“JP brings me peace,” says Bill Austin, a retired warrior whose memories have tended to be less than peaceful.

After three decades of serving as a medic and/or a radio operator in places like Bosnia, Kosovo, Iraq and Afghanistan (twice), this retired master sergeant remembers things like loading a guy who’d been blown up twice in five minutes onto a stretcher and not recognizing one of his best friends until the body on the stretcher suddenly said, “Hey mate.”

“And I said, ‘Mark, is that you?’ Later that day I went back to see him, and the bed was empty; I was afraid he’d died,” says Austin. “Later, I found out they medivacced him out, but I remember going back to see a lot of other guys that I’d helped, only to be told they died of their wounds.”

After retiring from the National Guard with a 100 percent diagnosis of post-traumatic stress disorder (PTSD), Austin found it hard to turn off the mindset that had kept him alive as he dealt with the carnage from the killing fields: the burns, broken bodies, shattered limbs and multiple amputations that regularly confront medics.

“He’s hyper-vigilant,” says his wife, Janet Austin. “He has to sit with his back to the wall, and he doesn’t like to be in crowded spaces. If someone comes up behind him, he turns in a protective posture to see what you’re up to.”

But peace came in the form of a 2-year-old Great Dane named JP, a 150-pound service dog with a harness that says “PTSD – not all disabilities are visible.”

JP pulls Austin out of their house near the Mission Mountains of Montana for regular walks, and people generally stop to talk about the unusual-looking dog.  “He’s a natural ice-breaker,” Janet says. “When someone’s coming toward Bill, he steps between them to provide a safety zone. And when someone’s coming up behind him, he provides advanced warning that someone’s there.”

JP even knows when Austin is having nightmares, says Janet, and he’ll wake Austin out of a troubled sleep by licking his face.

“I’ve had a lot of road rage because there’s too much stimulus and my brain can’t handle it fast enough. It’s sensory overload. But now when I drive, JP puts his head in my lap and I pet him and I hear his gentle breathing and it’s very peaceful,” says Austin.

JP was provided by a breeder in North Carolina, and the Austins trained him themselves as a service dog. They estimate they’ve spent close to $5,000 on him over the first two years. CHAPS (Canines Helping Autism and PTSD Survivors) estimates that a 75-pound service dog will cost at least $4,000 for the first year and more than $2,000 a year thereafter.

Many civic organizations recognize the importance of dogs in stabilizing vets’ mental health. Companions 4 Heroes (C4H) has provided vets with about 150 shelters dogs that would otherwise have been euthanized, says its executive director, Lynne Gartenhaus. “The care and nurturing of an animal brings a veteran to a different place,” she adds. “The animal gives the vet something to think about other than what’s always going through his head.”

But C4H doesn’t train many service dogs. That training can be expensive and difficult, both for the dog and for the vet. “You’re dealing with two very fragile and vulnerable entities,” says Gartenhaus. “It’s really complicated, both for the dog and for the veteran.”

The VA doesn’t provide service dogs either, although it will pay for veterinary care and equipment for some service dogs owned by vets who are blind or who can’t walk. A VA regulation printed last September in the Federal Register does not provide for service dogs to vets suffering from PTSD.

“VA does not cover psychiatric service dogs,” says Janet. “They’ve done studies, but there’s not enough evidence to justify it. They’ll cover seeing-eye dogs and mobility dogs, but not psychiatric service dogs.”

To Janet, however, that evidence was clear on the second day that JP bounded into their lives.  “Janet said, ‘Don’t you get it? This is the first time in two years that you’ve smiled and laughed,’ ” Austin says.

“JP was still a puppy then, and I said, ‘He brings me peace.’ ”

Shortly after the Pentagon announced that more soldiers took their own lives last year than were killed in combat, the Veterans Administration also announced that suicide rates for military veterans are hitting record levels.

Last week, the VA announced its estimate that 22 vets a day are killing themselves, up from 18 vets a day just a couple of years before.

The good news – and the bad news – is in that word “estimate.”

The VA began focusing on suicide prevention in 2007, but only at its own hospitals and clinics. Then in 2010, VA Secretary Eric Shinseki reached out to the governors of all 50 states to request suicide data from their health departments on vets who might have been outside the VA healthcare system.

Using that data brought the suicide estimates up from 18 a day in 2007 to 22 per day in 2010. So the rise in suicides is understandable, to a point; the VA has expanded its data base.

