Efmp?

In theory a good idea. In practice................it can allow abuses.

NavyFP said:

In theory a good idea. In practice................it can allow abuses.

Click to expand...

Because of someone abusing the EFMP program, I got screwed.

Anti-AFmed said:

Any opinions/comments about the exceptional family member program?

Click to expand...

I give the entire story on my site, and have discussed it here in this forum, so I shall relate merely the Readers' Digest version:

1 autistic son born in 1990 at WRAMC (mild PDD/NOS, but still years behind peers verbally and emotionally)

1 severely autistic son born in 1992 at Wilford Hall-- no communicative speech; not potty trained until recently at age 14

Made "Medical Director of Anesthesia" Oct 97 at Travis-- responsibility without, as I later found out, any authority. Naive enough to try to improve medical care.

Oct 98: Very Bad sentinel event involving permanent brain damage of a patient; MII and JCAHO investigation committees determine large chunk of blame due to inappropriate CRNA-Anesthesiologist coordination (CRNAs wanted independence forbidden by AFI and MGI).

Pissed off hierarchy by standing up for 1) medical direction of medical care as Medical Director of Anesthesia and 2) good order and discipline, given that an O-5 CRNA Anesthesia Element Leader was publicly refusing to follow the consultation policy codified in a Medical Group instruction, and insisted upon by her O-6 Flight Commander. Fired as Medical Director by surgeon squadron commander who was good friends with O-5 CRNA, and, according to her, had approved her insubordinate policy of independent practice.

Given orders to go to Elmendorf on an accompanied tour.

EFMP package put together for overseas clearance.

SGH at Elmendorf denied clearance: 1) autistic kids, but also 2) oldest son had asthma [evidently a few deaths of kids with asthma in Alaska due to inadequate peds support, from what I was told]

I thought that was that.

A few months go by.

When my wife, an active duty Major AF FP physician is in premature labor, on mag, on the labor deck with our third son at 29 weeks EGA, I get orders to Elmendorf UNaccompanied for THREE years without my kids.

I am told literally the following by AFPC dweebs: Your kids are EFMP. You are not. The needs of the Air Force can dictate that you go overseas on a long tour without your kids.

Obviously, in hindsight, the result of machinations by my former Residency Director, now Consultant for Anesthesia, and best buddy with the fired O-6 Flight Commander (AFA and USU together)...told this was so by next Consultant.

Appealed these orders through EFMP...finally, Col. Taxin, Chief of AF EFMP, overturned the orders. My Consultant was furious. His attempt to ostracize me, at the cost of being separated from my AD wife and three sons, one of whom was a 33 week preemie after my wife spent a month in the hospital on mag, had failed. EFMP just barely saved me...if I hadn't had two handicapped and one preemie kid, I would have been sent overseas on an accompanied tour unaccompanied for three years.

A few points:

1) If this is what you guys call an "abuse" of EFMP, tell me: what would you have done?
2) As the military medical system is "force shaped" into the Porta Potty of history, probability of being stationed where you can get EFMP-level care at your MTF (had pediatric neurologist, pediatric developmental specialist at Travis) rather than downtown through frustrating TRICARE system is diminishing rapidly. TRICARE refused to reimburse for anesthesia for 3 hour total dental rehab for my severely autistic son at age 12-- until after weeks of appeals, including letters from his NHB developmental pediatrician stating that he would not have held still in a clinic for 3 hours for x-rays, cleaning, sealant, etc. involved in TDR.
3) As the number of autistic kids born to docs increases, military is not increasing care available. The chief of neurosurgery at Travis had 3 autistic kids, I had 2, and the chief of endocrinology had a daughter with Asperger's autism variant. Autistic people need structure and continuity...hard to provide when moving q 2-3 years. I got lucky-- stayed at Travis for 6 yrs and Andrews for 5; not the norm by far...and threatened with moves almost monthly after reaching the "vulnerable" stage at 2 years on station.

Make a note on your Dayrunner: Do not have handicapped kids while on active duty, or else. The EFMP program is a joke.

--
Rob Jones, M.D.
http://www.medicalcorpse.com

militarymd said:

Because of someone abusing the EFMP program, I got screwed.

Click to expand...

I'm talking about the folks who use EFMP when their kids are really OK....One evoked EFMP on a child with a cleft lip when there was absolutely nothing wrong with feeding , etc.

your col taxin, who is 5' 6" on a good day and about 260 lbs and looks like a giant blueberry in his AF uniform once told me I had to mandate an AF SSGT to either lose weight or board him out at 16 yrs. I thought he was going to start eating those little lizards that jabba the hut ate while he had princess LEIA chained up.

former military said:

I thought he was going to start eating those little lizards that jabba the hut ate while he had princess LEIA chained up.

Click to expand...

Well, they taste great, AND are less filling!

I did not know about his weight issues. I don't want to open a can of worms about physicians who destroy our credibility by failing to maintain a professional military appearance; or of O-6s who manipulate the system to stay in, when patriotic NCOs get kicked out on their ass for far less egregious problems. I am hesitant to cross the threshold of going ad hominem against someone by name.

I will only repeat what I said: I never met him, but he saved me from being separated from my 2 handicapped (truly handicapped, as in, diapers at age 8 handicapped) sons and my newborn preemie son (who is neurotypical so far, other than his inherited tendency toward tendentious pedantry). And, please, Marines, please don't report me to the FBI for advocating pedantry in a chat room!

Heh, heh, just kidding, ya thin skinned leathernecks...Semper Fi! (insert grunting noises intended to promote camaraderie among testosterone-toxic high school graduates...HERE).

