What Is PTSD And What It Is Not

So we'll start again, shall we? Third time's a charm.

We can do it.

I'm here, I'm here with Doc. We've done this twice really well. I just forget to push the button. So you'll notice her accent's great, better than mine. Yeah, I've got the hair, she's got the accent, and Mel's just got the package. So, you know, we're both lucky to all be here really. And Doc's our family doctor, and she's a great lady, and she works with a whole bunch of people And really spends a lot of time with people with post-traumatic stress disorder. And, you know, we're just talking beforehand and, Doc, would you mind just filling us in a little bit on what you see as post-traumatic stress, how you define it, and some of the things you've dealt with in your practice?

So I think an important thing about post-traumatic stress disorder is that we used to think it only was caused because of trauma, sexual abuse, violence, or whatever. And we found, you know, more recently that there are other aspects that can cause post-traumatic stress disorder, and it can happen in chronically ill patients. It can happen— an important study actually was done on soldiers. About 11 to 20% of them, if they had a traumatic brain injury, they come back with PTSD.

Mm-hmm.

So it's really important to screen them after they come back. to see what's going on with them and things like that. And, you know, anything can really trigger post-traumatic stress disorder. It's just important to figure out what's underlying cause and then try to deal with that in the treatment.

Yeah, I read some stats. It said that like 60% of people will have some form of PTSD, post-traumatic stress, PTSD. But the difference between post-traumatic stress and post-traumatic stress disorder Was that, um, whereas if you had a car accident or even an assault or something, it might last 6 to 12 weeks and eventually fade away. But the disorder is something that after 6 months, particularly recurring, the memories, the flashback, the— it seems to be a lot of that emotional attachment that happened with the very first cause of the trauma really plays a role and plays havoc in a person's life. life on a daily basis. So you mentioned before about the need for planning and controlling environment and programming. Can you speak in terms of managing with PTSD? Can you speak to that a little bit?

So I'm not an expert in PTSD. Obviously, I'm a family doctor, so it's not my forte. But I've seen in my patients when we have a structured plan, when we come up with the things that they can do on a daily basis— go to the gym, eat well, exercise, you know, have a routine in their daily life— they do a lot better because that's one aspect of their life that they can control. They cannot control PTSD. They cannot control when they're gonna get hit by a flashback. But if they control these other things, then maybe that won't happen as much. So I think that routine is really important for them.

That's great. That's actually something that we go through with people when we're doing the recovery coaching, is we help them sort of— John calls it defining your normal, and that's laying out your day. What's your structure going to look like on a daily basis? What sort of things are you going to eat? What's your diet going to look like?

Yep.

And all those things, and sort of laying out that whole sort of framework to live within so you can live well, you know.

And I think that is important because if you don't, I think it takes a level of courage to admit you have an issue, but then on a greater level to say, well, I'm going to take control of this issue and I'm going to manage this as best I can within my circumstance and environment. So a family doctor, you deal with everyone in the family, obviously. So you've got someone who's got post-traumatic stress disorder. So a spouse who's married, they're committed, you would see a lot of, you know, the rub and the tension that sort of happens between those 2 parties, wouldn't you? So how would you, what sort of things would you advise someone who is a non-PTSD spouse living with, you know, a man or a woman who has it? How do you, how do you, how would you coach them or encourage them in that environment?

Um, I think the most important thing to do is to remember why they married that They marry that person because they love them, which means that if that person comes with baggage afterwards, if you love them, you'll stay and cope with it.

Yeah.

And if you don't, you'll go. And I think the best thing to do is actually stay in and fight or go. You know, that whole in-between where you're trying to spend time and change that person, you won't change them. Uh, I think, and, but I think the other aspect of it is also important that we need to recognize that the spouse needs help too, because the spouse has to deal with the aggressive behavior or flashback or depression. And, uh, you know, it's hard on the spouse as well because it does put emotional toll on them as well.

