Happy Birthday Togus, Maine VA--and thank you

This week Maine’s Togus Veteran's Administration Hospital celebrates its 150th birthday. It is the oldest VA Hospital in the country, purchased by President Lincoln for $50,000 in 1861 for the purpose of housing seriously wounded veterans just as the Civil War was beginning. The 150 acre property was built by a Maine granite dealer who had a grand vision for turning the property into a spa resort. But when his plans failed to come to fruition the government stepped in and bought the property. Its name Togus comes from an old Indian name meaning “place by mineral springs.” I always thought it was a weird name for a VA facility until I actually became acquainted with Togus.

I joined the Army to pay for my college education and spent three years on active duty in the Army Nurse Corps. At my final duty assignment in Ft Knox, KY I met, fell in love with, and married a fellow Vietnam Veteran, recovering from wounds he received as a medical evacuation helicopter pilot. He received a disability discharge from the Army that gave us access to military hospitals or out-patient clinics and use of the commissary. So needing the VA rarely crossed my mind.

When I was in officer’s basic training at Ft Sam Houston, TX, I was the victim of a near rape. Although I was physically uninjured by what happened on that Sunday morning in the summer of 1969, its result developed into what we now recognize as PTSD. I was always on guard when I was in public places after dark (and sometimes during the day;) I went through the house to make sure all the downstairs windows and doors were locked before going to bed at night, and when Jim was out of town on business I shoved tables against doors and slept with a butcher knife under my pillow. Logically, I could see that these behaviors were signs that something was wrong. I knew it was some form of PTSD, but I didn’t do anything about it. After all the source of my stress disorder was not from being in combat.  

Over time I stopped moving tables or sleeping with a knife, but if I came home to an empty house after working an overnight shift and heard a weird noise I would use that knife to walk through the entire house, check under beds, inside closets and bath tubs. It didn’t matter if the house felt empty. For me to get any restful sleep I had to check to see if I could go to bed safely.

And then, in 2012, our family went through a crisis that bore absolutely no relationship to sexual assault. My anxiety over our family problem, which eventually was resolved in a positive manner, seemed out of proportion to the actual events. Something was definitely wrong with my behavior. At the same time the news media was focusing its attention of the high rate of sexual assault against both women and men in the military. When both the local and national news pointed to the Maine VA as having the best practices program for people who suffered from MST (Military Sexual Trauma) my husband suggested I get help.

And so, I entered the VA system. A phone call to the MST hotline was a godsend. Once the staff determined I was not suicidal they referred me to the counseling program at the Portland, ME clinic. But before the appointment could be made I had to get into the system. An appointment was made for me with one of the Portland clinic’s primary care providers, Dr. Renate Medrano. I missed my first appointment. I wasn’t expecting to receive such a quick response and opened the letter telling me of my appointment at the precise time I was supposed to see the doctor. Once I finally saw Dr. Medrano, I got my referral to meet with a therapist in a week.

I don’t remember what the counselor and I talked about. But she was great. She might have only been able to see the weakest of connections between my MST and current events, but she was quite certain I had PTSD, which can result from any traumatic event, and not simply war. It is even possible to develop PTSD simply from seeing the results of a traumatic event such as the Boston Marathon bombing. She reminded me to use the coping mechanisms a kind psychiatrist had taught me a few months after the MST. She encouraged me to attend some group yoga sessions, which sounded interesting, but the time of and the distance to the classes were inconvenient and I demurred.  

Then about two years ago I was encouraged to join the “Agent Orange Register.” This database compiles lists of veterans who were exposed to dioxin, usually in Vietnam, but also during a few specific times on the Korean DMZ. It consists of a questionnaire, some basic health assessments like a chest x-ray and blood work. Some of my friends from Vietnam have illnesses thought to be caused by Agent Orange, and so on a sunny afternoon in the fall of 2014 I joined the Agent Orange Registry, not for my own sake but for that of my fellow veterans. To do this I had to drive to Togus (near Augusta,) about 90 minutes north of where I live.

