As a newly licensed acupuncturist in 2014, I was thrilled to live just blocks away from one of the region’s VA Medical Centers. As students & interns, we had been frequently regaled about the VA’s uncommon openness to acupuncture, even bringing some on full-time with quite generous salaries.

When I attended my very first Society for Acupuncture Research conference (the first time I had gone to a conference that wasn’t about HIV/AIDS in nearly 30 years!), in Ann Arbor, MI in the spring of 2013, Wayne Jonas was one of the keynote speakers, and was quite inspiring. I will look up my recording of his talk and share more details asap.

Not long after, I purchased his book, "How Healing Works." And as acupuncturist positions became listed as VA Medical centers in Minnesota, in Seattle, in PA or VA, I think, I eagerly applied. (None of the VA Medical Centers in the NYC region, apart from one just 2 years ago in Huntington, Long Island, had ever posted anything to my knowledge.)

So when my first veteran came knocking earlier this summer, I was elated. Finally an opportunity to collaborate. Finally a window into the workings (& thinkings) of this organization.

I was completely unprepared for what I was to learn.

Yeh sure, my father, in his 60s and 70s occasionally frequented the local VA hospital back home, only, I suspect, because he was a notorious tight wad (I suppose that whole generation was)-- and everything at the VA hospital seemed to be free.

He had his own private, family doctor, the same one who cared for all of us kids as well as my mom, but he seemed to particularly enjoy the handouts at the VA hospital, and would come home a bit giddy from each visit, showing off to all of us the new (100% free) prescription they had given him. (If he had gotten the same rx from his private doctor, they would have asked him for a co-pay. At least that is my memory of the motive behind his kind of “doctor shopping.”)

My father, who I guess did 2 years in the Army during the Korean War (but was stationed in Europe, lucky sod), ditched our family doctor for the VA after discovering all their freebies.

I wasn’t all that involved in my father’s clinical care at that time in my life. Heck, I was the one with a life-threatening illness. All he suffered from was (if you can believe it) mild hypertension and what at the time was considered elevated cholesterol.

(Today, of course, we know better (or should know better) and that, for seniors at least, a total cholesterol somewhere between 200-220 (closer to 220 for women) is actually associated with decreased mortality. It’s really all about inflammation. And insulin/glucose instability. The absolute lipidology geeks will tell you that no one really understands HDL cholesterol. (They won’t even measure it.) And my Bensonhurst to SoCal MD friend Mimi Guarnieri will tell you that an elevated LDL is more often than not a sign of stress: psycho-emotional and/or physical.)

Then a new brother-in-law, a Vietnam vet if you can believe it, was a regular if maybe sometimes a reluctant regular, at the Hollywood, FL and then after being worn down by Broward County, the VA Medical Center in Tampa. He even got acupuncture there a few times! Again, I wasn’t super clued in to his care, certainly not the Hollywood, FL time, but paid a bit more attention once he was up in the Hillsborough County area, and pretty much realized that they too were “painting by numbers” in their medical reasoning & care: take this for your cholesterol, that for your anxiety, this for your ED and your knees are hurting you? Let’s replace them!

Decidedly not my kind of medicine.

When this cool, half hippie, half surfer dude from the old neighborhood turned up in my office, diagnosed with  fibromyalgia, I was determined to help him.

So when this really cool, kind of laid back, half hippie half surfer dude who had lived in the old neighborhood almost longer than I had appeared in my office, I was determined to help him. From a Navy family, he had spent 2 years on a ship. At sea!

But something snapped that second year and, at least in his telling, he was given a medical discharge. (Had the food? the air? the constant vibration? the electromagnetic fields? done something to him?) The diagnoses would evolve over time but seemed to start off as a kind of bipolar depression and then morphed into what was characterized as a schizoaffective disorder, with weird pains here and there that got better or got worse and then never went away, eventually to be settled on as fibromyalgia: the catch-all diagnosis of exclusion.

And what role here for acupuncture? you might legitimately ask.

Well pain management, certainly. But the rest of it? And the underlying potential causes or triggers? Those were almost certainly beyond acupuncture’s reach. We could address the pain presentation, but if this was all being created by either what the VA was doing to him or by something going on in his body that the VA docs are not trained to consider much less look for, would this not be a dog chasing his or her tail kind of thing?