What about you, babe? Like, you know, living with me. I know it's a breeze. You know, it's phenomenal. It's an, it's a privilege for you. We get that. Thank you. Thank you for saying that. But what are the sort of—

No, he's laughing at his own joke.

I'm awesome, what can I say? Just what a ridiculous statement. But what sort of things do you find that we do on a regular basis?

I think the first thing that really kind of comes to mind for me is commitment to communication. Like, we, before, during, and after any sort of event, We make that commitment to communicate to each other. And even for me, I think it's important for us that we both take responsibility for everything. This is our fight. We're in it together. We are committed to living well, even with PTSD. And so I take my responsibility for Things that I can do better in helping you. And I think a lot of times too, if you, if you let all the negative aspects sort of pile up and you don't talk about them, then, you know, you, you do get that sort of communication breakdown. You get bitterness that comes in. And so, like, if I can openly communicate to you, look, you, you know, when you were upset before, you said this. And it hurt me. And you are always so faithful to come back and say, you know, I'm sorry I said that. Can you forgive me? You know, things like that. So I think communication like that takes a lot of courage, like on both sides. So I think communication is probably the biggest one for us.

But I think also it's important to not allow the person with PTSD to use it as an excuse to be an ass.

Yeah.

You know what I mean?

Oh yeah. I know you guys are good at it, you've been doing this for a while, but I think especially for patients, people who are, you know, newly diagnosed and stuff, they can't use it as an excuse because the other person, you know, they didn't sign up for it voluntarily. So I think we have accountability.

We had a coaching partner person that we were working with, a married couple, and she said that, she said, Well, I've got these 5 diagnoses and when I got them, um, I used them as a reason to justify my behavior. And her words were, and I was an asshole.

Mm-hmm.

And, and here she is, um, 15 years later and she has been an asshole because she had these 5 diagnoses and that justified her behavior. And it wasn't until we're at a stage now talking to them as a couple, it's like, okay, well then we have to move past The diagnosis, we have to get into—

How can we help you take responsibility for your behavior, which she will admit is unacceptable? You know, how do we—

It's the next stage after that.

How do you grow past that?

I understand this is unacceptable, but then how do I move into acceptable behavior? And I think to your initial point of, um, you're either in it or you're out. There can be no middle ground because, you know, it's so detrimental to both people. Personal experience. There's no way you can get whole if it's not there. And I think marriages get to a stage where they, there's too many miles on the clock. Like there's too much and people can't rewind that clock and go back to, I married this. Well, some can and some can't go back to that. I married this person.

Because, you know, even if you married for 5 years, you're a different person. You are 5 years later, even if you didn't have any kind of Stress and anxiety. So I think, uh, you have to adjust your expectations as things change, but you know, you have to decide whether you're gonna work on it or not. And I think as a family doctor, sometimes, you know, medicine— obviously I believe in medicine, I do, you know, stuff like that.

Sort of an occupational hazard, isn't it?

But like, lots of times all I do is just like, it's common sense stuff.

Yeah.

You know, it's just like talking it out. Then it's like, sometimes I just let them talk and they're like, oh yeah. I'm like, yep, that's it.

You do some coaching too. Yeah.

Because that's the way it is. Sometimes you just need to listen and do nothing else.

We've found that it's, it's, um, I think some people think, well, if they take a magic pill or if they go to the gym or they do this one other thing and they're not prepared to say, well, if I trip, and I think it's a choice about quality of life. Yeah, you can have a quality of life and be stoned on opioids all the time. Yeah, you can have a quality of life and if your drug of choice is going to the gym, get it. But if you really want to have a quality of life that is going to be beneficial across the board, then it's going to be, you know, what are the role of preservatives, the role of sugar, the role of lack of sleep, the role of alcohol, the role of weed. Um, you know, even the sort of movies or music. Sometimes I've found even the clothes I wear, if I'm on a dark day and I'm wearing dark clothes, I will not break a dark. It doesn't matter how sunny it is outside.

Mm-hmm.

