural competency applies when working with them as well. Gaining a basic understanding of the different branches of the military, core values, various implications of rank and the many differences between "commissioned" vs. "enlisted" and "active" vs. "reserve" – for example – helps provide context. Courses are available online, while organizations like the Military Veteran Peer Network (milvetpeer.net) also offer thorough military cultural competency training.

The MVPN is a Texas non-profit developed to connect veterans to peers and resources in their communities and is another great place to start for acupuncturists in Texas interested in working with veterans and their families. USA Jobs (usajobs.gov) is worth exploring as well, as they regularly post job openings for acupuncturists at VA hospitals and military bases around the country.

Working within the military population, one gains a deep understanding of the significance of "no man left behind." As acupuncturists, we are particularly well-equipped to lend a hand to the servicemen and women – and the families serving with them – as they struggle to heal on their return from combat. There are many, many more Ellas out there we should never leave behind.