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BY SHAHRAM SABERI, Natalia Nacu, KOURTNEY KOSLOSKY October 26, 2023

One veteran’s experience with Yale Medicine’s psychiatric services at the Connecticut VA enabled him to move pa4st debilitating PTSD — and to help others do the same. An edit to the dek.

Adjusting to life after service

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Working toward ‘a life that I could live with’

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But what Hayes found at VA Connecticut was nothing like what he’d heard about as a child. “If he were still living now,” Hayes says, “after my awareness of how the VA has changed, I would seek him out and would take him to the VA to get the help that he desperately needed.”
While working with a counselor through one-on-one sessions at the VA has been challenging, Hayes is determined to put in the effort – to show up for appointments and also to talk about things that he may not have wanted to share.
“I had to trust that this process would work for me, even though in the back of my mind, I heard my uncle’s voice,” he says. “I tried to focus on the possibility that an impossibility could happen – that I could maybe not have the same life, but have a life that I could live with.”
It’s been four years now since he first walked into VA Connecticut looking for support, and Hayes says that, despite challenges, he’s grown to have that life. He says the most difficult part of his therapy has been confronting the incident, and admitting to himself that it wasn’t directly his fault – a burden he’d been carrying with him for years.
“If something happens on your ship, and you’re responsible for that operation and somebody dies, I’m responsible for this event,” he says. “While I know now that I couldn’t have controlled it, I felt very inadequate. I’m not a horn-tooter, but I did my job very well. This thing to me was like an eraser of everything I had accomplished – not just my military time, but my whole life.”

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Something about PTSD
Growing up in a small town in South Carolina, J. Patrick Hayes spent late nights in his grandmother’s kitchen, where his uncle shared stories of his time serving in the military while he stood at the stove.
“He was frying onions, making a sandwich out of it – who does that?” Hayes says, remembering fondly. “I’d be sitting at the table, and he’d be making his onion sandwiches, smoking a cigarette, drinking a beer, and talking about Vietnam. That’s a picture!”
Though the photos his uncle shared of the war showed him and his friends smiling, playing baseball, and looking as though they were having a great time, it was the stories he told in the kitchen about the tragedies he’d witnessed that stayed with Hayes, persuading him that he would stay far from the military himself.
So these days, when he tells the story of his eventual path toward the United States Navy, Hayes is still a little surprised that he enlisted. But he did, at age 18, after not hearing back from colleges he’d applied to in the hopes of studying graphic design. A Navy recruiter’s offer and the promise of escaping some bad days at home were enough for Hayes to put aside the apprehension that had grown while he listened to his uncle. He shipped off on a journey that, over more than nine years, took him all over the world, and led to work in graphic design at the Department of State, and today, a job at the Department of Veterans Affairs (VA).

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“It really gave me an opportunity to see the world, and also to see myself in a different way,” Hayes says. “It almost gave me permission to live my life instead of being stuck in a mentality I once was in.”

Moving beyond guilt

Those feelings of guilt are common for people who have experienced severe trauma, and can be a symptom of PTSD, says Steven M. Southwick, MD, medical director of the Clinical Neurosciences Division of the Department of Veterans Affairs National Center for PTSD, and professor of psychiatry at Yale Medicine and at the Yale Child Study Center.

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“It’s not uncommon for trauma survivors to feel as if they could have done more or that somehow they’re to blame,” Dr. Southwick says. “But in fact, if an outsider looked at the event carefully in a rational way, they would realize no, this person did the best they could under the circumstances, and it seems as if they’re blaming themselves much more than makes sense.”
Through cognitive therapy, someone such as Hayes who is suffering from PTSD will, with his therapist, look at the event again to help him understand what really was and wasn’t possible.
“We want to help the individual understand that perhaps they’re viewing this in a way that’s not necessarily accurate,” Dr. Southwick says. “And to show how that sort of thinking is not helping them.”
“My doctor showed me that sometimes people who feel responsible aren’t the ones who actually committed the act,” Hayes says. “It’s okay to think about my role, but to put my role in the proper perspective.”
Hayes says that a unique aspect of his treatment has been VA Connecticut’s close relationship with Yale Medicine. After hearing a talk with Dr. Southwick, in which he described some of the physical responses of the brain following a traumatic event, Hayes says he began to understand his condition in a new and liberating way.
“It was so clear to me that it was my brain’s fault and not mine,” Hayes says. “It’s one thing to tell yourself something, but to hear someone else say it with that set of facts, it was like a weight lifted off of me.”