It was an absolutely glorious early fall day the first time I saw Togus, and I was blown away. Yes, there were the conglomeration of red brick buildings that made up the hospital’s in-patient division, and I got lost three times trying to find the right building. But that gave me a chance to drive around the campus. I saw a chapel, a pond, well- groomed lawns and flower beds, a couple of mansion like buildings, and some of the small cottages that housed veterans in the late 1800s. It was gorgeous. Yes, the room where I was to be examined was standard industrial ugly, but the people were nice, helpful. The person who examined me was a nurse practitioner. We compared notes about going to graduate school. He, too, went to Vietnam-- as a medical corpsman, and we compared notes.

I had not expected to return to Togus because I have excellent health insurance, thanks to Jim’s disability. But then I started having significant tinnitus. Someone suggested a hearing test at Togus because the VA apparently assumes all veterans have been exposed to some sort of loud noises, and thus, willingly supply veterans with state of the art hearing aids. And so two more trips to Togus, one in the early spring of this year, the other a month or so later. Yes, I have a mild hearing loss, yes I qualified for hearing aids. I chose ones with sapphire blue microphones. In all the hearing aids cost me $100.

The main hallways of the hospital at Togus looked worn, but I was also surprised by what I saw. The receptionist at the front desk could not have been more helpful. There was coffee and water set out on a table near the elevator. The hearing test room was state of the art. So were the hearing aids. As I waited for my appointment to get my hearing aids I was astounded to see a robot patrolling the halls carrying charts from one place to another. When I remarked about that to the audiologist she laughed. Yes, the facility looked like it badly needs a face lift, but it is the care that is important. And I got good care.  

According to an anniversary publication from Togus, its staff has been able to significantly reduce the number of outstanding veterans’ claims. Improvements to the hospital’s physical plant, building a new Fisher House, and other improvements, including a nursing home, are being planned.

Before I retired from nursing I taught the basics, such as how to take a blood pressure, to new students. The last time I was at the clinic in Portland my blood pressure was a little high. Not surprising since I had just driven in bad weather for 45 minutes, and the nursing assistant was using an electronic blood pressure cuff. Before he would deem me fit enough to go another year without seeing him Dr. Medrano insisted on taking my blood pressure the “old fashioned way,” with a cuff and stethoscope which is more accurate. He did everything correctly. So I jokingly told him he was one of my nursing students I would have given him an “A.”

Meanwhile, Jim, who has a partially paralyzed right foot from his wounds, began to experienced problems walking. He believed, rightfully, that his best choice for treatment was the VA. Because we live closer to the VA Hospital in Manchester, NH than Togus he chose to enter the medical part of the system in Manchester. By then he had already seen a civilian podiatrist who had dismissed the problems with his foot as not needing much of his attention. Not the VA podiatrist. One look at Jim’s foot and he was able to make several suggestions, such as ordering special orthotics, to help him cope with his chronic foot pain. And it may seem crazy, but the podiatrist was happy to care for someone who needed his expertise. Since then Jim has seen the podiatrist several times and been happy with his care.  

I used to think we no longer need the VA. That its system of care was outmoded. But I was wrong. Pinned to the cork board in the audiologist’s office was the picture of one of Maine’s most well regarded Veterans. His name is Travis Mills, who lost all or part of both arms and both legs in Afghanistan when he was 24. And he is not alone. There are, sadly, hundreds more men and women like SSG Mills who will need significant care related to these, and other serious wounds, in the coming decades. So I hope the VA continues to improve and continues to provide outstanding care, especially to older veterans like me and younger ones like Travis Mills. So happy birthday Togus VA. And thank-you.

         Travis Mills with his son

Important Links:

https://www.travismills.org/foundation/

https://www.fisherhouse.org/

https://va.gov/togus

www.mentalhealth.va.gov/.../mst_genera...