But the bad news remains because it’s still an estimate. That figure comes with only 21 states reporting.  And it doesn’t yet include data from states like California and Texas, states which have large numbers of vets living around huge military installations.

So you can expect higher … but more realistic …suicide statistics from the VA as it continues to receive data from the remaining state health departments.

But one aspect of this incomplete data is already proving out what I’ve suspected for years: that Vietnam vets are a big part of the picture. The VA said that vets who killed themselves tended to be older than non-vets. More than 69 percent of the deceased vets were 50 years or older, while only 37 percent of the non-vets were that old. Of the 60 year olds, only 8.1 percent were civilians, but 16.5 percent were vets and 19.6 percent participated in the VA system. Of the 70 year olds, only 4.6 percent were civilians, but 18.6 percent were vets and 20 percent participated in the VA system.

According to the Census Bureau in 2010, there were 7.6 million Vietnam-era (1964-1975) veterans, or about 35 percent of all living veterans. In addition, 4.5 million served during the Gulf War (representing service from Aug. 2, 1990, to present); 2.3 million in World War II (1941-1945); 2.7 million in the Korean War (1950-1953); and 5.6 million in peacetime only.

And that would make sense that the ‘Nam vets are providing this surge because these were the kids who came home before psychiatrists had invented the term post-traumatic stress disorder and before there was counseling available. They learned to live with their pain, their disabilities, their nightmares and their flashbacks. Thank God we’re making some progress, even though there’s a long way to go.

I’ll keep you posted as the VA guesstimates become more and more based on reality.

For years, I’ve argued that PTSD is really two very different disorders, improperly lumped together as one by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM).

The first, of course, is the fear of being killed which manifests itself in hypervigilance, vivid nightmares and flashbacks. It’s about what others have tried to do to you.

But the second, which I’ve come to call the Wounded Soul Syndrome, is based in the guilt of what you have done to others. It’s about violating your own moral code, about trying to reconcile your actions to your beliefs.

I saw a classic example of the Wounded Soul Syndrome recently in a guest column published in the Washington Post. Authored by retired Marine Capt. Timothy Kudo, it said that military suicides reflect the moral conflicts of war.

“I held two seemingly contradictory beliefs: Killing is always wrong, but in war, it is necessary. How could something be both immoral and necessary? I didn’t have time to resolve this question before deploying,” wrote Kudo, who had deployed to Iraq in 2009 and to Afghanistan in 2010-11. “And in the first few months, I fell right into killing without thinking twice. We were simply too busy to worry about the morality of what we were doing. But one day on patrol in Afghanistan in 2010, my patrol got into a firefight and ended up killing two people on a motorcycle we thought were about to attack us. They ignored or didn’t understand our warnings to stop, and according to the military’s ‘escalation of force’ guidelines, we were authorized to shoot them in self-defense. Although we thought they were armed, they turned out to be civilians. One looked no older than 16.”

Kudo, who’s now a graduate student at New York University, says he thinks about killing those people on the motorcycle every day. He also remembers the first time a Marine several miles away asked him over the radio whether his unit could kill someone burying a bomb. The decision fell on him alone, and he said yes.

“Many veterans are unable to reconcile such actions in war with the biblical commandment ‘Thou shalt not kill.’ When they come home from an environment where killing is not only accepted but is a metric of success, the transition to one where killing is wrong can be incomprehensible,” Kudo wrote. “This incongruity can have devastating effects. After more than 10 years of war, the military lost more active-duty members last year to suicide than to enemy fire. More worrisome, the Department of Veterans Affairs estimates that one in five Americans who commit suicide is a veteran, despite the fact that veterans make up just 13 percent of the population.

“While I don’t know why individual veterans resort to suicide, I can say that the ethical damage of war may be worse than the physical injuries we sustain. To properly wage war, you have to recalibrate your moral compass. Once you return from the battlefield, it is difficult or impossible to repair it.”

Kudo says he didn’t return from Afghanistan as the same person – “I’m no longer the ‘good’ person I once thought I was.” He says he wrestles with justifying his actions, but that he’s beginning to believe that killing, even in war, is wrong.

I have to salute Kudo’s courage and honesty in writing this Op-Ed piece. It should make us all reconsider what we’re asking our young men and young women to do in combat.

