Caring for veterans: 3 DOs who’ve served share expertise

For U.S. Navy Lt. Jacob Duong, DO, caring for military personnel is a means of putting the holistic philosophy of osteopathic medicine into action. “If any group really needs osteopathic care—not just manipulation, but whole-person care—it’s our military and veterans,” says Dr. Duong, who is stationed in Fort Worth, Texas. Here’s how three osteopathic physicians who’ve served in the military recommend addressing these patients’ unique health needs.

Starting the conversation

Physicians should be sure to ask new patients whether they’ve served in the military, notes William Bograkos, DO, a retired U.S. Army colonel. For patients who are veterans, ask in what branch of the military they served and whether they were deployed.

“Don’t jump right into the question of whether the person has been in combat,” Dr. Bograkos advises. “Asking someone about their military experience is like peeling an onion—there are a lot of layers and there might be some tears, so you have to proceed gently.” Routine inquiries about sleep, pain and substance use can guide the conversation, he says. For instance, if a patient indicates she has trouble sleeping, the physician could ask whether she’s troubled by dreams, nightmares or intrusive thoughts.

Location-related health risks

Knowing where a veteran was deployed can alert physicians to health problems that aren’t typically seen in the U.S., such as malaria or leishmaniasis, a skin disease carried by sand flies. Both have affected veterans who served in Iraq and Afghanistan. U. S. Navy Lt. Cmdr. Jaime Longobardi, DO, who’s stationed in Fort Meade, Virginia, says veterans who served in those countries could also exhibit signs of pulmonary disease if they were exposed to burn pits where military waste was incinerated.

Musculoskeletal pain

When Dr. Longobardi was stationed at a Marine base in southern Afghanistan in 2012, she ran a clinic providing osteopathic manipulative treatment (OMT) for troops. She frequently treated pilots for low back pain and infantry troops for somatic dysfunction from wearing heavy protective equipment, helmets and gear.

Over time, the physical demands of military service can take a toll, Dr. Longobardi says. “If I have a 45-year-old patient who just retired from the military, I treat his knees and back as if they’re 65 years old,” she explains. “From a musculoskeletal perspective, active-duty military personnel have more in common with professional athletes than with the general population.”

Mental health

Up to 18% of veterans who served in Iraq and Afghanistan have posttraumatic stress disorder, and up to one-quarter are estimated to have depression, according to the U.S. Department of Veterans Affairs. Nearly half of the Iraq and Afghanistan veterans who sought treatment at the VA between 2002 and 2009 were diagnosed with a mental health disorder.

“As physicians, we have to remember that military personnel and veterans who’ve seen combat have been placed in situations most Americans have never experienced,” says Dr. Longobardi. Physicians should be aware that these patients’ experiences mean they may respond differently to mental health screening questions than civilian patients, she notes. For example, a veteran who responds “yes” to the question “Do you think about killing people?” could be remembering experiences he had in combat, rather than displaying signs of homicidal ideation.

Returning home after a deployment brings its own stresses, Dr. Bograkos notes, such as readjusting to family roles that have shifted while the service member was away. He recommends physicians ask returning service members how the transition is going and what they’re doing to cope with stress, emphasizing the use of positive coping skills, such as exercise, over negative ones such as using alcohol or drugs.