Page 76 - Journal of Special Operations Medicine - Winter 2015

suicidal thoughts, disinhibition, and mood alteration. The current treatments that are now available (or
Combining more than two psychoactive medications quickly becoming available) are slowly being accepted
(unless monitored very closely by a physician) can lead by the medical community. No single therapy will be
to unexpected side effects and behaviors. able to completely undo, reverse, or repair the damage
that has been done to the brain or mind. It will require
a combined approach to heal the damage.
What Can Be Done
The training a physician receives has a deep and long- Our experience as clinicians and medical researchers
lasting effect on how one makes diagnoses. Subtle biases has shown us treatments like hyperbaric oxygen therapy
may affect the diagnostic outcome. The diagnosis of (HBOT), eye movement desensitization and reprocess-
PTSD can be made with little hesitation and then the ing (EMDR), and low-intensity infrared light therapy
workup stops without having the possibility of TBI or (LILT) can have measurable improvements in TBI and
PCS investigated. The experience of one of the authors PTSD (Table 2). Yet, the combining of these therapies
(J.K.W.) involves several Servicemembers who received has not been applied as standard practice in military
blast injuries and were diagnosed with PTSD but re- medicine or become standard in civilian medicine. Mul-
ceived no diagnosis of TBI. Why? Because the diagnos- timodal approaches will likely yield greater benefits than
ing physician did not ask any further questions or do single, sequential applications of therapies. Multimodal
a full interview to discern the difference. The affected approaches will also shorten time to recovery, increase
Servicemembers clearly stated how their symptoms were resiliency, and help increase retention rates in the Special
related to the concussive event. In the rush to misdiag- Operations field.
nose PTSD, the TBI was overlooked and untreated.
Furthermore, the treatments for PTSD (pharmaceutical A combined and coordinated treatment approach using
interventions) made the PCS worse. physical rehabilitation, neurological rehabilitation, psy-
chological and drug and alcohol counseling, vocational
At this point, you are probably asking yourself “Ok, training, HBOT, EMDR, infrared therapy, and other
ok, ok . . . so now what!? What do I have!? All you noninvasive techniques should provide greater-than-
are telling me is that I am probably misdiagnosed and/ expected results, as will nutritional support during and
or mistreated [in the medical sense].” All true, but the after therapies. In our opinion, the fear and assumption
important difference is that you now know you are po- that neurological injuries are not recoverable and PTSD
tentially misdiagnosed and can seek help or a second is a lifelong condition are mostly due to unwillingness
opinion from a physician with experience in this area. by practitioners (and insurers) to apply novel therapies
Treatment plans and therapies exist that can help treat in a concerted manner or break away from conventional
PTSD and TBI effectively. You are not crazy, lazy, or let- thought. TBI and PTSD can be treated and recovery is
ting anyone down. An injured brain betrays the body in possible.
much the same way that a shattered femur stops a per-
son from walking or running: you are not functioning Another aspect of recovery from a TBI or PTSD (any in-
at 100% and cannot function at 100%. PTSD and TBI jury, really) is the need to incorporate a nutritional plan
are mental and physical injuries that can be treated once that promotes mental alertness, supports healing, and
you know how to identify the problem. helps reduce inflammation in the body. When deployed

Table 2 Therapies With Evidence for Treating PTSD, TBI, or Both
Used for Used for
Treatment PTSD TBI/PCS Comments
Drugs Yes No Do not help with brain healing. May control some symptoms of PTSD.
Usually ineffective for TBI/PCS or make symptoms worse.
Acupuncture Yes – No large controlled studies. Limited case reports show some efficacy.
EMDR Yes No Accepted by the VA and DoD medicine. Helpful for PTSD. Untested for
TBI/PCS, but not expected to help.
Low-intensity infrared No Yes In very early stages. No stage I trials yet
light therapy
HBOT Yes Yes Impressive track record of improvement in TBI/PCS. Early evidence
shows that PTSD may improve where there is concomitant TBI/PCS.
Yoga Yes No No enough evidence to claim efficacy
DoD, Department of Defense; EMDR, eye movement densensitization and reprocessing; HBOT, hyperbaric oxygen therapy; PCS, postconcussion
syndrome; PTSD, posttraumatic stress disorder; TBI, traumatic brain injury; VA, Veterans Affairs.

64 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015