And I think all of that, it's not just the one thing and they want a cure-all instead of taking, saying, okay, in order for me to up my entire quality of life, I'm going to have to be prepared to address all of these different issues.

It's a whole system.

It is. And like, especially in the veteran community, the veterans I've seen sometimes will come to see me with like 28 medications.

Yeah, that's just crazy.

And they get like, you know, I can't do this, you get the medicine, this hurts, you get medicine. So you're really treating symptom, not what's causing it. And, um, you know, I'm 45 years old and I'm not on any medicine, but when I have to take antibiotic, I half of the time I forget to take one pill.

Yeah.

And like try to remember 28 pills 2, 3 times a day.

With no short-term memory, with TBI, it's—

And it's, and you know, not only that, but every medication, no matter how, you know, innocent it looks, has a side effect.

Yeah.

So now you're combining all these side effects and stuff. So one of the first things I do is take them off as many as I can. So we do, we do 3 medicine visits. We'll try to take them off and kind of try to adjust because you can't treat the symptom. You have to figure out what's causing it.

Yeah. I've, a lot of the work that I've done has been with veterans. Um, well, I work with both veterans and non-veterans and a lot of the work I'm starting to find is that trauma, childhood trauma of a particular nature, sexual trauma, particularly with, with male veterans, is that they're trying to treat wartime PTSD, but they're not addressing childhood trauma. And all of the guys that I've been working with or speaking with, it wasn't until they started to address this, this root cause that they actually started to see wholeness come across their life.

Mm-hmm.

Um, and I think it's— I think any of that stuff we need to— and, and because sometimes it's really difficult to unpack that stuff. And I think vulnerability is courage. And if we're wanting to improve the quality of our life, and I think that's where suicide really plays a role, is that people get stuck and they don't believe they can improve the quality of their life. But, and I don't believe, I don't think people commit suicide because they're cowards. I think they're courageous. They just want to stop hurting the people around them. They just think that's the out. They don't realize it's going to just change the hurt. And I just, I think that if we're going to have courage, then let's have courage to address and face uncomfortable issues, whatever they are, whatever changes we need to make. And if we can have that level of courage, then it gives us a hope to live in a positive way forward.

Just think, I remember, just want to say this, and I don't remember the name. I'm terrible at names. There was a football player, I think Brown is his name. He actually played for Dolphins at some point. You know, I was in Florida, so I like Dolphins. And then he went to Chicago and he had several, and I'm gonna miss several, I think about like 10, 12, I don't know, concussions. And his behavior kept on changing, changing. He became more aggressive, wasn't sleeping and stuff, and he did kill himself. And he wrote a letter, and the reason I remember, someone just mentioned to me too, They did a special on ESPN. He wrote the letter to his family saying, I'm doing, you know, I'm killing, I killed myself because I'm hurting you guys.

Yeah.

No, I don't want to be doing this. I know, like, what I'm doing is, you know, not good for anyone and hurting you more than him. And it's just kind of sad to see that as a society we cannot address those issues.

Yeah. And I think part of the reason why we're not addressing the issue Is that we don't? I think medicine, Western medicine has a tendency to want to isolate the body into parts or components, as opposed to more traditional medicine looks at it as a system. You know, like we've talked a lot about.

I'm a deal.

Huh?

That's what we do.

Yeah.

Osteopathic medicine.

That's that's what you do. You look at everything as a system. And I think when you've got any government organization and they say, "Well, this is the parameters that we're prepared to treat with." in. And there's all these other things that sit around it. Like, you know, we've talked about this, the overlap between heavy metal toxicity, a dropping in testosterone levels in men, childhood trauma, trauma from battle situations or other extreme circumstances. All of those overlap. And you have to be prepared to have a conversation about all of that. Because it's a body, soul, and a spirit. This whole glorious thing called humanity and you can't just prescribe a pill and fit it in a thing. It's just, you know, you've got to be prepared to look at the whole thing.

Yeah. And I think especially maybe for guys, they don't want to talk about psychotherapy, but really with PTSD especially, it's really important to find someone you can talk to.

