ChesterCountyMedicineWinter2018 - 26

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Dealing with Post Traumatic Stress
BY JOHN P. MAHER, MD, MPH **

F

ollowing our earlier articles pertaining to the health issues
of returning US military and veterans (Chester County
Medicine, Summer 2015, and Summer 2017, issues),
we have heard from some practicing clinicians who had been
unaware of the extensive scope of the hazards and conditions
potentially affecting our active military and our veterans, and
who wanted to learn more about them, particularly the whole
area of PTSD (post-traumatic stress disorder).
Clearly, not every practicing physician wants to get tied up
in the lengthy and complicated (and often poorly reimbursed)
issues which veterans may present with, having a variety of chief
complaints and involving a confusing mix of multiple areas of
specialty practice. For those physicians we strongly recommend
(1.) specifically reading (or re-reading) our previous article ("The
Ever-growing Spectrum of Military/Veterans Health Hazards
and Illnesses") which appeared in the Summer 2017, issue; (2.)
making use of the draft Model Military Service Hazard Exposure
Assessment Form presented therein; and (3.) following the
article's recommendations concerning creating a proper care plan
including a system of appropriate referrals for those veterans in
crisis.
On the other hand, for those physicians with the level of
interest and empathy to want to build their capacity to help
those veterans in greater need, we present in this issue some
further specific information about PTSD.
One of the first points to recognize is that PTS (posttraumatic stress) and PTSD (post-traumatic stress disorder) are
related but distinct entities.

Post-Traumatic Stress (PTS): Trauma involves events

that pose significant threat (physical, emotional, psychological)
to the safety of the victim or loved ones/friends, and are
overwhelming and shocking. According to the National Defense
Center of Excellence (DCOE) for Psychological Health and
Traumatic Brain Injury, PTS is a common, normal, and often
adaptive response to experiencing a traumatic or stressful event.

26 CHESTER COUNT Y Medicine | WINTER 2018

Common occurrences, like auto accidents, physical altercations,
home fires, etc., can trigger PTS as well as can more unusual
events like military combat, assault or kidnapping. Almost
everyone who experiences a scary situation will show at least a
few signs of PTS.
National Center for PTSD data indicate that most Americans
(60% of men, 50% of women) experience trauma sometime
during their lives, and about 8 million adults here have PTSD in
any given year. PTSD is clearly common among the military and
veterans and varies with their deployment locations and combat
experiences: 15% of Vietnam War veterans, 12% of Gulf War
veterans, and between 11% and 20% of those in Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF).
PTS symptoms can appear as an exaggerated form of the
"fight or flight" reaction. They can be momentarily intense, but
usually subside a few days or weeks after the event and don't
cause any meaningful interference in the victim's life. Patients
experiencing PTS may notice their heart racing, shaky hands,
body sweats or clamminess, feelings of fear and nervousness,
bad dreams about the event, and avoidance of certain situations
remindful of the traumatic event.
PTS is not considered a mental disorder, but a heightened
physiological response, and treatment is generally not required
as the symptoms will likely improve or subside on their own
within a month. Still, patients should be advised to consult a
health care provider if they feel troubled by their symptoms; if
they are interfering with the patient's work, school, or personal
relationships; or if the patient is engaging in reckless behavior
(use of drugs or alcohol) to cope with their symptoms.
It is also true that some PTS patients might benefit from
psychological health care support to prevent their symptoms
from worsening, but PTS generally requires no medical
intervention unless the symptoms are severe or suggest crossover
to actual PTSD.
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