--
R

No, you don't qualify for abuse. You are the reason we truly need the system.

One of the weaknesses I see in military medicine is difficulty in treating chronically sick people like your kids. Ideally, they need to have a high level of services including child psychiatry, developmental peds and pediatric neurology and speech therapy. They also need a stable home environment and would probably do best with the same doctors for their entire childhood.

Those kind of providers are hard to find in the military. They command top dollar in the civlian world ($250k) and get treated with respect. I can see why it would be hard to justify having those providers. Why would you ever deploy a developmental pediatrician? Why would you have a military officer who was non-deployable?

The whole environment of the military (frequent moving around the world, sudden deployments) etc are hard enough if you have healthy kids.

As military docs we are used to seeing healthy young people for the most part. We understand the science of taking care of chronically sick people but we don't do it enough to be really good at it.

IgD said:

One of the weaknesses I see in military medicine is difficulty in treating chronically sick people like your kids.

Click to expand...

Roger that. Those who are sick enough usually go to places like Walter Reed (d'oh! closing!), Wilford Hall (d'oh! downsizing to superclinic), or (heh) Andrews ("Force-shaping" to 12 inpatient beds according to MAPPG-06, at least 3-4 of which are always taken by overflow OIL [Operation Iraqi Liberation] patients from the ASF...in fact, sometimes have to stick 3+ patients in room at a time, with some sleeping on floor, I have been told). Meaning that most military physicians have limited contact with the kinds of desperately sick folks I see in the civilian world on a daily basis.

IgD said:

The whole environment of the military (frequent moving around the world, sudden deployments) etc are hard enough if you have healthy kids.

Click to expand...

Especially true with autism, which is the fastest growing serious developmental disability: http://www.msnbc.msn.com/id/6844737/

IgD said:

As military docs we are used to seeing healthy young people for the most part. We understand the science of taking care of chronically sick people but we don't do it enough to be really good at it.

Click to expand...

If you think military medicine has prepared you to practice in the real world, think again. I had a shocking learning curve when I started civilian practice. My entire mental concept of "really sick" had to be shifted about 3 quartiles to the right. Nowadays, the 350 lb, 5'2" 70 year old who only has MO, DM, HTN, COPD, ASCAD, and ESRD looks positively healthy compared to the *really* sick patients. While the military touts its CSTARS program designed to familiarize AD surgeons/anesthesiologists with civilian trauma, it has done nothing to recapture the experiences with abysmally sick people that were lost on today's crop of residents/attendings with the cruel downsizing of nearly every single MTF. Perhaps someone should suggest to the idjits in charge (IIC) that civilian rotations to ease M.D.s into caring for chronically-ill patients would make sense, given the 0.0% retention rate of actual clinicians, vs. paper-shuffling, peon-reprimanding, bird-brained/wearing Outlook commandos.

Oh, sorry, that would require the IIC to give a s*** about the well-being, training, and future of their subordinates, whom they only see as insignficant and expendable data points on an IMR graph on a Hollywood Squares ( https://p2r2.afmoa.af.mil/ ) presentation.

--
R

This is kind of funny too... there was this army lt col peds urologist who couldn't make full Col because of his weight... They take that stuff a little more seriously in the Army. Luckily, he was able to get liposuctioned down to standards and get promoted.

IgD said:

One of the weaknesses I see in military medicine is difficulty in treating chronically sick people like your kids. Ideally, they need to have a high level of services including child psychiatry, developmental peds and pediatric neurology and speech therapy. They also need a stable home environment and would probably do best with the same doctors for their entire childhood.

Those kind of providers are hard to find in the military. They command top dollar in the civlian world ($250k) and get treated with respect. I can see why it would be hard to justify having those providers. Why would you ever deploy a developmental pediatrician? Why would you have a military officer who was non-deployable?

The whole environment of the military (frequent moving around the world, sudden deployments) etc are hard enough if you have healthy kids.

As military docs we are used to seeing healthy young people for the most part. We understand the science of taking care of chronically sick people but we don't do it enough to be really good at it.

Click to expand...

Boy, oh, boy. IgD using the word "weaknesses" and "military medicine" in the same sentence! And, furthermore, "we (mil med) are not good at taking care of chronically sick people"! I really am beginning to believe that he may be finally coming around to our way of thinking! Oops! I'm falling out of my chair!

former military said:

This is kind of funny too... there was this army lt col peds urologist who couldn't make full Col because of his weight... They take that stuff a little more seriously in the Army. Luckily, he was able to get liposuctioned down to standards and get promoted.

Click to expand...

Col. "Poppinfresh" operated on my third son at WRAMC. We had been told that my 2 year old would be first, given that he was the youngest on the schedule. On the DOS, I had to chase around an NPO toddler for 5 hours to prevent him from getting water (from the toilets, etc.), because Col. P. put an older, inpatient, ureteroneocystostomy patient before Arthur for MRB, I was told.

Then the civilian contractor peds anesthesiologist, the wife of a very nice ENT at Andrews, rolled her eyes at me when I asked if she would be present for induction of my only non-autistic son. The very competent SRNA, er, "NAR", whom I knew from Andrews, and her staff CRNA did a fine job, as far as I could tell, without any significant oversight, given that Arthur's operation wasn't complex enough to merit the attention of a self-aggrandizing 7-3 contract anesthesiologist.

P.S. In order to prevent thirsting to death 2 year olds from flinging themselves off of the gurneys, and in order to diminish pre-op holding area staff to zero, they put little kids into literal cages which completely enclose their beds. Arthur was reaching out through the bars of his cage like a concentration camp survivor to get love from his parents. I insisted on removing him from his cage so he could be held...my request was denied due to "policy" and "staffing limitations". So I opened the cage anyway...what were they gonna do...send me to Malcolm Slow?

