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Can science make diagnosing PTSD less of an ordeal?

March 30, 2017 at 6:35 PM EDT
Researchers around the country are trying to nail down a more specific diagnosis of PTSD through the use of an array of methods, from genetic testing to MRIs. In part two of our series War on the Brain, special correspondent Soledad O’Brien reports on the difficulties patients can face when physicians struggle to accurately identify their condition.
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JUDY WOODRUFF: Now: part two of our series War on the Brain.

Tonight, special correspondent Soledad O’Brien reports from North Carolina on the difficulty in diagnosing PTSD and how that complicates treatment.

SGT. 1ST CLASS MICHAEL RODRIGUEZ (RET.), U.S. Army: Sometimes, it’s fear. Sometimes, I’m scared of — of everything. Sometimes, I feel sad. Sometimes, I feel overwhelmed. The biggest trigger I have is myself.

I don’t like the way I smell. I frequently bathe, at least four or five times a day.

SOLEDAD O’BRIEN: After years of denial, Michael Rodriguez has finally found ways to deal with the symptoms of his post-traumatic stress disorder. He’s a retired special forces Green Beret. He forges steel to help him manage the often gruesome memories that flood his thoughts.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: It’s so physical, it requires a lot of force and heat and intensity. I’m facing and processing a lot of the stuff that I remember. The pain goes away. I’m forging myself.

SOLEDAD O’BRIEN: Why does that make you emotional?

SGT. 1ST CLASS MICHAEL RODRIGUEZ: Because I get passionate about it, because it means a lot to me.

SOLEDAD O’BRIEN: For four years, Michael misled doctors about his PTSD, fearing he would lose his job. He minimized his symptoms for this PTSD checklist used to diagnose all veterans, like question one: Are you bothered by repeated, disturbing and unwanted memories?

Question four: Were you bothered by feeling very upset when something reminded you of the stressful experience? There is no concrete diagnostic test that would have forced him to get treatment.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: If there was an actual test, like a hard copy test, as opposed to…

SOLEDAD O’BRIEN: So, like something tangible.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: Yes, because when you have that, you will remove the human element out of the diagnoses.

SOLEDAD O’BRIEN: Undiagnosed, but the damage was done. In 21 years of service in the Army, Michael was deployed nine times, from Operation Restore Hope in Somalia to Operation Enduring Freedom in Afghanistan.

During that lifetime of service, he was rattled by frequent small explosions, and, Michael guesses, at least a dozen very severe blasts.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: They were significant enough to where I had my bell rung. I could feel it through my whole body, felt numb, some memory issues, dizziness definitely, vomiting.

SOLEDAD O’BRIEN: In 2006, driving in a convoy on patrol in Afghanistan, the vehicle in front of him was hit by an IED.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: It threw the ATV I was on, four-wheeler, kind of pushed through it, and threw me. I couldn’t see out of my left eye. I had really the worst headache I have ever had in my life.

SOLEDAD O’BRIEN: The blast gave Michael permanent double vision. Today, he wears a tinted prosthetic lens in his left eye to correct it. He also suffered massive daily headaches, slurred speech and balance problems. He was left with emotional scars as well.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: The wheels were just coming off my wagon. I was falling apart. Anger issues. I was drinking a lot. I was trying to hide it. I would — I was very moody.

SOLEDAD O’BRIEN: He knew he had suffered multiple brain injuries, but believed he’d get better. Eventually, Michael’s commanders forced him to get help.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: And they were like, and you have severe post-traumatic stress. And I — I got upset.

SOLEDAD O’BRIEN: So why did PTS upset you?

SGT. 1ST CLASS MICHAEL RODRIGUEZ: At that time, I didn’t think I had it. Bought into the stigma.

But if there was a tangible test, I think it would make it easier on the patients, but — because it will validate it. You know, like if someone has leukemia, no one ever says, you don’t have leukemia.

SOLEDAD O’BRIEN: Right.

SGT. 1ST CLASS MICHAEL RODRIGUEZ: So, if there was some, say, type of biomarker or something like that, yes, then I think it would definitely help.

DR. SAM MCLEAN, University of North Carolina at Chapel Hill: Yes, we’re really living in the dark ages of post-traumatic stress diagnosis.

SOLEDAD O’BRIEN: Dr. Sam McLean is a doctor of emergency medicine and anesthesiology at the University of North Carolina at Chapel Hill.