In Defense of Hillary: What's It is Like to be Dehydrated on a Hot, Sunny Day

I have had the good fortunate to bike in six "Maine MS Society 150" bicycle fund raisers. My first ride, of 100 miles divided into two days, was in 2002, when my first hip replacement was only nine months old. But I had my doctor's blessing, even though the ride, over the back country roads of York and Cumberland Counties in Maine had some fairly hilly terrain. I was reasonably well trained, albeit a slow rider, and my only problem was flying over my handlebars when I over-braked to avoid colliding with other bikers at the beginning of the ride. I had a little road rash but otherwise was fine, The hardest part of the day was not falling, but a hill at about mile 35. I call the "the hill from Hell," because just when you think you have crested it, you discover there's a left turn to take you up the other half of the hill.

We had so much fun we rode again the following four years, including one where my two daughters were stuck riding a rented tandem.  But in 2009 and 2010 Karen, several co-workers, and I abandoned the bike ride in favor of walking a total of 50 miles over 2 days to raise a lot more money for the MS Society. For me the walking was harder. So I was happy when, in 2012, my biking friend Nancy suggested we use the MS 150 as training rides for our planned cross country bike ride the following spring. Not wanting to stress the third person in our biking trio-- a woman with MS in her 50s-- we decided to limit the ride to 50 miles each day, rather than the full 150, or for the truly crazy among us, two days of consecutive "century" rides of 100 miles each.

These days the MS 150 is held on the second weekend of August, but in 2012 the ride was scheduled for the first weekend in August, often the hottest weekend of the summer here in Maine.That Saturday and Sunday the temperatures were supposed to be in the mid 90s with humidity also in the mid 90s. I wanted to start early so I could get in as much riding as possible before it got really hot, but I was dissuaded by our team captain, who wanted team pictures. Yuck. I am a good 50 pounds overweight and posing for a picture in a typical biker's garb of lycra shorts and top was not exactly my idea of the best way to show off my astounding physique.

By the time we began riding it was already 90 degrees with not a cloud in the sky. In years past I'd ridden a hybrid bicycle with road tires, but my new cross country bike was a road bike with narrow tires. At the very least I hoped to be a little faster than in years past. Not so, I still biked at a steady 12 mph on the flat, and between 7 and 9 mph on hilly terrain. [I am now convinced my inability to ride much faster is related to having that artificial hip, but I digress.] I was wearing a pair of padded lycra bike shorts, a bra, and a sleeveless top. Oh, and lots of sunscreen. I also had a camel-back filled with 2 liters of cold water, and two water bottles filled with Gatorade.

Even though I was wearing next to nothing the heat was unbearable. By the time I reached the first rest stop at the 10 mile mark I had gone through a bottle of Gatorade and more than half the water in the camel-back. One is required to check-in with each rest stop, even if it is just a salute to point to the rider number on one's helmet. And boy was I glad to see that rest stop. Part of me--the part that hates the heat--was ready to throw in the towel. But the other part--the never wants to give up or give in part--wanted to continue.

 I must have looked awful as I got off the bike because suddenly one of the volunteers was beside me asking if I was OK.

I started to say "yes," Then I fessed up. I was a little dizzy. Then I started to shiver. As a nurse I knew I was in trouble.

 The body's first defense against overheating is to perspire. If you are still sweating but feel cold or are shivering you are definitely dehydrated. If you stop sweating, are nauseated, or have cramping you are suffering from some form of over-heating, and  you must get out of the heat, cool off, and consume significant quantities of electrolyte rich fluids like Gatorade or Emergen-C, which has a similar quantity of electrolytes as Gatorade but also has vitamins and some minerals.Failure to recognize and respond to dehydration, whether it's from a stomach virus or the heat, can ultimately lead to death. And if you can not drink enough fluid fast enough you must have an I.V., even if only long enough to get a liter or two of fluid.

Fortunately the other person manning the rest stop that day was an EMT. He ran to his car, got his stethoscope and blood pressure cuff and took my blood pressure. It was 90/60, the blood pressure of someone in shock. Someone grabbed some ice packs and asked my to hold them under my arms. I started guzzling Gatorade. The EMT called for an ambulance. Fortunately my blood pressure was starting to rise so I did not have to go to the hospital for intravenous fluid. When we got back to my dorm room an EMT stayed with me until I had to pee--after consuming 32 ounces of cold water, and another 32 of Gatorade. At  dinner that evening almost everyone knew  I was the woman who had had to be rescued. It was a little embarrassing but at least I was at that dinner to get embarrassed.