We did a better job with kids, I must say, at least preop, at Andrews. We anesthesiologists aggressively lobbied to put the youngest kids first on the schedule; often had to fight knockdown, dragouts with surgeons who wanted their Pentagon Cols' noses or prostates fixed before kids' ears or weewees, etc. In the end, we sometimes had to change the schedule unilaterally, with the support of the Dragon Lady chief O.R. nurse, She Who Must Be Obeyed (more on her in my book). Admittedly, this could never happen in the civilian world; conversely, we have many nice nurses and techs to watch kiddies, so we can save money on buying cages.

--
R
http://www.medicalcorpse.com

Never heard about the cages.... we have an invisible electric fence that I use to keep my dog in the yard... that could be a good deterent to keep kids from migrating to the water. Instead of shock treatment aversion you could call it "non-restrictive redirection" The AF loves spin.

Why are children being made NPO from water for 5 hours before surgery?

That is WAY too long.

militarymd said:

Why are children being made NPO from water for 5 hours before surgery?

That is WAY too long.

Click to expand...

Because we were initially told that Arthur's surgery would be at 0930...then 1030...then 1130...then...kept going on and on (you know the drill)...didn't want him canceled for drinking water, and didn't want him to aspirate...ended up going to O.R. around 1330, as I recall...

I agree it is way too long...when Andrews moved to 12 hour elective O.R. times (0730-1930 scheduled cases, thanks to Col. "Rusty"), we often got kids who had been NPO since before midnight..."California Raisins", as I affectionately called them. A few were already lethargic from dehydration, and had to be tanked up vigorously prior to induction.

Military Medicine: "Yesterday's Medical Care Tomorrow"

--
R

medicalcorpse said:

we have many nice nurses and techs to watch kiddies, so we can save money on buying cages

Click to expand...

The best ICU nurse I have ever seen in 10 years of medical experience happened to be stationed at Andrews. He never became the slightest bit flustered (come to find out he had been an air traffic controller before becoming an RN, so that might have had something to do with his level of composure in high stress settings), never let his superior rank get in the way of listening to the techs and RT's, he treated everyone with kindness and utmost respect, and he was eager to learn from anyone who had something to offer him regardless of position or age.

Sometimes you find the best people in the worst places.....as is evidenced by Dr. Jones. You probably know the nurse I'm speaking of, a male lieutenant, tall thin, brown hair with a moustache with a little white spot in it.

DropkickMurphy said:

Sometimes you find the best people in the worst places.....as is evidenced by Dr. Jones. You probably know the nurse I'm speaking of, a male lieutenant, tall thin, brown hair with a moustache with a little white spot in it.

Click to expand...

I do remember him...and you as well. Two of the finest, trapped in the Ninth Circle of Hell.

Both of you were too talented and dedicated to stay in the military.

--
R

BTW, I actually wrote him up for being a good nurse (after receiving an e-mail looking for recommendations for an Air Force nursing award) and was told by the group commander (a BG) that it was the first time she'd ever seen an E-3 write up something like that, let alone make it "concise, functional and appropriate." When I pointed out that I had been an officer on the fire department before enlisting and was used to writing reports, awards and grant proposals, she smiled and asked why I hadn't gone to college and become an officer.
Me: "Do you want me to be completely honest ma'am?"
BG: "I expect nothing less Airman. Say what is on your mind."
Me: "Yes, ma'am. Simply put, I don't like having to tell people to do things I find, at best, questionable, more commonly morally reprehensible, and at times outright unethical and in violation of every standard I hold myself to as a caregiver, an airman, and a fire officer. Out of all the officers I have met, and or served under....there are five that have my utmost, unquestioning respect: Lt. S-------- (the ICU nurse), Drs. Alonso and Maybee (our pulmonologists), Dr. Watkins (one of the ER docs), and yourself ma'am, simply because I have seen none of them do anything that makes me question that they have the same values that I do. I respect the rank the other officers wear, but that does not imply that I respect them in anything but the very cursory level that is required of me by the Air Force." The audible gagging noise that emanated from my squadron commander when I said that (she was standing behind me, along with my first sergeant and my immediate supervisor) was well worth the ass chewing I received after we left the general's office.

NOTE: This was before I met Dr. Jones, and if I were asked today whom I respected out of the officers I served with, I would count him and a couple of others among that number.

Two of the finest, trapped in the Ninth Circle of Hell.

Click to expand...

Thank you for saying that and for providing an explanation as to why my feet are still cold.

ahhhh . . . EFMP.

it's not a bad program. at least in the army, it seems to do its job of keeping complex medical needs kids from ending up PCS'd to timbuktu. the EFMP program originally came from a DoD equal schooling initiative-- overseas schools lacked the adaptations for special needs kids, and were subsequently not meeting the standard set in the US. it grew to include medical care as well (what GMO wants an MRCP ex 24 weeker strolling into his clinic in korea with respiratory distress?). the AF and navy EFMP systems i'm not as familiar with, but the DoD EFMP form trumps whatever service specific form they may use may be, so i always turn the same form in.

from my experience, most people are ok with EFMP-- there are a handful that resist tooth and nail to enroll. theoretically it has no bearing on your "promotion and career progression". it definitely has no bearing on deployments. it's merely a database of people who have limited PCSing capacity due to dependent medical care. (a valuable database of pediatric disease prevalence in them military-- a epidemiologist dream that we can't access due to IRB ******edness). EFMP is dynamic, and can be changed at any time.

autism is a tough one. being a spectrum disorder, it can range from needing only a general pediatrician to needing developmental, psych, and/or neuro follow ups. sorry to hear about your situation with your kiddos rob.

as far as the NPO thing-- we always put our kids on maintenence IVF while NPO. even for sedated procedures (versed/pentobarb) we'll likely bolus them post procedure as they're almost always on the dry side.