There’s a glimmer of hope now for soldiers who worry that they may be suffering long-term effects of battlefield concussions.

Previously, the only way to know if concussions were progressing into degenerative brain diseases like Alzheimer’s or Parkinson’s was to autopsy the brain of a dead soldier or athlete. So that wasn’t much good for the living victim.

But researchers at UCLA used PET (positron emission tomography) scans on five retired NFL players, all 45 years or older and suffering from mood swings, depression, or difficulty in thinking and remembering – all potentially early signs of CTE (chronic traumatic encephalopathy).

All of the players’ scans showed signs of tau protein deposits, which is consistent with the autopsied brains of other pro football players and combat vets suffering from CTE.

Tau is a protein that occurs naturally in brain cells, but it’s the bunches or tangles that are abnormal. Normally tau links together to bring nutrition to brain cells, and that long supply line also helps hold up cell walls. When tau proteins clump up, the supply of nutrition is interrupted, and the cell walls may collapse, letting in external salts and/or calcium.

So researchers may be able to use brain scans to tell living athletes and combat vets whether they are beginning to develop CTE.

There are a couple of caveats, however, which is why I said a “glimmer of hope.”

First, five players is a sample size so small that it’s easily subject to error; we need a much larger sample, and then we need to be able to replicate it. Second, we don’t know yet whether the players actually are suffering from CTE so the tangled tau proteins can’t prove anything yet. And third, if this is an early indicator of degenerative brain diseases, we still don’t know how it progressives or how we can stop that progression.

However, several studies at Boston University and the Boston VA Heathcare System have demonstrated that brain injuries, and particularly repeated brain injuries, can progress into CTE. So all we can do is watch – and hope – as researchers attempt to understand how a brain injury progresses into the massive death of brain cells.

As I said, it’s a glimmer of hope. But it’s still more than we had before.

The skyrocketing number of military suicides is perplexing. Why did more American soldiers take their own lives last year (349) than were killed in combat (310)?

The first conclusion is that the suicides don’t appear to be related to combat stress. Most of the suicide victims had never been deployed. Only about 47 percent had served in Iraq/Afghanistan, 15 percent had direct combat experience, and only 8 percent had a history of multiple deployments.

It’s true that just the possibility of being deployed overseas adds additional stress, but that should be less of a problem last year with the prospects of massive deployments apparently behind us.

Instead, it appears that personal issues were a greater problem.

The 2011 DoD Suicide Event Report found that death rates for divorced service members were 55 percent higher than for married service members. It said that 47 percent of the decedents had a history of a failed marriage or intimate relationship, with more than half of them experiencing breakups within a month before their deaths.

Legal problems were also common. More than 18 percent were facing Article 15 judicial proceedings, and another 13 percent faced civil legal problems. More than 21 percent had lost their jobs or been demoted.

A couple of years ago, Gen. Peter Chiarelli, the Army’s vice of staff at the time, blamed the mounting suicides on loosened retention standards that had allowed 47,000 personnel to remain in the Army despite histories of substance abuse, misdemeanor crimes, or misconduct.   He noted that loosened recruitment standards also were allowing people “coming in the Army to start all over again, and we see this high rate of suicide.”

Since 2009, the Pentagon has been pursuing an anti-suicide initiative that stresses the importance of counseling and attempts to reduce the stigma of a soldier reaching out for help. Among other things, it has increased behavioral health care providers by 35 percent over past three years, increased the number in a primary care setting, and embedded more counselors in front-line units. But clearly, that’s not enough.

One new tool is contained in the National Defense Authorization Act of 2013, which President Obama recently signed. It authorizes military commanders to ask at-risk soldiers about the firearms that they privately own and to recommend that they get those weapons out of the house until their mood stabilizes.

The act also requires the Secretary of Defense to develop a comprehensive suicide prevention program for the entire military rather than a hodgepodge of individual service programs.

Those are undoubtedly valuable initiatives, but I think back to the recommendations that came out of the Montana National Guard following the suicide of one of its members six years ago, and I think some of them could be adopted nationally. They certainly served Montana well.

One of the key steps taken there was setting up a crisis response team – typically a senior commissioned office, a senior NCO, a personnel officer and a chaplain – which was poised to check out any concerns about an individual’s mental or emotional health. If needed, the team could immediately refer a troubled soldier to counseling.