We worked on doing as thorough as possible a health (& life) history: This drug and that drug and this psych admission and that psych admission. This merry-go-round had been going round and round for the past ten or even fifteen years. How had no one been able to help this cool, smart guy?

He kept shifting his position in the chair, switching from left buttock bone to right buttock bone, from the edge of chair to the back of chair. Even got up for a while and paced. The expression “crawling out of one’s skin” came to mind.

And as pretty much anyone would do in a first visit for acupuncture, I asked him his top five or so quality of life complaints. I noticed that he kept shifting position in the chair he was sitting on, switching from left buttock bone to right buttock bone, from edge of chair to back of chair. This is not my world at all, but it reminded me of when people describe other people as “crawling out of their skin.” Why as this guy so jumpy, so edgy?

And then he told me the latest drug they had given him: Latuda

I had never heard of it before. I thought I had heard of most psych meds. But there seems to be a new one every month these days. (Along with a new, focus-grouped diagnosis!) So I had to hit the computer later that day after seeing him.

It was my own personal PTSD trigger: the day I had run into an old yoga friend who bear hugged me on the corner of Seventh Ave & West 16th only to joyfully confess to me (within mere seconds of seeing each other for the first time in like 6 or 7 years) that someone had “finally” figured out what was wrong with him (he shared that he had gone through a very dark year even to the point of thinking of suicide), and that it was that he had been diagnosed “bipolar.” And that the Callen Lorde clinician had lickety split written him two prescriptions that would fix him: one for an antipsychotic & one for an antidepressant. No inquiry into his fatty acid or amino acid status. No look at methylation. No Dhea:cortisol check. No hormones or mineral status. My heart sank. 

Back home at my desktop computer, I furiously Googled common luradisone side effects.

Sleep disturbance? Check. Gagging/choking feeling? Check. Restlessness/agitation?

Weird abdominal pain? Shaking/jerking? Anxiousness?

Check, check, check, check.

Back home at my desktop computer I furiously Googled common Latuda side effects, patients’ experiences on the medication, and potential interactions with other medications. Literally verbatim came the list of just about everything this youngish man had shared with me as ailing him-- down even to the constant restlessness, the choking sensation, the inability to sleep, the weird sweating, and the suicidal thoughts.

He had come to me to help him with these things, but it seemed they were all being caused by the drug he had been prescribed. Acupuncture be damned?

I felt it my obligation to at least explore these possible connections. Persistent suicidal thoughts, not to mention some of the others, one would think would be reason enough to say “hell no” to a new medication. But it turned out there was more, much more, to the picture.

I decided I would bring this up at our second visit, which we had not yet scheduled. I like to give new clients time to decide if they want to return, rather than strong arming them into booking like 2 months’ worth of appointments the day of that first meeting. The exact opposite of what we’re taught in our business classes, but then it always kind of gave me the creeps to think of medicine as a business. But hey, the joke’s on me.

So he emails me on a Friday afternoon. Wants to know if he can come in on Monday. I do not have my own private office; the rent for even the most modest accommodations would run something like $10,000 a month. At $100 a session, I’d need to sell (ok, push) supplements or other products. I’d need to convince short-time patients they actually needed my services for life. I’d have to sublet empty office hours out, or hire new graduates and take half their pay. (When a new patient first presents herself/himself, your’re supposed to size them up and estimate the total sales-- services plus products-- you might get out of them over the course of their time time with you. You do that for everyone in your practice and keep a running tally month by month.) That’s just not me. So I work out of what is kind of a on-demand communal space. I check to see if my preferred rooms are available the time on Monday he wants to come, and they are. I book the room, with a 15 minute buffer on each side just so that I can better focus on the visit (and not worry so much about the clock).

He’s a no show. (And I’m out sixty bucks.)

I read more about the most common side effects of this drug. "Disorganized thinking“ and ”impulsivity" appeared among them. Might that explain the late Friday plea for an early Monday morning visit, only to ghost?

What is my professional obligation here? I am half tempted to draft my “It Is My Pleasure To Collaborate With You In the Care Of...” medical report to the neurologist & internist at the VA who made the referral. But what exactly do I say? “Are you guys fucking insane? What are you thinking?” That wouldn’t have gone over well, I don’t suppose, and would have made certain that this was my last referral from the VA. So I put that on hold.