WRAMC is closing, but the peds support won't be changing at all. we're already fully integrated with NNMC-- so our department has been "BRAC"d for quite some time now. our current problems as a program primarily stem from the navy's utter disdain for pediatric medicine. two years ago they were within a hair's breadth of completely shutting down peds GME. if not for some political leverage from the AAP, it likely would have went though. GMO tour aside, it's not a good time to be interested in navy peds.

--your friendly neighborhood EFMP paperwork completing caveman

Anti-AFmed said:

In my experience (at least with AF EFMP), the program is a joke. It should have stopped us from coming here. It should have stopped many of the families I know from coming here, etc. The problem I see is that the EFMP person here is told to say the service exists if it exists in the state (regardless of true availability or distance).

Click to expand...

If it is a joke, it is a sick joke that is inappropriate for a family audience.

In fact, it is a tragedy, because mismanagement of EFMP issues can cause PERMANENT and IRREVERSIBLE damage to children, none of whom raised their right hands to sacrifice their lives and health for the good of the nation. When I joined the military in 1981 (ROTC), I was given to understand that my future family, a decade hence, would be cared for. One of the significant attractions of military service was the availability of absolutely free specialist physician care at MTFs around the the country and around the world.

Fast forward to 2006, when (my estimates) 50-60% of those MTFs have been shuttered, 80% have been downsized/rightsized/force-shaped, and 100% of the remaining clinical military physicians struggle daily to provide excellent care for an increasing number of increasingly old, sick, and wounded patients, against increasingly desperate odds inflicted upon them by an uncaring military bureaucracy which places quality dependent medical care at the very bottom of their Pentagon wish list, behind service-specific BDUs and upgraded on-post golf courses. What used to be free for life (MTF care) is now denied with strife (TRI to get CARE).

Remind me once again what 2000 was in the Air Force? The Year of the Family? That's when I got my orders to be separated from my 3 (three) handicapped kids and active duty physician wife for 3 (three) years. What was April, 2006? That's right, the "Month of the Military Child" (http://www.defenselink.mil/news/Apr2006/20060403_4687.html). What shameless, Orwellian, double-think bull hockey. I wonder how many special needs, dependent children's lives were permanently damaged that month due to "the (Extra-Special) Needs of the Air Force" (Army, Navy, Marine Corps...).

--
R
http://www.medicalcorpse.com

Anti-AFmed said:

See that is where my problem lies...I am in "timbuktu," there are many other families here that also should not be here. I have two special needs children (one was diagnosed prior to PCSing here and he was/is in EFMP). My older child has autism and while he is 'high-functioning,' he still needs a developmental ped, ot, pt, st, a neurologist, a child psychologist and/or psychiatrist (to have a diagnosis that the state will accept), etc. Yet, we are in an area where there is only one dev ped (and the wait list is often at least 6 months long), one main place for pediatric therapies (and wait lists are between 6-18 months long and it is an hour away), a few neurologists, but to see them at the office tricare has them approved for you need to have a qualifying condition and autism is not a qualifying condition, so there is one ped. neuro. and again with a long wait list. There isn't a pediatrician on base...yes, just a general pediatrician (although there was when we got here). Has that stopped EFMP from approving SN families to move here? NO! Then again, the EFMP person here has changed 3 times in just a hair over a year.
In my experience (at least with AF EFMP), the program is a joke. It should have stopped us from coming here. It should have stopped many of the families I know from coming here, etc. The problem I see is that the EFMP person here is told to say the service exists if it exists in the state (regardless of true availability or distance).

Click to expand...

again-- i can only comment on the army side of things. the army has a central database the detailers go through prior to assignments (or so i'm told). we see a TON of people in the WRAMC catchment area that are here simply b/c they have kids so complicated they can only be near a major MEDCEN. i'm not sure what the AF or navy does.

--your friendly neighborhood army green (or speckled ACU tan/gray) wearing caveman

Homunculus said:

again-- i can only comment on the army side of things. the army has a central database the detailers go through prior to assignments (or so i'm told). we see a TON of people in the WRAMC catchment area that are here simply b/c they have kids so complicated they can only be near a major MEDCEN. i'm not sure what the AF or navy does.

--your friendly neighborhood army green (or speckled ACU tan/gray) wearing caveman

Click to expand...

On paper, everyone is supposed to do the same thing.....HOWEVER, and this includes the Army, things will be applied only when it is CONVENIENT....or if and when you KNOW SOMEONE with stars or eagles on their shoulders.

The problem with this program, along with everything else military, is that things are supposed to go a certain way, but ONLY WHEN IT IS CONVENIENT.

The recruiters will sell you the Empire State Building, but the reality is....well, those of us who served...know what the reality is.

Anti-AFmed said:

Any opinions/comments about the exceptional family member program?

Click to expand...