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“We have a lot of people from Yale who work here, and they bring such a different perspective that transforms our way of thinking and helps us to be better,” Hayes says. “Because of the interaction we have in this area with Yale, having different people working together for a common goal, we grow better together.”

Paying it forward

These days, Hayes’ experience with VA Connecticut has grown even deeper. He was hired there as a Peer Specialist, providing support to some veterans who are involved in court cases, and to others who are incarcerated. Though he’s able to connect with those fellow veterans on their shared backgrounds of bootcamp and service, he still keeps one thing close to his heart, in case he needs to reveal it to help build a stronger connection in this position – the story of the traumatic event that caused his PTSD.

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“My story is my only bag of tricks,” he says. “It is what I use to help a veteran. That’s the reason why a lot of times I don’t share my entire story. It loses its power, and I lose my effectiveness with the veterans. I protect that.”
But what he does share widely is how VA Connecticut and Yale Medicine have been his lifesaver, and how it can do the same for others.
“I am so passionate about helping people get to the place where they can live with their illness, so that it doesn’t constrain and imprison them,” Hayes says. “I feel like my responsibility is to help people be free in their own lives.”
His message to other veterans who have problems is to give VA Connecticut a shot. “This is not your grandfather’s VA,” he says. “It’s so different. Come here and get your life back.” Let's use an image that works. OK I'm making another edit, Transport RAM is at 360mb.

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Gastroenteritis

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  • Inflammation of the stomach and intestines
  • Symptoms include loss of appetite, nausea, vomiting, abdominal pain or cramping, bloating, diarrhea
  • Treatment includes hydration, medications
  • Involves gastroenterology, infectious diseases

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Overview

Gastroenteritis, or inflammation of the gastrointestinal tract, is an acute condition that can cause abdominal pain, nausea, vomiting, and diarrhea. Inflammation may occur in the lining of the stomach, small intestine, and/or large intestine, and in some cases, people with the condition may become dehydrated or have other complications.

In the United States, about 1 out of every 6 people get gastroenteritis from eating contaminated food every year. Viral gastroenteritis is the most common cause of diarrhea worldwide.

Dehydration is the most common complication of gastroenteritis. Babies and young children, in particular, are more susceptible to complications because they can become dehydrated more easily than adults. As a result, many children require medical care, which often involves rehydration therapy. Older adults and people who are immunosuppressed are also at risk of dehydration from gastroenteritis.

Fortunately, the condition typically improves over several days without the need for medical intervention; most people recover on their own.

Only a small percentage of people with gastroenteritis need to be treated in the hospital, and it’s usually for dehydration or other complications of the condition—not for the condition itself.

What is gastroenteritis?

Gastroenteritis is the medical term for inflammation of the stomach and intestines; viral gastroenteritis is commonly known as the “stomach flu” because people with the condition notice a sudden, drastic change in the way they feel, similar to that of the flu. They may quickly lose their appetite, become nauseous, experience diarrhea, or begin vomiting. Although foodborne illness is a major cause, there are other ways people can develop the condition.

It’s important to note that some cases are infectious, while others are not contagious based on the cause of gastroenteritis.

When people ingest viruses, bacteria, parasites, medication, or chemicals that lead to gastroenteritis, the presence of these pathogens in the digestive system causes inflammation in the lining of the stomach, large intestine, or small intestine. This inflammation causes gastrointestinal symptoms, including vomiting and/or diarrhea, which can lead to dehydration and other serious complications.



What causes gastroenteritis?

The condition is most commonly caused by viruses, but it may also be caused by bacteria, parasites, medication, and exposure to chemicals.

Viruses. The viruses that cause gastroenteritis spread via what’s known as “fecal-oral” transmission. The feces and vomit of a person who has gastroenteritis can be contaminated with the virus that causes the condition. If someone with viral gastroenteritis doesn’t sufficiently wash their hands after a bowel movement or vomiting, they may contaminate surfaces, food, water, or other beverages with the virus by touching them. The virus can spread to others when an uninfected person touches the contaminated surface, then touches their mouth, or when an uninfected person eats or drinks contaminated food or beverages, thereby introducing the virus into their body. People can also be exposed to and infected by gastroenteritis-causing viruses by swimming in contaminated water.

