If you read the post about the visit from the Office of the Surgeon General you may recall what a study in comparative coprology it was, but at least there was a consensus about what would be asked of our dear leader, the above described General. However, that was not the end of the smear. It seems, after some digestion, the office has gotten it totally wrong, at least in regard to the substance abuse service. At no time did we discuss a concept called an IOP or intensive outpatient program for substance abuse services. That would require a totally new and separate unit with space, equipment and staff that currently does not exist. An IOP, which does not exist in the DOD would be a valuable service, but it is not part of the current RTF that already exists. But the Office of the Surgeon General, after all the talking and the very specific and detailed briefing, thinks such a service does exist. This is a perfect example of the grand canyon that exists between the actual services and staff that attempt to provide care and the upper echelons of the Army that are out of touch with reality. The lower levels really know what is going on, and the echelons above reality can’t find their butt with both hands. Keep this in mind when you read or hear something in the media about the Pentagon. To keep in touch with reality, don’t swallow all you hear about the soldier who killed all those civilians in Afghanistan. Unfortunately, I currently have a patient who was in the same unit as the alleged mass murderer; they were both in the same WTU at Fort Lewis. Yes, the same Fort Lewis of the infamous Madigan hospital debacle, depending on who you believe. Mark my words, it will not be very long before the soldier is labeled as having PTSD and we now know all soldiers with PTSD are destined to be mass murderers. Finally, in this update I need to add some information on the soldier I mentioned with 6 deployments, Bipolar disorder and a history of suicide attempts. I learned today that he has had both knees replaced as well. It sounds preposterous, but it is true, he got deployed again after the hardware was put in place. And he has hopes that when he finishes our program he will once again be ready for Afghanistan, or wherever our servicemen and women are headed.