Leader

“I was about 50 meters away when it blew up. The blast knocked me off my feet and into the side of a Humvee. I must have blacked out for a minute or two, but when I came to there was nothing left of the vehicle. No remnants; just char and a crater.” When 28-year-old Christopher Harmon was discharged on May 26,2006, after eight years in the Marine Corps, he had a chestful of dec-orations and a pile of honorable citations.
During his deployment to Iraq in 2005 Chris led an elite bomb squad patrolling the neighborhoods and alleyways of Baghdad andsmaller towns like Kandari, site of Abu Ghraib Prison. During thesiege of the prison on April 5, 2005, Chris and his 15-man team werethe only ground troops outside the walls during the precision-timedoffensive. “We were on a foot patrol at the rear of the insurgents. Theydidn’t know how many of us there were but we knew there were over100 of them, so I told everyone to spread out.” Chris sprinted from man to man during the 54-minute firefight, encouraging them to be aggressive. “My machine gunner shot 850rounds. It was like nothing I’ve ever experienced.” Afterward, US mil-itary officers would call the siege the most sophisticated and concert-ed insurgent attack up to that point in the war, and would single outChris’ leadership as critical to the attackers’ defeat. The next day,while securing a deserted car suspected of containing an IED, the vehi-cle exploded. “I was about 50 meters away when it blew up. The blastknocked me off my feet and into the side of a Humvee. I must have blacked out for a minute or two, but when I came to there was noth-ing left of the vehicle. No remnants; just char and a crater. It scaredthe living shit out of me.” While his discharge papers described compression injuries to his back, knees and ankles, and a chronically dislocated shoulder fromrepeatedly jumping out of vehicles while carrying heavy backpacksand equipment, as well as his two-year struggle with PTSD, Chris wasnot tested for Traumatic Brain Injury.
Chris returned to Seattle with his wife, Kathy, and their three boys, Austin, 9 (from a previous marriage), Zachary, 5, and Xandar, 2.
Kathy was from North Carolina and she’d never been out of the state.
“Except for worrying about Chris’ safety, the boys and I had beencomfortable at Camp LeJeune. I didn’t see the logic of moving toSeattle but I was willing to try it if that was what Chris wanted to do.
The hardest part was getting out there a month before he was dis-charged.” She had met his parents once. Chris and Kathy moved inwith Chris’ father and stepmother, and almost immediately the situa-tion soured. “Before I went to Iraq I was open and happy; but after Igot back I started getting depressed. I was scared of going out incrowds. When Kathy and I would go to the grocery store, I’d breakout in a cold sweat if I couldn’t find her. The smallest things like a popor a bang made me jump.” Chris’ VA benefits hadn’t kicked in yet, and he had to find a way to support his family. He started job hunting. Personable and, at thetime, highly motivated, Chris overcame his lack of a college degreeand mental problems and found a job at the Union Pacific Railroad asa conductor in training. During his time in Iraq Chris had been given80mm of Proszac a day for his PTSD, an amount that shocked thephysicians at the Seattle Veterans’ hospital where he went for treat-ment. “Why the hell are you on a major anxiety drug?” one doctorsaid. “I wouldn’t give this to anyone in your condition, particularly incombat.” The doctors experimented with various cocktails of medica-tions: Zoloft, Paxil, Efferex, Cymbalta and others, singly and in com-binations. Each prescription had side effects and none really worked.
Then, after just six weeks, the Union Pacific training program was suddenly dismantled and Chris was let go. He became depressed andanxious and withdrew into himself. “I tuned out. I’d stare at the tele- Deployed, Decorated and Living in a Car vision all day and see nothing. I had headaches and ringing in my ears,but most of all I was drowning in a black hole.” His father, an Armyveteran of 32 years, couldn’t understand why his son, the youngest offour brothers, two of whom were deceased, could not get his acttogether. They fought. “He yelled at me, ‘The way you’re acting,you’re spitting on all your dead brothers.’ I took Kathy and the kidsand left the house.” Chris moved his family to Spokane to live with hisbirth mother, whom he had not seen since he was two, but he wasunable to find work and returned to Seattle, this time moving in withhis brother’s family.
He was accepted into “Hard Hats,” a program training military veterans to become sheet metal workers. “The problem was, I was outof shape and had gained weight and my body couldn’t take it. I’d tryto lift or carry those heavy sheets of metal, and my back would justgive out.” Two weeks into the job Chris told the foreman he couldn’tphysically handle the work. A few weeks later he found another job,this time as a security guard at $6.00 an hour. But his depression wasworsening along with disturbing new symptoms such as loss of mem-ory. He was unable to concentrate on the simplest of tasks.
“I got so paranoid. I was in a state of panic most of the time. I don’t think people understand the pain of what goes on in your head.
You’ve lost yourself and it’s scary as shit. No one sympathized. I meanit wasn’t as though I’d lost a leg or gotten shot up. It was all in myhead.” After ten minutes on the security guard job, Chris’ back, kneesand legs would seize up, putting him in excruciating pain. He had toquit. “I had no money for gas so I spent a lot of time on the Internettrying to find a job. My brother didn’t understand what was going on.
His wife got fed up with us and had the cable disconnected. We had abig argument and I said, ‘Okay, I guess we’re uninvited.’” Chris andhis family were homeless.