A second key step was creating a system of embedded counselors, who were present during the weekend drills. Soldiers could make appointments to see them, but the counselors also mingled with the soldiers, observing those who appeared to be struggling and talking with troops about how fellow soldiers were faring.

Both were highly effective. For those who want more information, I wrote about “the Montana model” in my book, “Faces of Combat: PTSD & TBI.” Check out: http://facesofcombat.us/

Many also worry that soldiers aren’t getting the help that they need because they’re afraid they’ll be flagged for visiting military counselors. Despite the official policy, there remains a stigma among soldiers who believe their mission is to provide help, not seek it. Some suggest the Pentagon ought to reimburse soldiers for seeing private, civilian counselors. Certainly, it’s worth a try.

Finally, there’s a special Military Crisis number: 1-800-273-8255. Please pass it along to anyone you think might need it.

More American soldiers took their own lives in 2012 than were killed in combat, according to new statistics just released by the Department of Defense.

It said that 482 service members killed themselves last year. By comparison, there were only 310 combat-related deaths, which is 64 percent of the suicide rate.

Again by comparison, there were 301 active-duty suicides in 2011, 205 in 2010, and 309 in 2009 – the year the DoD launched its anti-suicide initiative – and 268 in 2008.

The numbers are shocking … but also deeply puzzling. They suggest that personal factors are more important than combat-related deployments; that the vast majority of suicides occur at home, not on a battlefield; and that the majority of deaths are among Army and Marine Corps personnel, not among the National or the Reservists.

The 2012 DoD Suicide Event Report isn’t available yet, but the 2011 report gives these statistics:

A whopping 89 percent of the deaths were regular service members. Only 7 percent were National Guard personnel and 4 percent were Reservists.

Only 10 percent of the suicides occurred during deployment. The DoD report said that 45 percent of the decedents lived in homes or apartments near their bases, while 26 percent lived on base.

Most of the suicide victims had never been deployed. Only about 47 percent had served in Iraq/Afghanistan, 15 percent had direct combat experience, and only 8 percent had a history of multiple deployments.

That’s a shock because most people link combat and suicide. “That is the storyline that we have created in our society because it’s a simple storyline and it intuitively makes sense,” Craig Bryan, associate director of the National Center of Veterans’ Studies at the University of Utah, told PRI’s The World. “The problem is that the data doesn’t support the notion that it is as simple as combat leads directly to suicide risk.”

Instead, Bryan believes the culprit is increased stress. “Life in the military these days is stressful, whether you’re in a combat zone or not,” says Bryan, who has nearly completed a three-year study of military suicide. “We’re increasingly asking our military personnel to do more with less.… And even when you’re here in the United States, even if you’re not in a combat zone, things aren’t necessarily easy.”

Even more stressful would be a pending deployment.

Some have raised questions about the prevalence of pharmaceuticals among our troops, but most of the service members who took their own lives (55 percent) had no history of a behavioral health disorder. Nearly 20 percent had mood disorders, primarily major depression. Another 16 percent had anxiety disorders, primarily post-traumatic stress disorder.

Instead, the 2011 DoD Suicide Event Report found that death rates for divorced service members were 55 percent higher than for married service members. It said that 47 percent of the decedents had a history of a failed marriage or intimate relationship, with more than half of them experiencing breakups within a month before their deaths.

Legal problems were also common. More than 18 percent were facing Article 15 judicial proceedings, and another 13 percent faced civil legal problems. More than 21 percent had lost their jobs or been demoted.

Firearms were the most frequent weapon of choice (60 percent), and nearly half killed themselves with their own weapons. Another 20 percent died of hanging.

Finally, only 13 percent had a prior history of self-injurious behavior, and nearly 74 percent of the service members did not communicate their intentions to others. If they did, it was most often to family members.

So how do we keep these guys and gals (only 5 percent of the suicide victims were female) from taking their own lives? That’ll be the subject of my next column.

Our government asks that our soldiers give up an arm or a leg or their life,” says “Crazy Eddie” Colosimo, “but then when they get out, it says, ‘Thanks. Now go away and don’t bother us anymore.’ That makes me so mad!”

Colosimo’s revulsion at the way America’s vets are treated underscores a poignant Christmas tale that I watched play out in Florida a couple of weeks ago.

Colosimo is president and chief executive officer for Bikers/Americans For First Amendment Rights (BFFAR), which for the second year joined up with American Legion Post 361 to offer homeless vets in the Daytona Beach area a safe and warm Christmas.