I am a Navy wife of 15 years and I was placed on the EFMP back in 2004 when I was finally diagnosed with Cold Induced Urticaria (although I've been breaking out since I was 17) by actually becoming so cold and broke out into hives that itched like a you know what, my BP dropped and I went into shock, was given EPI injection and other meds in the ER, placed on Allegra 180 (which tricare no longer covers and I have to pay out of pocket)(i've tried several others that didn't help) and carry an EPI PEN everywhere I go, I can not go swimming etc and I have been able to keep it at bay with the allegra because our last 2 duty stations were in FL , well we were recently given orders to DENVER, CO.. yep even though my Navy Dr. in Jacksonville, FL put plain and simply in my EFMP that the best treatment is avoidance to cold climate etc, the great Navy still sent us here, I have been here since the end of April, it snowed May 1, the day out HHG's arrived, I survived Summer but since the beginning of October I have taken my Allegra every single morning and to no avail, broken out every single day, we had our first big snow storm here this week and luckily it was fall break for my kids so I didn't have to go anywhere (ps can't find a job here either) but I felt horrible, my kids want so badly to play in the snow with me, go bike riding, go to the park etc and I cant do any of it with them. I am becoming really depressed as this is putting a major hinder and stress on my life.. I don't think they understand the seriousness of my condition, not only is it life threatening but I can't live a normal life here. I have no idea how to prove to them the seriousness of this short of getting out of the house and allowing my body to breakout so bad that my BP drops and have to be sent to an ER several times and possibly lose my life before they realize it. Meds do not work when temps dip below 60 degrees.... I don't feel like the military cares at all about the families well being..

rn32mb said:

I am a Navy wife of 15 years and I was placed on the EFMP back in 2004 when I was finally diagnosed with Cold Induced Urticaria (although I've been breaking out since I was 17) by actually becoming so cold and broke out into hives that itched like a you know what, my BP dropped and I went into shock, was given EPI injection and other meds in the ER, placed on Allegra 180 (which tricare no longer covers and I have to pay out of pocket)(i've tried several others that didn't help) and carry an EPI PEN everywhere I go, I can not go swimming etc and I have been able to keep it at bay with the allegra because our last 2 duty stations were in FL , well we were recently given orders to DENVER, CO.. yep even though my Navy Dr. in Jacksonville, FL put plain and simply in my EFMP that the best treatment is avoidance to cold climate etc, the great Navy still sent us here, I have been here since the end of April, it snowed May 1, the day out HHG's arrived, I survived Summer but since the beginning of October I have taken my Allegra every single morning and to no avail, broken out every single day, we had our first big snow storm here this week and luckily it was fall break for my kids so I didn't have to go anywhere (ps can't find a job here either) but I felt horrible, my kids want so badly to play in the snow with me, go bike riding, go to the park etc and I cant do any of it with them. I am becoming really depressed as this is putting a major hinder and stress on my life.. I don't think they understand the seriousness of my condition, not only is it life threatening but I can't live a normal life here. I have no idea how to prove to them the seriousness of this short of getting out of the house and allowing my body to breakout so bad that my BP drops and have to be sent to an ER several times and possibly lose my life before they realize it. Meds do not work when temps dip below 60 degrees.... I don't feel like the military cares at all about the families well being..

Click to expand...

Wow, blast from the way past.....2006????

Some of these threads are like fine wines. You have to let them age a bit. Hmm...MedicalCorpse, DropKick Murphy, island doc, former military, Homunculus, NavyFP, IgD...this is VINTAGE SDN MilMed.

backrow said:

Wow, blast from the way past.....2006????

Click to expand...

I apologize, I did not look at the date, I simply googled help with EFMP docs and this site came up..I read the thread and thought MAYBE I could post my concern and get some feedback on what I can possibly do..IDK.. perhaps I should start a new thread?

rn32mb said:

I am a Navy wife of 15 years and I was placed on the EFMP back in 2004 when I was finally diagnosed with Cold Induced Urticaria (although I've been breaking out since I was 17) by actually becoming so cold and broke out into hives that itched like a you know what, my BP dropped and I went into shock, was given EPI injection and other meds in the ER, placed on Allegra 180 (which tricare no longer covers and I have to pay out of pocket)(i've tried several others that didn't help) and carry an EPI PEN everywhere I go, I can not go swimming etc and I have been able to keep it at bay with the allegra because our last 2 duty stations were in FL , well we were recently given orders to DENVER, CO.. yep even though my Navy Dr. in Jacksonville, FL put plain and simply in my EFMP that the best treatment is avoidance to cold climate etc, the great Navy still sent us here, I have been here since the end of April, it snowed May 1, the day out HHG's arrived, I survived Summer but since the beginning of October I have taken my Allegra every single morning and to no avail, broken out every single day, we had our first big snow storm here this week and luckily it was fall break for my kids so I didn't have to go anywhere (ps can't find a job here either) but I felt horrible, my kids want so badly to play in the snow with me, go bike riding, go to the park etc and I cant do any of it with them. I am becoming really depressed as this is putting a major hinder and stress on my life.. I don't think they understand the seriousness of my condition, not only is it life threatening but I can't live a normal life here. I have no idea how to prove to them the seriousness of this short of getting out of the house and allowing my body to breakout so bad that my BP drops and have to be sent to an ER several times and possibly lose my life before they realize it. Meds do not work when temps dip below 60 degrees.... I don't feel like the military cares at all about the families well being..

Click to expand...

Sometimes the military can do what is called a tour curtailment. For example, you are serving overseas, develop a medical problem that you need to be somewhere else to get treatment or to recover. The military cancels your orders. The military could also make your husband's tour unaccompanied, maybe send you somewhere else but leave him where he is at.

What military base is in Denver? Is that Fort Carson? Do they have a MTF there? Wonder what an allergy/immunology specialist at the nearest MTF would recommend or if they would support you in some type of administrative action.

