As soldiers return from Iraq and Afghanistan, most will resume their lives in the civilian world, returning to family, friends, jobs and community. Approximately one of three veterans will experience continuing symptoms of combat stress, depression, anxiety and PTSD. Others will have symptoms of Mild Traumatic Brain Injury (mTBI) as a result of concussive injuries from exposure to IED’s which may manifest itself in the form of memory and attention problems, irritability, having a “short fuse”, sleep disorders and mood problems. In fact, the symptoms may closely mirror those of veterans with PTSD and there are individuals who have both a brain injury and PTSD.
The Family Physician may be the person who is in position to first recognize the problems and this requires that the physician be sensitive to the issues experienced by individuals returning from combat and be aware of the services they may need. As these “wounds of war” are invisible, the Family Physician may need to ask probing questions to develop an understanding of the problem and to formulate a treatment plan. A few of the questions to ask are:
- Where were you deployed? What was your job in the military?
- When did you return? Were you assessed for any medical or psychological issues before your discharge and return home?
- Were you exposed to any explosions or blasts? Were you assessed for a concussion?
- Are you having problems with short-term memory? Paying attention? Staying on track?
- Are you troubled with depressed feelings or overwhelming sadness since your return?
- Are you feeling anxious, having panic attacks or bouts of fear?
- Are you have trouble sleeping? Or, experiencing nightmares? Flashbacks? Night sweats?
- Are you using drugs, alcohol or prescription medications to seek relief from these problems?
Many returning veterans will seek their healthcare with their primary care physicians and not through the VA. So, it becomes important that civilian physicians develop the skills to identify potential problems and to know the resources that are available to help their veteran patients. Helping the person find the right resources to address their problems on a timely basis can produce better outcomes.