I'd like to say I've never gotten a heat related illness again, but I came close this summer. It was mid July and Washington DC was in the midst of a terrible heat wave. Nevertheless my Danish friends were undeterred. They wanted to see our wonderful capital. We had te plane tickets in hand. What else were we to do? I stayed out of the sun as much as I could. I sat near a bubbler while my friends explored the Lincoln Memorial. We walked along the Wall. But when one of my young guests and I started to shiver, we found a cab and went to Union Station. By the time we finished lunch we'd had a great meal and lots of water. Everyone felt fine.

Heat exhaustion or heat stroke can happen to anyone at anytime or any place. Add pneumonia into the mix and it is amazing Hillary Clinton was able to go to the 9/11 ceremonies at all. But I guess, like me, she has a stubborn streak that won't let her give in, especially when the media has practically written her obituary.

If You Want to Know What a Trump Presidency Might Look Like Come Stay Awhile in Maine

When New Jersey governor Chris Christie took himself out of the running for president, Maine’s governor Paul LePage, endorsed Donald Trump. In doing so he claimed “he was more like Trump than Thump.”  So if you wonder just what it would be like to live with a leader who paints himself in a similar vein read on. For this is a bit about what life has been like for Mainers over the past six years.

In 2010 five people ran for Governor of Maine in the general election: a republican, a democrat, and three independents. Thus, the vote for governor was split five ways. When the dust settled the tea party republican, Paul LePage won with 39% of the vote. Eliot Cutler, an independent came in second with 20,000 fewer votes than LePage. I thoroughly disliked LePage, but, as a good citizen I wanted to give him the benefit of the doubt. Whether or not he was my choice, he was still the leader of the state in which I live, and where I intend to die and have my ashes (or at least some of them) interred.

            On paper Paul LePage appeared to be an ideal candidate. His parents were French Canadians who came to the United States to work in the manufacturing mills in Lewiston. He was the oldest of 18 children. As a child he spoke only French. His father was an alcoholic who regularly beat Paul, and so at age 11 Paul LePage ran away from home. For two years he lived on the streets until eventually someone took him in, gave him food and shelter and saw to Paul’s education. His mentor even went so far as to persuade the officials of Husson College in Bangor to let Paul take an entrance exam in French, after doing poorly while writing in English.

            In this rags to riches story LePage, with help, pulled himself out of poverty, graduated from college, because fluent in accent-less English, married, had children, and steadily rose the corporate ladder through a series of jobs in both Maine and eastern Canada. He was hired by Marden’s, a Maine institution (“I should have bought it when I saw it at Marden’s”) that sold salvage and surplus material at drastically reduced prices. Eventually, in addition to his role as the CEO of Marden’s, LePage served as a selectman and mayor of Waterville, ME.

            You might think that with this background LePage would have empathy for the poor of Maine. Not so much. He ran for governor on a tea party platform that relied heavily on welfare reform, reducing the size of government, and, cutting taxes. He has succeeded in cutting the number of able bodied single people on welfare, offering job hunting, job training, and even volunteering to get them back into the work force. And that is good. (This program does not include women with small children, nor does it include our ever-graying elders.) (Maine has one of the highest percentage of residents who are 65 or older.) And it ought to be of aid to former paper mill workers whose plants have closed down.

I also applaud LePage for reimbursing the hospitals of Maine the millions of dollars in Medicaid funds the state had received from the federal government during his predecessor's administration. It was meant to repay hospitals for care already given but LePage's predecessor and the legislature kept spending it on other programs.

   

Unfortunately, it is almost impossible to see the good because of all the bombastic behavior coming out of the governor’s office. Here are just a few examples:

·         Within a few weeks of taking office LePage was asked if he would join other newly elected governors in meeting President Obama. His reply, “Obama can kiss my butt.”