MedicalCorpse said:

If you think military medicine has prepared you to practice in the real world, think again. I had a shocking learning curve when I started civilian practice. My entire mental concept of "really sick" had to be shifted about 3 quartiles to the right. Nowadays, the 350 lb, 5'2" 70 year old who only has MO, DM, HTN, COPD, ASCAD, and ESRD looks positively healthy compared to the *really* sick patients. While the military touts its CSTARS program designed to familiarize AD surgeons/anesthesiologists with civilian trauma, it has done nothing to recapture the experiences with abysmally sick people that were lost on today's crop of residents/attendings with the cruel downsizing of nearly every single MTF. Perhaps someone should suggest to the idjits in charge (IIC) that civilian rotations to ease M.D.s into caring for chronically-ill patients would make sense, given the 0.0% retention rate of actual clinicians, vs. paper-shuffling, peon-reprimanding, bird-brained/wearing Outlook commandos.

Oh, sorry, that would require the IIC to give a s*** about the well-being, training, and future of their subordinates, whom they only see as insignficant and expendable data points on an IMR graph on a Hollywood Squares ( https://p2r2.afmoa.af.mil/ ) presentation.

--
R

Click to expand...

medicalcorpse-- I AGREE 100%

--just the fact that CSTARS exists tells you that the USAF has nothing close to this level of critical care learning OR practice environment.

--I'm so glad I GMO'd and got the heck out of there and wasn't fooled into trying crumbling USAF GME. at least for surgical subspecialties, it's a shadow of its former self, and pales to the outside world.

thanks for sharing your story again, Dr Jones.

rn32mb said:

I am a Navy wife of 15 years and I was placed on the EFMP back in 2004 when I was finally diagnosed with Cold Induced Urticaria (although I've been breaking out since I was 17) by actually becoming so cold and broke out into hives that itched like a you know what, my BP dropped and I went into shock, was given EPI injection and other meds in the ER, placed on Allegra 180 (which tricare no longer covers and I have to pay out of pocket)(i've tried several others that didn't help) and carry an EPI PEN everywhere I go, I can not go swimming etc and I have been able to keep it at bay with the allegra because our last 2 duty stations were in FL , well we were recently given orders to DENVER, CO.. yep even though my Navy Dr. in Jacksonville, FL put plain and simply in my EFMP that the best treatment is avoidance to cold climate etc, the great Navy still sent us here, I have been here since the end of April, it snowed May 1, the day out HHG's arrived, I survived Summer but since the beginning of October I have taken my Allegra every single morning and to no avail, broken out every single day, we had our first big snow storm here this week and luckily it was fall break for my kids so I didn't have to go anywhere (ps can't find a job here either) but I felt horrible, my kids want so badly to play in the snow with me, go bike riding, go to the park etc and I cant do any of it with them. I am becoming really depressed as this is putting a major hinder and stress on my life.. I don't think they understand the seriousness of my condition, not only is it life threatening but I can't live a normal life here. I have no idea how to prove to them the seriousness of this short of getting out of the house and allowing my body to breakout so bad that my BP drops and have to be sent to an ER several times and possibly lose my life before they realize it. Meds do not work when temps dip below 60 degrees.... I don't feel like the military cares at all about the families well being..

Click to expand...

i can't comment on navy (first off, a navy gig in denver? ) but i'm sure there is something similar to what they do in the army. i have had countless parents come in asking for "compassionate reassignments"-- which is basically the command ok'ing you to PCS early to another duty location due to medical/family/personal issues.

EFMP only works if the detailer, the doc filling out the paperwork, and the person submitting does their job correctly. and on top of that, if you did not renew your EFMP enrollment every 3 years, it expires-- you are not disenrolled (that requires more work, and is a different process) so if you originally enrolled in EFMP in 2004 you should have renewed it at least twice. if you had an expired EFMP status, your husband should not have been cut orders, and he should have had all kinds of emails reminding him it needed to be renewed. the problem is servicemembers ignore the renewals, and detailers don't want to have to wait to get them renewed when it comes time to cut orders. i'm not even sure if they can see what the EFMP enrolled problems are if you are "expired." so while the system should work, it doesn't because people ignore it. then you end up in denver with cold induced urticaria. ask your husband about it, he probably has emails somewhere from an EFMP coordinator telling him he needed to get yours redone.

anyway, the military is not an automaton, and one thing i learned during several of these is that there actually is someone who does have the power to say yay or nay to something like a reassignment.

the problem you will run into is that at least in the army, being an administrative process, you have to start the process with the servicemember's command (not the medical folks). there are forms and such, but the best thing to do is to get the ball rolling now. a better time would have been upon hearing you were moving to denver-- knowing it would get cold, this is something you could have worked on over the summer-- and you need to be prepared to answer why you waited so long if this was such a problem for you.

once you get the admin side going, you can get a letter from your doc specifying why a move is appropriate-- and it needs to be spun in a way that it 1) saves the military money by moving you, 2) saves the military work by moving you, and (most importantly) how staying will impact your husband's ability to perform his mission. ie, if you are admitted to the hospital, or require frequent visits to subspecialists that are far away, and he has to drive/accompany you, take care of the kids, etc he will miss time from work and it will negatively impact his mission.

most docs have done these before, and likely have a general template they will use. i encourage you to be proactive, because like anything the squeaky wheel gets the grease. don't sit back and complain for the next 2-3 years (like i've seen some people do) and not even make an attempt to change it. yes, some people get the shaft in the military, but as a general rule i find that those who know the system and are willing to try working with it are much happier than those who throw up their hands and give up at the first sign of difficulty.

good luck and i hope things work out. and i hope someone in the army gets the navy denver slot, lol.

