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Command Post What is this?
Posted on Mar 19, 2015
CPT Aaron Kletzing
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SGT(P) Michael H.
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As a seasoned Army Combat Medic, who has been fortunate enough to cut my teeth under the direct supervision of the Associate Dean of JSOMTC back from 2002-2005, as well as numerous other DR.s, PA's, 18Ds, and a few very well versed 68Ws, I can say that it should be mandatory for every 68W to be taught and maintain the skill set of performing a full Flight/Dive neurological exam. If this were the case, many of the injuries slipping through the cracks downrange would be caught in plenty of time to treat the patient properly.
The "bare minimum" "you will get OJT at your next assignment" mentality needs to stop. It is killing many of our soldiers and lowering their standard of life for the long term.
Also, this Motrin mentality needs to stop! And I can say from experience...be a man and step up and stand up for yourself and do the right thing...get the medical treatment you need and deserve! 20 years down the road YOU are the only one who is going to remember how "hard" of a soldier you were, and your chronic injury issues will be talking to you and keeping you company everyday for the rest of your life.
I am a huge advocate of TBI studies and treatment. I hope all goes well for you and the others who take part.

Regards,

Doc Harris
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SFC Mark Merino
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Rub some dirt and drive on is only a great mentality in combat. Your career WILL end one day. ONLY you will remember how "hard core" you were and your body will pay the price. I am paying the price now post-Army. Now that I can enjoy life without that 24/7 sense of urgency, I am unable to do a great deal of things physically. You want to be able to have a good quality of life post service so PLEASE take care of yourself. Also, no one knows your body better than you. If you are told you are ok (or in the aviation troubleshooting world.....'could not duplicate, MOC'd OK') get a 2nd opinion. I spent 15 months with severe nerve impingement and was threatened with a MEB at 14 years because the same jackhole couldn't read an xray and now my hands are paying for it and my left arm is essentially for show. You can keep the 100% disability and the pension. You will want your body back, believe you me.
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SFC Mark Merino
SFC Mark Merino
>1 y
Great point MSG Tom Earley. God help you if you missed a rollout to the field. Even with a broken leg you would feel like you weren't worthy of respect back in the day. I got knocked out on my Sheridan tank (VISMOD BMP at NTC) and my eye was swollen and I had a gash 2 inches long. My 1SG told me to close it with 100mph tape and put goggles on (we were in the field). I was going to do it without question until some horrified medic threw me in his crackerjack vehicle and said "life, limb, or eyesight, 1SG." I went in, got xrayed, got 9 stitches, and was ordered to stay in an empty barracks room for 72 hours since Top was so pissed about being overridden by a medic. I would have killed someone to get back out to the field to avoid that 'shame'! Different times.
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MSG David Johnson
MSG David Johnson
>1 y
I was under the mentality when I was a young Soldier that I would 'sleep when I'm dead', that mentality caught up to me at about the 18 year mark. I've dealt with bad knees, back, and neck. After my truck was hit by an IED near Ramadi my days were numbered, 362 days after getting blown up I was retired with a 30% Army rating and a 90% VA rating. Both have increased since then, 40% Army, 100%+ VA.
I still do things around the house but I have ice packs, heating pads and a TENS unit to help out, plus the pain meds. I've had ulnar nerve surgery, and carpal tunnel surgery on my left arm, and will be having the right side done in October. I had a discektomy in 2012 to remove a disc that was pushing on my spinal cord. The discektomy helped some, and the ulnar nerve, and carpal tunnel surgeries have helped more, but there is still positional issues with nerve pain.
I'm on Gabapentin for the nerve pain but I get spasms on occassion, they are sometimes kind of funny, except when I spill stuff on my lap, or food falls off my fork.

