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VA CLINIC HEALS THE INVISIBLE WOUNDS, TOO --

Holistic approach focuses on the entire person.

 

 

Story here... http://seattlepi.nwsource.com/local/297934_vahosp01.html

Story below:

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VA clinic heals the invisible wounds, too

Holistic approach focuses on the entire person

By CAROL SMITH
P-I REPORTER

The grim milestone of 3,000 dead is a reminder that the toll of fighting in Iraq and Afghanistan has now exceeded the lives lost during 9/11.

Hidden under that bleak statistic is an even larger one -- the numbers of lives changed in profound and unexpected ways since the advent of the war.

The VA Puget Sound Health Care System, which is a designated Level II polytrauma center for war veterans, has begun offering new and expanded services to take care of those service members who return to this region with wounds visible and invisible.

About 40 patients are under care by the polytrauma team, which includes specialists in brain damage, spinal cord injuries, limb loss, blindness and rehab, said Jay Uomoto, director of the Polytrauma Program at the VA. The VA treats returning vets from Washington, Alaska, Oregon and Idaho at its Beacon Hill hospital.

A far greater number are seen in the VA's Deployment Health Clinic and the affiliated Post Traumatic Stress Disorder program.

The Deployment Health Clinic provides primary care for those returning from conflict and gives them a way into the system to get other, more specialized, services ranging from vocational counseling to help with substance abuse.

Since the U.S. began sending troops to Afghanistan and Iraq, the VA Puget Sound has treated about 3,000 patients, about one-third of whom have dealt with mental health issues, said Miles McFall, director of the VA's PTSD program, who works in conjunction with the polytrauma clinic and the VA's deployment-health specialists.

"Going off to war can change your life in a very profound, physical and emotional way," said Dr. Stephen Hunt, director of the deployment clinic.

Some have difficulty returning to work, or have lost jobs, marriages or housing in their absence. The Deployment Clinic, which started as a Gulf War treatment center, has expanded to accommodate the needs of Iraq vets.

Vets from the most recent war make up 4 percent to 5 percent of the total population served by the VA, but those serving the latest returning war veterans learned from treating previous generations of returning vets what worked and didn't work.

Thirty-some years ago, when vets came back from the Vietnam War, for example, there was no coordinated or well-understood treatment for PTSD. There were no specialized rehab programs.

"We learned from our mistakes," McFall said.

"We owe a great debt to the Vietnam vets. They taught us a lot about PTSD and how to take care of them."

Still, the stigma of PTSD that lingers from other wars makes some veterans of Iraq and Afghanistan reluctant to seek psychiatric care. The Deployment Health Clinic is set up specifically to provide mental health counseling in a less threatening, primary care type setting, Hunt said.

Instead of asking veterans whether they have PTSD, doctors now take a more holistic approach. They look for all the ways the war experience might be affecting a new patient. Some have sleep or concentration problems. Some have problems driving after months of evading or encountering roadside bombs. Some are uncomfortable in crowds, or no longer enjoy former activities such as going to baseball games because they are anxious in crowds. Nightmares, feelings of guilt or substance-abuse problems are all common.

"This is really a clinic based on the notion it's going to affect everyone one way or another," Hunt said.

Vets might not want to seek mental health assistance right away, but they can relate to the idea that their lives are not going to be the same. That gives doctors an entry point to identify constructive ways to help -- whether it's recommending family counseling, housing assistance, group support or individual therapy.

"We're trying to get the word out that everyone coming back deserves" good care, Hunt said.

Those whose wounds are more physical in nature also face a tough road back.

The polytrauma system of care is still evolving in response to a fast-moving target -- the new war wounded, Uomoto said.

In past wars, about 20 percent of vets faced combat situations. In the current war, combat stress is more pervasive and extends to people outside the war zone, such as truck drivers.

Another unique aspect of treating Iraq/Afghanistan vets is that many have suffered repeated concussive brain injuries from being in or near explosions.

"We are seeing a silent epidemic of closed head injuries," Uomoto said. "The damage is in the brain, but you don't see it." That damage could manifest as severe memory loss, attention/concentration problems or difficulty processing information quickly.

Such injuries can exacerbate PTSD symptoms and vice versa, McFall said.

PTSD is part physiological and part psychological, McFall said. Many returning vets have heightened adrenalin responses, for example, because the systems that regulate their stress hormone levels have been disrupted.

The message the VA team wants to get out, though, is that stress disorders, including PTSD, are highly treatable.

"People who get care make progress," McFall said.

Many gatekeepers in the community can help facilitate veterans getting that care, he added. Other primary-care doctors, clergy, teachers, even hairstylists might be the first to notice symptoms, he said. People can help by being understanding and helping direct veterans to places they can get help.

Some PTSD resolves on its own, particularly if the vet has good family and community support. In some cases, though, there is an incubation period, and symptoms don't emerge in the first phase of re-entry to civilian life when the vet is busy with family and work.

Often they don't have time to process what's happened to them, Hunt said.

"A year or two later, they come to us and say, 'I guess I do have a problem.' "

Because of that, the VA has made primary care treatment for returning vets a priority for their first two years.

"We're really trying to look at it proactively," Hunt said. "We want them to get checked out."

MORE INFORMATION

For more information, contact the VA Puget Sound Deployment Health clinic, 206-764-2636, or www.pdhealth.mil.

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.

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Larry Scott

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