-- your friendly neighborhood old EFMP chief caveman

Homunculus said:

i can't comment on navy (first off, a navy gig in denver? ) but i'm sure there is something similar to what they do in the army. i have had countless parents come in asking for "compassionate reassignments"-- which is basically the command ok'ing you to PCS early to another duty location due to medical/family/personal issues.

EFMP only works if the detailer, the doc filling out the paperwork, and the person submitting does their job correctly. and on top of that, if you did not renew your EFMP enrollment every 3 years, it expires-- you are not disenrolled (that requires more work, and is a different process) so if you originally enrolled in EFMP in 2004 you should have renewed it at least twice. if you had an expired EFMP status, your husband should not have been cut orders, and he should have had all kinds of emails reminding him it needed to be renewed. the problem is servicemembers ignore the renewals, and detailers don't want to have to wait to get them renewed when it comes time to cut orders. i'm not even sure if they can see what the EFMP enrolled problems are if you are "expired." so while the system should work, it doesn't because people ignore it. then you end up in denver with cold induced urticaria. ask your husband about it, he probably has emails somewhere from an EFMP coordinator telling him he needed to get yours redone.

anyway, the military is not an automaton, and one thing i learned during several of these is that there actually is someone who does have the power to say yay or nay to something like a reassignment.

the problem you will run into is that at least in the army, being an administrative process, you have to start the process with the servicemember's command (not the medical folks). there are forms and such, but the best thing to do is to get the ball rolling now. a better time would have been upon hearing you were moving to denver-- knowing it would get cold, this is something you could have worked on over the summer-- and you need to be prepared to answer why you waited so long if this was such a problem for you.

once you get the admin side going, you can get a letter from your doc specifying why a move is appropriate-- and it needs to be spun in a way that it 1) saves the military money by moving you, 2) saves the military work by moving you, and (most importantly) how staying will impact your husband's ability to perform his mission. ie, if you are admitted to the hospital, or require frequent visits to subspecialists that are far away, and he has to drive/accompany you, take care of the kids, etc he will miss time from work and it will negatively impact his mission.

most docs have done these before, and likely have a general template they will use. i encourage you to be proactive, because like anything the squeaky wheel gets the grease. don't sit back and complain for the next 2-3 years (like i've seen some people do) and not even make an attempt to change it. yes, some people get the shaft in the military, but as a general rule i find that those who know the system and are willing to try working with it are much happier than those who throw up their hands and give up at the first sign of difficulty.

good luck and i hope things work out. and i hope someone in the army gets the navy denver slot, lol.

-- your friendly neighborhood old EFMP chief caveman

Click to expand...

Thank you both so very much for the responses and tons of information, I greatly appreciate it As for the Navy gig in Denver, yes it's with the NSA at Buckley AFB. I went to my PMC today and informed him that the current meds were not helping , with great dsicussion, we agreed to switch to Zyrtec and add Zantac along with it and I was given Atarax that I can try at night and on severley cold days. He also provided me with a twin EPI pack and a referral to Allergy Specialist to see if it can be " controlled". I have a high respect for Dr.'s and Nurses and obviously do not want to move my children away from dad but I also discussed your answers with my AD spouse who in turn has a meeting with his command EFMP coordinator tomorrow. To answer your questions on that, I have kept my EFMP packets up to date since 2005, they did require that to be done prior to orders being cut. We were suppose to be given orders to HI, but in the span of funding running out and over the fiscal year we were cut these orders on a whim, unfortunately. I am willing to move back home to FL for my health if I need to. It would have to be at the Navy's expense b/c there is NO way I can afford to do it myself. I t would also be ideal for him to come along but I myself could deal with it if it means staying alive and living a normal life. Once again I greatly appreciate you taking the time to explain this alll to me.

61November said:

This thread is awesome. Corpse, dropkick and former military were among the best. If you look back far enough you can even catch glimpses of crazed mil cheerleader igd before he saw the light. He and galo used to have some legendary tilts.

How can we, as the newest generation of bitter gmo's and flight docs hope to live up to the glorious legacy bequeathed to us by these heroes? Would any of us dare to write a derogatory letter to the aftimes denouncing hpsp as island doc once did? Or get a letter of reprimand for jaywalking like galo?

No gentlemen, these were different times, when giants truly walked among us. I lift my glass in tribute and drink a toast to their memory.

61N

Click to expand...

Where can I find that letter? I'd love to read it.

Galo's jaywalking LOR was awesome too. We have to find that thread again. I read it first as a med student when I didn't know what an LOR was. Now I do, having narrowly escaped a couple during my time on active duty. I was actually a bit disappointed that my last threatened LOR never came off; when they realized that the rumor that I would immediately have my LOR and rebuttal framed side-by-side under a calligraphied "INTEGRITY FIRST" and hung in my office was true, they seemed to regard me as a lost cause and signed the separation paperwork.

Also, second the EFMP squeaky wheel stuff. I had many people who wanted to be EFMP'd from my little neck of the woods; everyone who made a big enough pest out of themselves got out.

Anti-AFmed said:

Any opinions/comments about the exceptional family member program?

Click to expand...

Homunculus said:

i can't comment on navy (first off, a navy gig in denver? ) but i'm sure there is something similar to what they do in the army. i have had countless parents come in asking for "compassionate reassignments"-- which is basically the command ok'ing you to PCS early to another duty location due to medical/family/personal issues.