He is one of a group of researchers around the country trying to nail down a more specific diagnosis of PTSD.

DR. SAM MCLEAN: We hope to advance the diagnosis of post-traumatic stress by assessing what’s going on in the brain, not simply a symptom checklist, getting at the actual biology that’s underlying those symptoms.

SOLEDAD O’BRIEN: Researchers at the University of North Carolina are decoding blood samples taken from recent trauma victims at civilian emergency rooms. They’re sequencing genetic material, RNA, DNA and other types of molecules, to identify biological markers for PTSD.

DR. SAM MCLEAN: The blood is such a valuable tool to use to better understand what’s going on with post-traumatic stress, because, after traumatic event, the brain communicates with the body via the blood.

SOLEDAD O’BRIEN: To find out how PTSD physically changes the brain, researchers at the Veterans Affairs Health Facility just outside of Boston are using MRIs to look at brain structure and volume, as well as connectivity, to see how different areas of the brain talk to each other.

DR. SAM MCLEAN: The goal that we need to get to is get to the point where there is a certain accurate molecular diagnosis that we can make. I’m hopeful that that is going to happen within our lifetime.

SOLEDAD O’BRIEN: Kelly Rodriguez is Michael’s wife. She’s a platoon sergeant with the 18th Airborne Corps at Fort Bragg in North Carolina. She too suffers from PTSD. She practically had to beg her doctors to get an accurate diagnosis.

How many deployments have you done in your 20-plus years?

SGT. 1ST CLASS KELLY RODRIGUEZ, U.S. Army: Five.

SOLEDAD O’BRIEN: What was your most traumatizing posting?

SGT. 1ST CLASS KELLY RODRIGUEZ: My last deployment.

SOLEDAD O’BRIEN: In Afghanistan.

SGT. 1ST CLASS KELLY RODRIGUEZ: In Afghanistan 2009 to 2010.

SOLEDAD O’BRIEN: Kelly served as a medic, treating casualties from one of the bloodiest attacks on U.S. troops in Afghanistan. Kelly and her team saw hundreds of trauma patients go through the operating room that year.

SGT. 1ST CLASS KELLY RODRIGUEZ: It’s not just engaging in combat. It’s seeing it. And when you have soldiers come in, and they’re literally holding their jaw because they just got hit in the face with a rocket, or an NCO came in, and he’s holding his arm.

SOLEDAD O’BRIEN: One patient hit her the hardest, a female soldier who volunteered for a convoy so she could see her husband before he shipped out.

SGT. 1ST CLASS KELLY RODRIGUEZ: The convoy was hit and — by an IED.

SOLEDAD O’BRIEN: By an IED?

SGT. 1ST CLASS KELLY RODRIGUEZ: she was alive when she got to us, but she died. And her husband was there. And I think the reason it was really hard is because, if Michael was downrange, I would have done the same thing. That could have been me.

SOLEDAD O’BRIEN: After returning home, Kelly suspected that she might have PTSD, but trying to get an accurate diagnosis was a difficult ordeal for her too.

SGT. 1ST CLASS KELLY RODRIGUEZ: It came down to screaming. Find out if it is PTS. Great. If it’s not, great. One way or the other, I need something, besides, you have got anxiety and you’re depressed.

Well, you know, so does half of America.

SOLEDAD O’BRIEN: It took more than two years before Kelly was finally diagnosed with PTSD.

SGT. 1ST CLASS KELLY RODRIGUEZ: You can’t treat it if you don’t put your hands on it, put a name on it. And that’s why, for me, it was frustrating trying to get any diagnosis.

SOLEDAD O’BRIEN: A shortfall they both hope science will someday resolve.

Will someone who is just entering the military 10 years from now have a completely different experience, do you think, than you both had?

SGT. 1ST CLASS MICHAEL RODRIGUEZ: I hope there is. That would be fantastic.

SGT. 1ST CLASS KELLY RODRIGUEZ: Because, at the end of the day, if there is something going on with them, they want to know what it is.

SOLEDAD O’BRIEN: For the PBS NewsHour, I’m Soledad O’Brien in Fayetteville, North Carolina.

JUDY WOODRUFF: Our series War on the Brain concludes Friday with a look at the efforts to find the true cause of PTSD.

PBS NEWSHOUR “WAR ON THE BRAIN” IS SUPPORTED BY Cohen Veterans Bioscience.

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