Kathy sent her oldest son, Austin, back to North Carolina to live with his father. “It was the hardest thing I’ve ever done in my life,” shesays. “I’d raised him by myself, and it broke my heart to have to sendhim where I knew he wasn’t wanted, but we weren’t getting by and Ididn’t know what else to do.” To make ends meet, Chris and Kathysold their belongings and pawned their wedding rings. Yet a few dayslater they and their two sons were living out of their car. Someone told a radio station about their plight and it broadcast their story, whichraised enough money to pay for a cheap motel and food for the twoboys.
“I wanted to give up so many times,” Kathy recalls, “but even at his most depressed, Chris believed we could do it.” At the end of theirrope, they were rescued by the Marine Corps in the form of a finalcheck for moving expenses for transitioning out of the military. Theygot their rings out of the pawnshop, packed up their few belongingsand drove across country back to Raleigh, North Carolina whereKathy’s older sister lived. However, instead of improving, their liveswent downhill.
“We got Austin back and moved in with Patty. But her husband was a drunk and a month after we got there he threatened me with ashotgun. That night we packed up our bags and left. It was the worstof the worst. We’d sold all our furniture, and the souvenirs I’d broughtback from my deployments. Everything we owned was in threeRubber Maid tubs. By 3 a.m. we’d been driving around Raleigh forhours.” The next morning Chris called “Marine 4 Life” asking forhelp. Within 24 hours the Marine 4 Life team had moved the familyinto a motel.
It was then that Chris and his family first came to the attention of the Armed Forces Foundation. The Marine 4 Life team contacted theFoundation requesting financial assistance for Chris and his familywhile they helped him look for a job. The foundation immediatelypaid for the family’s lodging and food for the week. Chris interviewedwith Norfolk Southern Railroad and there was a good possibility ofemployment. At the end of the week the Marines moved the familyinto the Warrior homes at Camp LeJeune, fully furnished on-basehousing designated for injured veterans and their families. Better yet,during their two and a half months stay there Chris was able to getregular treatment for his PTSD symptoms. A number of organizations,including the AFF and the Semper Fi Fund, covered the family’sexpenses. Chris’s paranoia and depression lessened, and the night-mares that awakened him three and four times each night began todissipate. The worst was over.
The position with Norfolk Southern was still iffy, so in August when Chris was offered a job as a manager trainee with the Kangaroo Deployed, Decorated and Living in a Car Pantry in Greenville he took it, even though the starting salary wasminiscule and there was no health coverage until he spent a year withthe company. The Semper Fi Fund helped move the family and paidtheir first and last month’s rent so that they could get settled into anapartment. Austin and Zachary needed to begin school. The ArmedForces Foundation contacted Aaron’s Furniture to see if they woulddonate furniture since the family still owned nothing but a few bun-dles of clothing. Aarons donated a living room suite, bunk beds and atoddler bed for the boys’ room, a bed and chest for Chris and Kathy,and a washer and a dryer. By now Chris was receiving $1,100.00 amonth in Veteran’s benefits but he still couldn’t feed his family, gettreatment for his PTSD, and pay the rent.
In early October, Norfolk Southern accepted him into their con- ductor training program, and Chris decided to take their offer as a sec-ond chance to find the security he and his family so desperately need-ed. The railroad job came with medical benefits after two weeks ofwork, as well as higher pay. “His optimism always won me over,”Kathy says. “I remember times when we had to drop everything andleave, but I always trusted him because he never gave up. He said ‘Myboys deserve better and I promise I’m going to get it for them.’” Thefamily moved into an apartment in Norfolk, enrolled the two olderboys in school, and Chris started training. They had to pawn theirwedding rings a second time in February 2008 to pay their electricaland heating bills, but by the end of March Chris completed his train-ing and became a conductor for Norfolk Southern. He had made goodon his promise.
Combat Action Ribbon (Iraq), 2 Marine Corps Good Conduct Medals, Humanitarian Service Medal, 6 Sea Service Deployment Ribbon, ArmedForces Expeditionary Medal (Haiti), Iraq Campaign Medal, Global War onTerrorism Service Medal, National Defense Service Medal, 2 Navy UnitCommendations.
“The story of Mr. Woodruff’s recovery is nothing short of a miracle. He considers himself lucky to have received incredible care. Not only did he have to go through surgery and grafts to repair the physical damage to his face and head, but needed rehabilitative for the unseen damage to his memory, thought processes and speech. In addition to his initial treatment upon returning from Iraq, he needed constant follow-up therapy to recuperate his cognitive abilities.” —“Brain Injured Newspaperman Speaks Out For Returning Iraq War Veterans,” Fern Cohen, www.ezinearticles.com

Source: http://www.cfwd.biz/dlc/9781935149019/9781935149019.pdf

Medication management and polypharmacy

The Beer lists are used as a national guideline and reference guide forpharmacists and physicians to improve the use of medication in the elderly. Forseveral years, gerontologist Mark H. Beers, MD, has been advocating the use ofexplicit criteria-developed through consensus panels-for identifying inappropriateuse of medications. In a 1991 paper that looked at the nursing facility population,he wrot

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ARTICLES Libellé Prix UNIT Prix Total Dichloroisocyanurate de sodium (Na DCC), 167mg, Tab, 1000, VracAlcool dÚnaturÚ, 70¦, 1 litre, Bouteille, UnitÚTetracycline, 1%, pommade, tube, 5g, UnitéAcide benzoique +Acide salicilique, 6%+3%, Pommade, 50g, tube ou potAnti-hémorroidaire, suppositoire, 10, UnitéPolyvidone iodée, 10%, 200ml, flacon, UnitéNystatin, 100.000 IU, Tab v

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