·         Three months after being sworn in LePage ordered the removal of a large mural from the Maine Department of Labor offices because he thought it too pro-union, rather than simply factual. The way in which he did so was dictatorial with absolutely no insight into the way it might be perceived by the people who painted and donated the mural.

·         He has absented himself from more than one regional governors’ conference.

·         This summer he did not attend any of a four day working visit from various private and government organizations looking at creative ways to make Maine’s timber industry vital again.

·         In June 2013 LePage refused to sign a budget created by a bipartisan group of state legislators. In doing so he accused his major detractor of “trying to stick it to the people of Maine without the use of Vaseline.”

·         When trying to repeal the bill prohibiting the sale of plastic bottles with the chemical BPH he commented he didn’t see a problem with BPH other than some women would “grow little beards.”

·         Following his reelection in 2012, LePage  has followed through on his promise to veto every single bill proposed by a democrat in the state legislature, beginning in 2013.

·         Also, since 2013 he has done or said:

Allow 12 bills he didn't like to become law because he misunderstood his role in vetoing those bills.

Refused to meet with the legislature. He communicates with the people of Maine through a series of town meetings now.

But wait, there’s more, and it is these two SNAFUs that have caused many people in Maine to wonder if he is fit to lead the state for two more years.

            The first erupted as a result of LePage’s plans to create charter schools in Maine. Unfortunately, he and the speaker of the house, Democrat Mark Eves tangled over the details, especially whether or not virtual schools should have a place in the charter school program. Meanwhile, Goodwill-Hinkley, which until a few years ago was an orphanage or home for displaced children, closed. Goodwill Hinkley has a beautiful campus near Skowhegan and with the charter school concept in mind Maine educators went forward with a plan to create the Maine Academy of Natural Sciences, a residential charter school for students in grades 9-12. Mark Eves was among the people who applied for, and then was ultimately appointed as its first director. ( If there was ever a serious attempt to ask Eves about his change of heart, and how he might use that to the betterment of Maine people, I've not seen it-and I read the Portland paper faithfully.)

            LePage was incensed. How could the board of trustees of the Maine Academy of Natural Sciences have chosen Mark Eves? He didn’t ask. Instead he threatened. And then he threatened again, until finally he threatened to rescind the state’s financial support of the Academy as long as Eves was at the helm. This he did in a letter addressed to the chairman of trustees for the Academy. Eventually Eves resigned and the Academy got its funding. However, in threatening to withhold state money LePage broke the law. Lawsuits and impeachment were threatened but the latter was tabled indefinitely by the republican held senate.

            Which at last, brings me to the reason for the “Welcome to Maine, Our Governor is an Idiot” sign posted on Facebook. Like so many other states Maine has a serious addiction problem. Rather than seeing addiction as a medical problem with, at minimum, some mental health components LePage has tended to look at the problem as a crime. He was reluctant (still is) to make the opiate antagonist Naloxone widely available to the general public, insinuating that addicts’ lives are not worth saving, especially since, with Naloxone, an addict can shoot up, get high, and then be resuscitated again and again. He has failed to provide sufficient funds to social service agencies to treat addicts  and help them get clean.

            But what has really put him in hot water were claims made at a town hall meeting earlier this year, and then again last month: that all drug dealers are people of color who come to Maine to impregnate innocent white girls. (Maine is the whitest state in the country and most people of color are Native Americans.) He later restated his concern of drug dealers impregnating Maine girls. That he has been keeping track  of the ethnicity of drug dealers (and bragging about it) is an impeachable offense. But Maine has no methodology in place for impeaching a governor who no longer seems to have his citizen’s best interests at heart.

            There was a time when LePage was a source of humor. "Did you see what the Governor has done now?" Those days are long over. Whether or not any of the actions of Paul LePage have been useful to the state, whether or not he is correct, LePage does what Trump does: opens his mouth, shoots off, and then apologizes. His behavior is so like Donald Trump’s he remarked, when endorsing Trump, he was like Trump before Trump was like Trump.

 At least Maine doesn't own any nuclear weapons.