The Doctor is Deployed - LLM Publications

Diagnosing TBIin a PTS WorldBy TriWest Healthcare AllianceDiagnosing traumatic brain injuries can be complex, especially when somesymptoms overlap with those of posttraumatic stress.Russell Jenna, MD, a medical director at TriWest Healthcare Alliance, notesthat taking a thorough history of the patient could mean the differencebetween a proper TBI diagnosis and a misdiagnosis.“If a patient is complaining about feelings of agitation and isolation, butalso mentions headaches, you could ask: ’Since you mentioned you served,did you suffer any injuries while deployed, or were you near an explosion?’”Jenna said.“You can’t necessarily put a stamp on TBI, but if you ask the right questions,the answers may be very good indicators that the patient may be sufferingfrom TBI, as opposed to PTS.”Connection between TBI and PTSThe Defense Centers of Excellence outlined the similarities and differencesbetween PTS and TBI. According to the DCoE website, overlappingsymptoms of the two include:• Insomnia, fatigue• Irritability, anger• Problems thinking and remembering• Mood swings, personality changes• Hypersensitivity to noise• Withdrawal from social and family activitiesHowever reports from the Center indicated that a TBI patient will alsoexhibit headaches, dizziness and vertigo, reduced alcoholtolerance and sensitivity to light.In a study published Jan. 31, 2008 in the New England Journal ofMedicine, Dr. Charles W. Hoge, concluded PTS is strongly associatedwith mild TBI. In fact, about 44 percent of study participant soldiers whoreported loss of consciousness from their injury also met the criteria for PTS.Dr. Blake Chaffee, vice-president of Integrated Health Services at TriWest,emphasizes that often, a patient may have both.TriWest TBI ProgramTriWest has a TBI Program specifically to help active duty TBI patientsand their families. After diagnosing a patient with a TBI, a referral tothis program in addition to the provider’s recommended treatment maygreatly help the patient and their family. Anyone may refer a TBI patientto TriWest’s program by completing the TBI Program Referral Form. A factsheet about the program is also available. For more information, visithttp://tinyurl.com/TriWest-TBI.Resources, Continuing EducationTwo PTS continuing education opportunities are also available:• University of North Texas Posttraumatic Stress DisorderSeminar—A free online course (two CEU credits) in cooperationwith the University of North Texas (UNT) Health Science Center at FortWorth. It is offered for providers to better help TRICARE beneficiariesdeal with post-deployment behavioral health issues. For moreinformation, visit http://tinyurl.com/UNT-PTSD• PTS 101—A web-based PTS/trauma-related curriculum presentedby the U.S. Department of Veterans Affairs. It is available on-demandfor professionals who provide services to individuals who haveexperienced trauma. CE Credits are now available free of charge. Visitwww.ptsd.va.gov and click on the ‘Providers and Researchers’ linkContact the TriWest TBI team at (866) 209-0390 orTBIsupport@triwest.com.Spring 2010 • 17