Everyone has their own issues from the service and a lot of us that were the Gung Ho types have extra stuff to deal with. I retired 1 May 2008, and am still waiting for the doctors to pull their heads out and do something about the damaged discs in the low back.Hopefully someday I will be able to post that all the surgeries worked and I'm pain free...Ha! Like that's gonna happen. Maybe when Unicorns have Rainbows coming out of their asses.
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LTJG Robert M.
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Drug companies have never healed anyone or cured any disease, they just create new customers.
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SPC David Hannaman
SPC David Hannaman
>1 y
Except for polio and smallpox. ;)
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LTJG Robert M.
LTJG Robert M.
>1 y
Ah, those were vaccines which the human body converted to anti-bodies, which then provided the resistance to the full disease which, by attrition, the disease was eliminated.
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SGT Rick Ash
SGT Rick Ash
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The ARMY tried to vaccinate against Swine Flu in the late 70's and my best friend was paralyzed for 6 months. He had to learn to walk all over again.
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Sgt Sharon Allen
Sgt Sharon Allen
>1 y
Except for penicillin and other antibiotics, antifungals, malaria and other preventatives, etc... Tetanus, pertussis, measles etc... Almost all gone. And extended many lives, improved the quality of life for those with diseases that are incurable, such as AIDs,, MS, Alzheimers, cancers gone into remission or completely gone, countless genetic diseases where children die without the drugs by 5 or 6 but then live to 10 or more, controlling of both types of diabetes, should I go on? Many drugs are to suppress symptoms and not cure a disease. People need to take responsibility for their own health too, but they don't want to. They want to take a daily pill for heartburn and eat what they want. Our life spans as 35 years longer today than they were 100 years ago due to vaccines, blood pressure reducing agents and other drugs that suppress dangerous effects when not controlled. Babies who dies in 1912 were 150/1000 versus today it is 6/1000. Did you know that 1 in 10 drugs that ever make it to phase 3 trials ever make t to market? How about you tell a family with a child with Lupus, cystic fibrosis, severe allergies, asthma, mental health issues, blood disorders, severe digestive problems, Crone's disease, seizures, kidney or liver disorders, and so on, and so on..... that drug companies have not helped their kids or made the symptoms better, even for a while.

If you have ever been sick, why did you go to the doctor? So he could tell you to try something homeopathic?

Maybe we should take a look at how many chronic smokers, drinkers and obese people are in this country, because we all know that Phillip Morris and Jose Quervo have done the World a lot of good. Right?

I am not saying drug companies don't want to make money, but until you can make yourself feel better, and fix all the diseases, they have to pay for the research and dealing with insurance companies who don't want to pay for anything. They are the only hope for some families when it comes to research and finding a way to help.
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Why our “Take a Motrin” approach could be hurting our troops: Part I of II
MAJ Senior Observer   Controller/Trainer
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Edited >1 y ago
This is a leading cause of the VA backlog. This is partially the cause of my issues post-deployment; I however share in the blame because I bought into the Army mindset that as a Commander, I had to suck it up and lead by example for the sake of my Soldiers and my mission. The Motrin/quarters/RTD tread-mill is an antiquated model by any medical standard; but it seems to me it was only reinforced with the introduction of Combat Stress personnel in Theater who were quick to introduce sleep medications that often masked the lingering effects of a TBI.
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Sgt Aaron Kennedy, MS
Sgt Aaron Kennedy, MS
>1 y
Combined with the "We don't document anything associated with a motrin handout, they'll get better"
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SSgt Geospatial Intelligence
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I think that, as leaders, part of the mission now is that you also have to show human weakness. We have, unfortunately, learned that by not showing weakness, we are actually cutting through the links in our chain. We force our soldiers/marines/airmen/sailors to continue on because it would be weak to not to, when the opposite may be the case. If there is an instance of TBI, perhaps the strong thing to do now is to get some treatment so that the member can get back to the field in as good of shape as before, instead of sending them back out after half-assing the "concussion test" because they don't want to be seen as weak.
As leaders, it was believed that you had to work through the pain & issue in order to be strong for your men/women. Perhaps now it is time to recognize that another way of showing strength is also intelligence enough to know when to say when so you can get better?

