Dr. Charles Youngblood served in Iraq when treating post-traumatic stress disorder meant giving a Marine a day or two off before he returned to the fight.
Now Youngblood is Creighton University Medical Center's point man on a national plan meant to ensure that veterans living with PTSD are properly diagnosed and treated in ways that would have been unimaginable in Iraq at that war's outset.
Omaha's two medical schools have signed on to the Joining Forces initiative, which was co-founded by first lady Michelle Obama.
The idea: Get the nation's top medical schools thinking about the best ways to train doctors to detect and treat PTSD, as well as traumatic brain injuries, often caused by roadside bomb blasts.
Then get those medical schools — more than 100 have signed on — to agree to share information, making it more likely that a struggling veteran in Omaha could get a new kind of medication or therapy that's proving effective in Orlando.
Even the initiative's supporters say Joining Forces is somewhat symbolic — after all, there's no new funding set to flow to Creighton University Medical Center or the University of Nebraska Medical Center to study PTSD or combat-related brain injuries.
But the symbolism does matter, say administrators from both schools.
After a decade of war, most of the country's medical schools are pledging to better help veterans living with PTSD. Research suggests that up to 18 percent of troops who deployed to Iraq or Afghanistan might have post-traumatic stress disorder when they return home, according to the Department of Veterans Affairs.
"These are folks who did what the country asked of them, and now we have to take care of them," said Youngblood, a Creighton anesthesiologist and assistant professor. "One of the best ways to do that is get the medical community involved."
Both UNMC and Creighton have extensively studied PTSD and traumatic brain injuries for years, administrators said.
UNMC researchers have striven to understand "the basic mechanics" of a traumatic brain injury, said Dr. Bradley Britigan, dean of the College of Medicine, who attended the Joining Forces conference this week in Richmond, Va., hosted by Michelle Obama.
The number of such injuries has skyrocketed along with the prevalence of roadside bomb blasts in Iraq and Afghanistan. Some 320,000 service members are believed to have suffered at least one mild concussion during the wars, according to congressional reports.
Veterans suffering from severe traumatic brain injuries often suffer personality changes, memory loss and mood swings. Many also have PTSD, creating a combustible mix of medical and psychological problems tough to diagnose and tougher to treat.
One UNMC researcher is studying animals with brain injuries, while another is trying to develop treatments using antioxidants, Britigan said. And the med center's telemedicine efforts should allow doctors to better deliver education and treatment to veterans living in rural Nebraska, he said.
"Not everybody in medical school is going to be a psychiatrist or a neurologist," Britigan said. "But regardless, they are going to be encountering veterans who are suffering from PTSD or related problems. That idea needs to be part of our curriculum within medical school."
Much of Creighton's focus has been on understanding and treating PTSD, said Dr. Rowen Zetterman, dean of the School of Medicine. Before taking that post in 2009, Zetterman was a longtime VA doctor and administrator.
Students study sleep deprivation and alcohol abuse, both often associated with PTSD, and also examine the various coping methods that veterans with PTSD tend to use.
In one second-year course, a professor regularly brings in a soldier to speak and answer questions about PTSD.
Creighton also is working closely with the VA Medical Center, Zetterman said. Creighton psychiatrists and psychologists provide services there, and students often do a rotation there.
"They will always remember someone they saw rather than something they read in a book," Zetterman said.
Youngblood has seen the difficulty of PTSD — and the military's improvement at diagnosis and treatment — up close.
He recalls being a Navy doctor in Iraq in 2004 and watching a Marine walk away, seemingly unscathed, after a roadside bomb exploded under his Humvee.
But in the days following the blast, the Marine could barely force himself to leave his room. When he did walk outside, he reported having trouble breathing.
The Marine said he had asthma. Youngblood figured it was anxiety.
Youngblood and other military doctors had little understanding then of PTSD, he said. They had virtually no training on how to treat the oft-misunderstood, oft-misdiagnosed disorder.
"It was 'Just rest a couple days and go back out there,'" Youngblood said.
By contrast, during his second deployment, to Afghanistan in 2010, he and other medical professionals followed clearly outlined rules about how to treat concussions as well as soldiers who showed symptoms of PTSD.
"It was so much different," Youngblood said. "They essentially treated it as they would any other wound."
Local medical school leaders hope Joining Forces pushes the understanding and treatment of PTSD and traumatic brain injuries to yet another level.
"This needs to be brought to the forefront everywhere," Britigan said. "The sheer size and scope of the problem. The subtleties of PTSD and traumatic brain injuries. . Our consciousness needs to continue to be raised."
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