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Wrong Daniel Aaron?

Daniel Aaron

Orthopedic Surgeon

Rhode Island Hospital

HQ Phone:  (401) 444-4000

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Rhode Island Hospital

593 Eddy Street

Providence, Rhode Island, 02903

United States

Company Description

Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of the Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedic...more

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Web References(1 Total References)


http://ryortho.com/trauma.php?article=633_PTSD-Critical-in-Civilian-Orthopedics-Too

Dr. Daniel Aaron, an orthopedic surgeon with Rhode Island Hospital in Providence, is the lead author of this review article, which was recently published in the Journal of the American Academy of Orthopaedic Surgeons.
He states, "Posttraumatic Stress Disorder has been consistently noted in the literature as being a distinct entity, i.e., one that is a different behavioral phenotype that is separate from phobic anxiety or clinical depression. It involves three symptom clusters, the first being a reexperiencing of the traumatic event in the form of nightmares, flashbacks, and unwanted memories. The second cluster involves avoidance of things that remind the person of the trauma, as well as emotional numbing. With the third cluster we see hyper arousal that manifests itself in irritability, difficulty concentrating, insomnia, and an increased startle response." Orthopedists, naturally, are more accustomed to being attuned to physical complaints. But, says Dr. Aaron, it pays to adjust your tuning forks to the patient's inner pains as well. Dr. Aaron: "For example, let's take a patient with a femur fracture. Normally, you could expect a return to full functioning within about six months. If that person has PTSD, however, their entire recovery process could be extended by several months. But the bottom line is that at present there are no protocols for dealing with PTSD in those with musculoskeletal injuries...and we are only just beginning to explore the ramifications of this condition on orthopedic patients." Highlighting how the three symptom clusters might "show up" in the exam room, Dr. Aaron adds a bit of anecdotal information: Dr. Aaron says, Even genetics is involved, states Dr. Aaron. "One study we referenced was about people in the vicinity of the Twin Towers on 9/11...the researchers found specific genetic profiles that correlate with the risk of developing PTSD. Somewhere down the line we might be able to incorporate this information into risk stratification for this condition." Dr. Aaron, who says that there are likely many more psychological manifestations of change in patients' musculoskeletal functioning than we realize, notes, Discussing a possible point of intervention, Dr. Aaron says, "There is some evidence to show that individuals with Acute Stress Disorder (ASD) are more likely to develop PTSD." Dr. Aaron: "Socioeconomic factors come into play in that those patients with a reliable and caring support network tend to fare better. It's likely that those with more money have more flexibility in their schedules to take care of an ailing family member. This raises the question of whether we should enlist those in the patient's support system to be active participants in their care." Sounds complex and delicate...perhaps orthopedic care should be delayed until the PTSD is treated. An adamant Dr. Aaron says, "No. There is a very real interplay between the emotional and physical factors. If we can improve someone's physical health, then there is a good chance that they will start feeling better psychologically, and vice versa." "Overall," says Dr. Aaron, "we don't have a well devised strategy for preventing PTSD. So are Dr. Aaron's cohorts responding well to this study?


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