I dunno, just thinking out loud, MAJ (Join to see)
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True statement sir.....the mentality of suck it up buttercup is causing just as much harm if not more than poorly trained medics.....and I say poorly because a well trained one would stand up to a commander and say "i'm sorry sir but your down for a few days"
MSG David Johnson
MSG David Johnson
>1 y
I think that if my commander had allowed the paperwork to be turned in he might have had at least 5 PH's, may a couple more. He's the Gung Ho type that had to keep going for his men, and I am VERY glad he was my commander.
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LTC Stephen F.
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CPT Aaron Kletzing this discussion about Motrin reminds me of the over-prescribing of small doses of amphetamines in the early 1990's to primarily young boys who were "over-active" - ADD and ADHD seemed to be the diagnosis of the day for many parents of young boys in those days. Some children had ADD or ADHD but many didn't and the over-use of amphetamines on young children caused some issues at the time and I expect other issues will surface as those former-children age.
I had a concussion with amnesia when I was child and my prescription was bed-rest with fluids for one week.
Prior to going through mitral valve repair surgery at Walter Reed in 2003, I found Ibuprofen and Naproxin very useful for situations where pain was due primarily to inflammation.
Since Ibuprofen and Naproxin have blood-thinning properties I can no longer use them without express orders from my physicians.
I had been through more than enough opioid-based pain medications with all of their side effects to be thankful for anything that did not cause severe itching like Dilaudid (hydromorphone) and constipation including Oxycodone, percoset, etc.
The over-the-counter non-steroidal pain medications are wonderful when proscribed properly - aspirin, acetaminophen, ibuprofen all have there places. Hopefully ibuprofin will not be over-proscribed. [I am using over-proscribed versus over-prescribed because ibuprofin is available over-the-counter and four 200 mg tablets is equivalent to one 800 mg prescription tablet of ibuprofin :-)]
LTC Stephen C., SPC (Join to see), SGT Forrest Stewart, SSG James J. Palmer IV aka "JP4", TSgt Hunter Logan, SGT (Join to see)
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SFC Dan Sorrow, M.S.
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They're still throwing Vitamin M at everything, I see. I was on that and then Celebrex the last 5 years of my career and the first 3 years after I retired. It was later determined NSAIDS cause numerous side effects including gastrointestinal and hypertension. After a lengthy fight with the VA and an appearance before a VA judge under appeal, my hypertension became service connected. The GERD was service connected under their initial finding.
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SFC Dan Sorrow, M.S.
SFC Dan Sorrow, M.S.
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I agree MSgt! It's a different world to try and get an earned!
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Motrin is a very effective medication when taken and prescribed correctly one of the reasons we use it so much ......It Works!!!!!
SFC Dan Sorrow, M.S.
SFC Dan Sorrow, M.S.
>1 y
When it's over prescribed, MSgt, it's not a good thing though. I was on 800mg 3x's daily for 5 years rather than get a referral to a specialist to see what was wrong. By the time I was referred to Ortho, it was too late for physical therapy and other non invasive remedies to help. I also developed GERD from the med.
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CSM Charles Hayden
CSM Charles Hayden
6 y
MSgt Ronald Stacy Used correctly! Meds are only another resource, I appreciate having others availabe to me thru top notch medical coverage!
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SPC David Shaffer
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CPT Aaron Kletzing very good post Sir. Since I was injured with my STBI, I have been on a mission to learn everything about the brain and brain injury. Scientist have worked hard to understand the brain, but there is still so much they do not know. I know for a fact (I have a severe brain injury) that there are many variables that go into the healing process. When I came out of my coma, I could not function at all. I did not know my wife or child, my name, who I was, what happened, could not walk, eat on my own, or complete any of the functions of daily life. They told my wife that if I would come out of my coma that I would be like a child for the rest of my life. I obviously knew different! I have recently joined the "Golden Key Honor Society" for my high grade point average (4.0). I have also become a FreeMason, and business owner. The "Take a Motrin" approach is going to hurt more people that it will help. The biggest problem the SM will face is the fact that every single brain injury is different and each individual will heal/recover in their own way.

David Shaffer
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SPC David Shaffer
SPC David Shaffer
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If I lived closer I would take part in this study for sure!
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Of course MRS/MRI can't be administered in the field, so you have to rely on emergency field procedures for patient assessment. I think a part of the problem, from what I've seen working with disabled vets, is the old "huah, huah, three bags full" mentality. I can't tell you how many vets reported TBI to me, but when I ask about medical records, they say they never sought help. Far too many are very highly motivated and don't want to be seen as weak by saying they got hurt. DOD needs much better TBI awareness training among ALCON to address this.