Because I had found my new VA client a tad of what they call in medicine an “unreliable reporter,” I decided to propose a joint meeting with him and his spouse. His wife had accompanied him a couple of times to the VA Medical Center, to advocate for him for this or that. I needed two heads & two memories of facts & histories. So I put that plan into motion.

We met at a falafel place at noon one day in the Village.

I shared with them my concerns. The fact that 95% of his complaints are well-documented side effects of this drug-- up to and including the suicidal thoughts. “Not only is this drug making your life hell,” I continued, “but there is a very real chance that they are MISSING the real cause of your health complaints. These very likely include neuroinflammation and or immune reactions to foods, metals or other exposures that put you at risk for more serious neurodegeneration later in life: think Parkinson’s even Alzheimer’s or Huntington’s. Even something as seemingly innocuous as high homocysteine or insufficient glutathione can have more serious consequences after years and years of not being discovered and addressed. You want to KNOW about these things!”

You don’t understand, he replied calmly, unaffected by neither my words nor my building... let’s call it enthusiasm.

I looked over to his wife several times during this, expecting her to jump to my defense: “Help me get my husband back-- and the boys, their father!”

You don’t understand.

My disability payment is based on the complexity of my case. If I ask them to rule out all these possible causes, and they discover something fixable at the root of my pain or my depression, they will adjust my monthly payment. I made peace with this a long time ago. This is my life now. I say what they want me to say; I do what they want me to do. I do and say what they NEED me to do and say in order to keep the peace. This is my life now. Please, don’t ruin this for me.

I looked over to his wife several times during this, expecting her to jump to my defense. “This is completely nuts! The boys want their father back! Let’s do this!” But those words never came.

She gave me this look-- that look-- the kind of look Weeds’ Heylia James gave Nancy Botwin over her spectacles when questioned about the content of the goods she was purchasing: “Bitch, I can eyeball an ounce from outer space with my glasses cracked.”

She gave me this look: dude, don’t mess this up for me. I’m busting my ass at some thankless, minimum wage job from hell, and you want to take away our monthly disability check?? We’ll deal with the restlessness, the insomnia, the hollow person syndrome, the impulsivity.

And that was that.

Each time I thought back on our meeting, it was me who began to choke, or asphyxiate. This is how veterans must live?

I suppose I am overly sensitive. I am certainly idealistic. Yes, it’s a well worn cliche. But this was a gut punch. I literally had to force myself to breathe on several occasions during the subway ride back to Brooklyn. My stomach ached for 2 full days. If I revisited our meeting in my mind, it was now I who felt he was choking. This is our present day VA?

I thought back to my nephew, newly enrolled to serve (he just finished Basic Training and is due to receive his first assignment in November), and his new West Palm Beach fiancee, not long ago given a medical discharge after a tour in Iraq. With the modest but not inconsequential monthly check she gets from the VA, she is able to live independently and even pursue her jewlery making business slash hobby, free from the stress most other new business owners would be subjected to.

She can enjoy a simple life but one free of the usual (for 60% of Americans, accoring to one Vermont senator) chronic underlying economic terror. The army turned out to be her ticket to a kind of freedom. A de facto Guaranteed Basic Income; all she had to do was 1) enroll, 2) get injured, and 3) convince the VA she will never, to circle back to Dr. Wayne Jonas, be healed.

I suppose that’s no different, or little different, from many other disability cases where the disability is not incontestably lifelong-- and where the prospect of recovery or cure jeopardizes a new-found, however modest, economic peace of mind. I have to admit, it’s a tough call. But still it makes me incredibly sad.

The service man, the service woman, made it home. But did any better future greet them upon arrival than the prospective futures that led them to enroll? Only, it seems, in the cases I am aware of, that monthly disability check. And in order not to lose it, they have to prove for the rest of their lives that they are still sick. Some even & ever terrified of being candid with the people entrusted with their care. Maybe I am too sensitive. Melodramatic, perhaps. But what else would you call them? They are prisoners of their service, or prisoners of the system they enlisted in. Only they’re “home” now. But a type of prisoner of that war they went to fight all the same.

Mike Barr, a longtime Poz Contributing Editor and founding member of and scribe for the Treatment Action Group (TAG), is a functional medicine practitioner and herbalist in NYC. Reach out to him here. Or sign up for his curated (and 20-25% discounted) professional grade supplement dispensary here.