EFMP only works if the detailer, the doc filling out the paperwork, and the person submitting does their job correctly. and on top of that, if you did not renew your EFMP enrollment every 3 years, it expires-- you are not disenrolled (that requires more work, and is a different process) so if you originally enrolled in EFMP in 2004 you should have renewed it at least twice. if you had an expired EFMP status, your husband should not have been cut orders, and he should have had all kinds of emails reminding him it needed to be renewed. the problem is servicemembers ignore the renewals, and detailers don't want to have to wait to get them renewed when it comes time to cut orders. i'm not even sure if they can see what the EFMP enrolled problems are if you are "expired." so while the system should work, it doesn't because people ignore it. then you end up in denver with cold induced urticaria. ask your husband about it, he probably has emails somewhere from an EFMP coordinator telling him he needed to get yours redone.

anyway, the military is not an automaton, and one thing i learned during several of these is that there actually is someone who does have the power to say yay or nay to something like a reassignment.

the problem you will run into is that at least in the army, being an administrative process, you have to start the process with the servicemember's command (not the medical folks). there are forms and such, but the best thing to do is to get the ball rolling now. a better time would have been upon hearing you were moving to denver-- knowing it would get cold, this is something you could have worked on over the summer-- and you need to be prepared to answer why you waited so long if this was such a problem for you.

once you get the admin side going, you can get a letter from your doc specifying why a move is appropriate-- and it needs to be spun in a way that it 1) saves the military money by moving you, 2) saves the military work by moving you, and (most importantly) how staying will impact your husband's ability to perform his mission. ie, if you are admitted to the hospital, or require frequent visits to subspecialists that are far away, and he has to drive/accompany you, take care of the kids, etc he will miss time from work and it will negatively impact his mission.

most docs have done these before, and likely have a general template they will use. i encourage you to be proactive, because like anything the squeaky wheel gets the grease. don't sit back and complain for the next 2-3 years (like i've seen some people do) and not even make an attempt to change it. yes, some people get the shaft in the military, but as a general rule i find that those who know the system and are willing to try working with it are much happier than those who throw up their hands and give up at the first sign of difficulty.

good luck and i hope things work out. and i hope someone in the army gets the navy denver slot, lol.

-- your friendly neighborhood old EFMP chief caveman

Click to expand...

Just wanted to update you that I have not only gone through my PCM who referred me to an allergy/immunologist here in denver who spent over an hour discussing my condition with me and she also agreed that I do not need to be living here , she gladly filled out a new EFMP packet for me with extensive explanation in details the severity of my condition and also attached a letter that states " An immediate access to epinephrin auto-injectors is strongly reccommended in the event of inadverdant exposure to either prolonged or very low temperature since cold-induced urticaria can lead to fatal anaphylaxis. More over , a serious consideration should be given to re-locating the patient to a sub-tropical or tropical climate given the nature of her severe cold-induced urticaria and her history of life-threatning reactions to cold weather"

as for having an explanation of coming here in the first place: that is a given, I clearly was not thinking of just myself, I was strongly trying to keep our family together and not disrupt my children's lives, they just went through dad being on sea duty the last 3 years that consisted of 3 - 7 month deployments. I clearly have no other choice now but to move back and I realize my health is a very important key in living happy and healthy so my children do not lose a parent to death. Of course it would be the greatest thing if he were to get orders to transfer with us but I understand this may not happen especially knowing just who the detailer is and all the crap we went through before coming to Denver, we choose orders to Hawaii and we thrilled and ready to go until BAM , Navy ran out of $$$$ and it was too expensive to move a family of 4 from FL to HI....

my question now is: given the letter from the specialist, is it going to be enough to convince them? certainly it is not solely up to the detailer, right? I know that the command here, the EFMP coordinator and obviously the Physician are all being compliant and helpful... If I could afford to move everything back I already would have. This is also his last tour before retirement so I was wondering if it would be considered a "homesteading" category or a "pinpoint to specific location" category? any help and more advice is greatly appreciated.

What do you want the outcome of the situation to be? Are you wanting the Navy to issue a new set of orders and PCS your entire family?

Another thought. Have you been in touch with your Family Readiness Officer? What are they saying.

IgD said:

What do you want the outcome of the situation to be? Are you wanting the Navy to issue a new set of orders and PCS your entire family?

Click to expand...

Ideally that would be what any family would want but at this point I would really like for them to at least move myself and the kids back, I have not contacted the readiness officer?

Semi-necrobumping this thread in hopes of not starting a new one...

If anyone here knows the ins and outs of EFMP pretty well, please shoot me a PM. The story involves a dependent's healthcare, so I prefer not to post it openly.

Thanks.

colbgw02 said:

Semi-necrobumping this thread in hopes of not starting a new one...

If anyone here knows the ins and outs of EFMP pretty well, please shoot me a PM. The story involves a dependent's healthcare, so I prefer not to post it openly.

Thanks.

Click to expand...

sent you a pm.

medicalcorpse, galo, and militarymd. those were the days

--your friendly neighborhood old school caveman

Homunculus said:

sent you a pm.

medicalcorpse, galo, and militarymd. those were the days

--your friendly neighborhood old school caveman

Click to expand...

Much thanks to Homunculus.

Even IgD made an appearance on this thread. Seems like for a time he was the only pro-mil med voice on here, and even he eventually tempered his position.

colbgw02 said:

Even IgD made an appearance on this thread. Seems like for a time he was the only pro-mil med voice on here, and even he eventually tempered his position.

Click to expand...

Remember Navy Dive Doc? He was pretty pro and in a very level-headed way. I haven't heard of him in years. Makes you feel old, doesn't it?