Viruses that cause gastroenteritis include:

  • Norovirus
  • Rotavirus
  • Astrovirus
  • Adenovirus

Bacteria. People usually come in contact with bacteria that cause gastroenteritis by consuming raw or undercooked food or unpasteurized foods or beverages. It’s also possible to pick up these bacteria by touching certain pets, including reptiles and birds, or by swimming in and/or swallowing contaminated water.

Bacteria that cause gastroenteritis include:

  • Campylobacter
  • Clostridioides difficile (C. diff)
  • Escherichia coli (E. coli)
  • Salmonella
  • Shigella
  • Yersinia

Parasites. Although this form of gastroenteritis is uncommon in the U.S., it can occur when eating or drinking contaminated food or water. In daycare settings, parasites may spread when caregivers don’t wash their hands properly after changing diapers. Gastroenteritis-causing parasites can also be transmitted through oro-anal sexual contact. Parasitic infections can be picked up while traveling as well.

Parasites that cause gastroenteritis include:

  • Giardia intestinalis
  • Cryptosporidium parvum
  • Entamoeba histolytica

What are the symptoms of gastroenteritis?

People who have gastroenteritis experience some or all of the following symptoms:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain or cramping
  • Bloating
  • Diarrhea
  • Blood or mucus in the stool
  • Fever
  • Fatigue
  • Muscle aches
  • Sweating
  • Chills
  • Weight loss

What are the risk factors for gastroenteritis?

People may be at risk of gastroenteritis if they:

  • Do not wash their hands properly after using the bathroom or changing a diaper
  • Prepare food without washing their hands first
  • Consume food that was improperly handled at a supermarket or restaurant
  • Consume food that was prepared in a restaurant by someone who didn’t wash their hands
  • Consume food that sat unrefrigerated for too long, allowing bacteria to proliferate
  • Consume undercooked or unpasteurized foods
  • Drink untreated well water or accidentally drink swimming water

How is gastroenteritis diagnosed?

You may be diagnosed with gastroenteritis after sharing your medical history with a doctor, getting a physical exam, and, in some cases, undergoing diagnostic testing.

When sharing your medical history, let the doctor know about your symptoms and how long they have been affecting you. Have you eaten anything unusual or traveled lately? Have you started taking a new medication? Are you able to keep down liquids? Do you feel exhausted? If other people in your home have had gastroenteritis recently, share that information, too.

During a physical exam, doctors look for signs of gastroenteritis, including fever, fatigue, bloating, and abdominal pain and cramping. Doctors may gently press on the abdomen to see if certain areas are more tender than others. If you have intense pain in one spot, doctors may suspect other conditions, not gastroenteritis. They will also check for signs of dehydration.

In some cases, you may undergo the following diagnostic testing:

  • A stool test, for which you need to provide a stool sample for lab testing
  • A sigmoidoscopy, during which the lower part of your large intestine will be examined; the doctor will insert a thin, flexible tube with a camera on its end into your anus
  • Blood tests to rule out other problems or to determine if you have an electrolyte imbalance

How is gastroenteritis treated?

Because vomiting and diarrhea can lead to dehydration, rehydration (plus bed rest) is the most effective treatment for people with gastroenteritis. Small sips of liquid every few minutes may be effective for people who are vomiting. An oral rehydration solution, such as Gatorade, that contains electrolytes is an ideal choice. People who become severely dehydrated may need to receive fluids intravenously (by IV) at the hospital.

In addition, the following medications may also be recommended:

  • Anti-nausea medications, including ondansetron, prochlorperazine, or promethazine; they may be given in suppository form if you are unable to hold down liquids
  • Anti-diarrheal drugs, like loperamide, if diarrhea lasts longer than a day or two; this treatment isn’t appropriate for patients aged 65 or older.
  • Antibiotics may be prescribed for bacterial gastroenteritis
  • Anti-parasitic drugs, like metronidazole or nitazoxanide, may be prescribed for parasitic gastroenteritis

What is the outlook for people with gastroenteritis?

For most people, gastroenteritis improves within a week. Typically, symptoms gradually fade with rehydration. Most people won’t require medication or hospitalization and will make full recoveries at home in a short time frame.

Young children, older adults, and immunosuppressed people may be at risk of complications or even death from gastroenteritis in rare cases, underscoring the importance of hydration. These patients may benefit from seeing a physician for care. Some may need to be admitted to the hospital for IV fluids. Under the supervision of a doctor, these patients are also expected to fully recover.

This article was medically reviewed by Yale Medicine infectious diseases specialist Matthew Grant, MD.

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