post traumatic stress disorder

Hi Guys,
On my recent clinic I came across a fellow who was a former SAS member. I’m not sure if you guys are aware but these guys are the most highly trained soldiers in the world and take on the most isolated and dangerous work. This fellow was a Vietnam Vet and was now 65. Prior to meeting this fellow I had a discussion with some staff about him and they let me know of the situation. He had many psychological and emotional issues including the condition post traumatic stress disorder. He was on multiple meds and had a lot of surgery including lapband surgery and bilateral knee replacements. He had been attending the clinic for years for a variety of things. I was told he didn’t like strangers, didn’t like people getting too close to his personal space and didn’t like to be surrounded by lots of people. For these reasons it was sometimes hard to get him proper rehab because the gym and pool usually had a number of people using it at the same time. I began very cautiously with this patient and got advice of one of the more experienced physios, he thought it best that I stay clear of a lot of the hands on treatment as he thought much of the pain was of psychological origin. The poor fellows wife had just been diagnosed with breast cancer and after assessment it was a general consensus of the physios in the clinic that it was a cry for help as there wasn’t too many physical signs suggesting a mechanical origin of this pain and subjective nature of this pain was very random and a pattern could not be identified.
It was made clear to me by the owners that this fellow was a patient who should be given “special” treatment ie was a long term patient who was to be treated very gently. After a few private sessions which I viewed as more placebo/patient pleasing treatments than anything else involving some EPA, hot packs some gentle mobs and education, the patients condition improved. During these private sessions with the patient I worked hard on talking to this fellow, getting a feel for him character and really just trying to gain his trust and a mutually respectful relationship and slowly dropping subtle hints on were we needed to go with treatment. This was because after a few sessions it became clear to me that the this guy really needed to begin on a rehab program including gym and hydrotherapy asap, due to all these co-morbidities he had become very de-conditioned and was really in need of some general strengthening and endurance exercises. The reason I had to be so subtle and gentle with this idea of this sort of treatment was 1st the patient really wanted to be treated with EPA etc and secondly he was not very keen on been in the gym/pool with other patients around him or even a PT for that matter. Anyways after about a week and a half he actually said to me that he’s happy to go into the gym and pool and he also didn’t mind me been there. Getting him to do what I wanted is another story but I eventually succeeded with that via gentle education and compromise haha. He told me some amazing stories regarding SAS training and war, which I found very intriguing.
The main point I want to highlight with this blog is the importance of building a good patient/professional relationship even as in the case at the cost of “real” treatment. Because in the long run the gym and hydro sessions were going to help him far more than anything else and to get him in there I really needed to “trick” him into it. I have never really dealt with a patient of this sort previously and it made me very aware of the posttraumatic stress stuff. I feel much more prepared to treat this sort of patient in the future. I think the keys to this sort of patient is; patience, compromise and gentle confrontation of negative thought processes.
Yay last blog!
Thanks guys.