The other side of the coin is how common it was in my day, that no matter the injury, they handed you "Vitamin M" and did little else except for RICE (Rest, Ice, Compression, Elevation). They did very little in the way of diagnostics, and far too often serious injuries to joints could slip through the cracks. I had a Meniscus tear on a ship in the North Arabian Sea, that was treated in that fashion. This knee has been a problem for me for 30 years now...
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Great answer.....they report it....but yet never sought treatment or care for it while in service....a good portion of the problem lands in the patient's lap.....no-one can force anyone to seek care...you have to go to doctor and be open and honest with what is going on with you...regardless of what is does to your readiness standing.
Cpl Jerry Millar
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Cpt Kletzing,

I could not agree more with this! Add to football and futbol (soccer) the sport of hockey. I played hockey growing up and played Junior A (single-A or AA-equivalent to baseball) in my teenage and early 20's. It is another sport that has a deep rooted "tough guy" culture where most concussions are treated with ibuprofen, admitting injury is seen as a sign of weakness, and can ultimately cost you your spot on the roster. As I still live with the fears and effects of multiple concussions (my last season I had three within five months) I continue to do a lot of research to help explain what happened and what is next for me...

I came across a two-part article in National Geographic a few months back that talks about the effects of TBI (traumatic brain injuries) and concussion specifically for service members.

**Here is a link to the story; it does contain some IMAGES OF INJURIES so please use caution if you are sensitive to that.

http://www.nationalgeographic.com/healing-soldiers/index.html
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MAJ Labor And Delivery Nurse
MAJ (Join to see)
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This is an awesome story one that should be a must read for all military medical providers
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Sgt Aaron Kennedy, MS
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My doctor calls it Vitamin M, and just shakes his head.

Ibuprofen (Motrin) as a nonsteroidal anti-inflammatory drug (NSAID) is over prescribed.

When I started running (marathons), one of the first things I discovered was that I wasn't supposed to take it when doing Endurance Sports.

Chesty Puller's Ghost!?!

I used to have BAGS of these. Not 200mg, not 400mg, but the 1600mg pills. We popped them like tick tacs. For everything. We used to take a couple before Battalion Hikes to help alleviate the pain.

Here's a direct quote:

"NSAIDs may cause an increased risk of sudden kidney failure and even progressive kidney damage."

The hell. Now, I was young, stupid, didn't know better, and we even joked about finding out that Vitamin M would be discovered to cause Cancer later in life.

Excluding bullet wounds, Docs would normally tell you to 1) drink water, 2) change your socks, 3) have some motrin....
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Sgt Aaron Kennedy, MS
Sgt Aaron Kennedy, MS
>1 y
MSgt Ronald Stacy It's part of the "Mission First" mentality we ALL have. We joke about the water/socks/motrin thing, but it's dark humor a lot of times. The seeds of truth might be small but a lot of us have seen it.
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Sgt Aaron Kennedy, MS - understand....but don't blame medics on this at best this is a 50/50 thing and at worst its simply non-compliant patients not following the care treatment plan put forward to them.
Sgt Aaron Kennedy, MS
Sgt Aaron Kennedy, MS
>1 y
MSgt Ronald Stacy Definitely not meant to blame the medics on this. My docs would drag us to hell and back. Motrin was a tool in the arsenal. Unfortunately, it was the Hammer.... and everything just kinda looked like a nail.

When you are 18-22, a "solid" portion of what is happening is just "impact" or inflammatory related, so motrin becomes a go to solution. It's not that we don't have other injuries, the vast majority of what is wrong with us actually will get treated with water/motrin/socks (hence the dark humor) or just "knock it off" (rest).

My post just comes off more accusatory than intended.
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CW3 Kevin Storm
CW3 Kevin Storm
>1 y
MSgt Ronald Stacy - It does get down tot he service of choice. The more physical the service the less we give a damn about you the individual. We are a cog in a machine that was designed from the onset to chew us up and spit us out. Our forefathers lined up shoulder to shoulder and took volley after volley of fire, what's a matter with you? When the Army and USMC came out with new ruck sacks they bragged they could hold over a hundred pounds of gear or more. Who in the hell wants to carry a hundred pound pack anywhere, did we learn absolutely nothing from Grenada? We still issue way more crap than we will ever actually ever need, and for what? Improve Defense Contractor Sales? The end result is more injuries in an Army that preaches Safety.
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