Yeah.

Because sometimes until those words come out of your mouth and they actually Left your brain. You don't realize how hurt you are.

Yeah, you've got to drag it. You know, sometimes you've got to drag that devil into the light and beat the crap out of it because it's the only way you're going to do it. And, um, you know, I had a friend that once told me when it came to confessing things, he said he'd confess it to a jackrabbit, then shoot the jackrabbit. And I think that's how men approach some of those things.

Yes.

But, but like, women, I've found, talk face to face. men talk shoulder to shoulder. And whenever I've been talking to guys, it's always while we're involved in an activity. And you'll be sitting there doing something and you'll say, well, how are you going? And they'll go, well, it's been a bit tough. And it's like you've got this 15-second window to ask the next question of, what do you mean?

Yeah.

And that's a man putting his hand up. And if you don't take that 15-second window, uh, it's really difficult to get it back. And, and I think, I think all of us have a responsibility. If we've got friends and family who we know that have been through stuff, then to listen to those cues. Because I think a lot of guys will put their hand up. And even if it's to them, it's just the, it's been a bit tough, that half a dozen words. If you were to ask them, they'll say, yeah, I tried talking to someone once and it didn't work out. It's like, well, dude, what do you mean? Well, we're standing around and, you know, he asked and I said, and it's like, for them, that's, uh, you know, like 2 ladies having a cup of tea, you know, for 2 hours and sharing their heart. That's it.

Yeah.

You know, and I think we've got a responsibility to each other that have been through this when we've got friends and family going through It's worth it to listen to those cues and ask that next question. They might tell us to piss off. They don't want to talk about it, but at least we've tried to keep the door open on it.

Yeah. And that's what happens. Sometimes I'll have a patient come in and we spend 30 minutes talking about nothing. And then I'm ready to get out and they're like, hey, Doc. I'm like, yes. That's really when the meat of the conversation happens.

So that's the coffee machine going off. This really is Coffee with the Kings. It's running all over the floor. Well, that's unfortunate. So, Doc, you do telemedicine. How does that work for you?

It's kind of fun. I work for a company and I see patients all over Texas and they call in and usually it's for colds or rashes or things like that. And it's a job.

Holes and rashes.

Different things.

So for your patients that are on your—

You're blushing.

I know, I don't want to talk about rashes. For your patients that are on your, what do you call that?

So I do direct primary care and direct primary, so I'm a family doctor and obviously I do everything, children to older people. And the way my practice works is I don't take insurance. I don't bill insurance. Patient pays monthly fee depending on their age, anywhere between $25 to $75, and they get unrestricted access to me, which means sometimes I get phone calls. You know, he actually doesn't call you. You tend to call.

He's got this rash.

No, he doesn't call about rash.

But anyway, I have some patients who travel, especially, you know, here in Texas with rodeos and different things. So they'll call me, uh, and if they're sick, if I think they need something, I'll send the medicine to them. And, you know, sometimes they just stop by the office and check their blood pressure, anything like that. It's kind of nice because I don't have a huge panel of patients. I actually have about 300 right now, and I'm comfortable there. Actually, I'm gonna go up a little bit more. But it's nice because I get to know them. So usually, uh, you know, I'll get a text, uh, sometimes in the middle of the night, hey, I forgot to tell you I need this. And it's okay, I don't mind. I actually enjoy what I do. Lots of times I do home visits as well, and it's fun.

It's awesome. It's old school and we love it.

Yeah, it really is. Doc's great. You know, if you're in Brock, Texas, you need to go and see her. If you're not, you need to go and see her anyway. She is a Croatian George Strait fanatic. So if anyone is out there who knows George, we need to give the lady a ticket somehow.

Yeah, I'd like to.

Yeah, but in a box seat somewhere. So we'll try and hook you up. Come on, someone out there, 6 degrees of Kevin Bacon and George Strait, it's all the same. Anyway, hey, thanks, Doc. Thanks for having coffee with us.

No problem, thank you.

Bye-bye.