About 25 vets and a few spouses showed up on Dec. 24.

“One vet had been living in a storage unit and a couple had been living in their cars,” Colosimo told me, “but most of them came out of the woods.”

The volunteers checked the vets into a motel where they could get cleaned up, then took them to the BFFAR post in Holly Hill for haircuts and shaves. Then on Christmas eve, they got a big dinner: hams, turkeys and all the side dishes.

Christmas day was spent at the post, hanging out and playing pool and talking. Alcohol was off limits. The homeless vets were given military backpacks filled with sleeping bags and survival gear, as well as about $100 in cash and gift cards. Then on Christmas night, members of the two groups joined the homeless vets for another banquet before sending them back to their motel for a second night.

“It was a very emotional couple of days,” says Colosimo, himself a vet and the father of a military family. “On the third day, we gave them breakfast, and then they went back out into the woods or wherever they had been staying.”

Most homeless vets camp out in the woods, moving from place to place to hide from the police who are always looking to kick them out of their camps, according to Dennis St. Lawrence, chaplain for the American Legion Post.

It seems heartbreaking to send our vets back out into the swamp, but Colosimo saw the upside. Twenty homeless vets came in to the Christmas celebration a year ago, and seven of them have since found jobs and housing.

“We’re trying to end homelessness one vet at a time,” Don LePore, veteran affairs chairman for the American Legion Post, told the Daytona Beach News-Journal.

This year’s vets now know there are people they can trust and look to for help. And they’ve been given cell phones so the volunteers can keep in touch with them. Finally, the two groups are working to find free housing for vets who are willing to accept it.

“These vets don’t need a handout,” Colosimo says. “They need a hand up.”

Anyone interested in contributing to this cause can call “Crazy Eddie” Colosimo at 386/316-7441 or email him at bffar@hotmail.com.

We’ve only recently established the connection between brain injuries such as concussions and degenerative brain diseases like Alzheimer’s. We don’t fully understand yet why or how this is happening, and there’s not much we can do to prevent it now.

But help may well be on the way. There are three pharmaceuticals being tested that may reduce the amount of secondary brain damage that occurs right after the initial injury.

Potentially first out of the box is progesterone, with the results of its planned interim clinical study analysis expected sometime in 2013. Progesterone is best known as a reproductive hormone produced naturally in the body, but it’s also a powerful neurosteroid produced by the central nervous system. One study showed the glial cells naturally produced progesterone in the neurons of both men and women in the hours immediately after they had suffered severe traumatic brain injuries.

In two Phase II studies, the mortality rate among patients receiving pharmaceutical progesterone was approximately half of another group receiving only a placebo. Its manufacturer, BHR Pharma LLC is currently conducting a double-blind, placebo-controlled Phase III clinical trial on 1,180 severe TBI patients at about 150 sites in 20 countries to demonstrate that this pharmaceutical is effective in reducing injuries to the brain.

If the tests are successful, progesterone may “within a year or so, provide the basis for the first approved neuroprotective agent to treat severe TBI,” according to its manufacturer.

Not far behind is cyclosporine, which operates on the theory of the mitochondria, the tiny energy centers in the brain cells, are being destroyed by excess calcium. Cyclosporine has been used to prevent tissue rejection in organ-transplant recipients since the early 1980s, but a
Swedish firm, NeuroVive Pharma,  has been working for nearly two decades to prove that its medicine, called NeuroSTAT, can also protect mitochondria in brain injuries.

After an injury to the brain, a protein called cyclophilin D enables pores in the mitochondria’s membrane to open, through which water seeps. The mitochondria fill up, pop and die, ending cellular energy production and killing the brain cell. However, cyclosporine inhibits the cyclophilin D from helping open the pores, thus preserving the mitochondria, according to NeuroVive Pharma. “As mitochondria survive to produce energy for the brain cell, fewer brain cells die during the secondary (injury) stage,” it said. “Protecting brain cell mitochondria and energy production is the critical front line in the war against TBIs.”

Earlier mouse-model studies showed an 80 percent reduction in neural damage through the use of cyclosporine, the company said. Another mouse-model study by researchers at the University of Rochester, published this year in Nature magazine, showed that too much cyclophilin led to Alzheimer’s-like symptoms, but that “the administration  of cyclosporine inhibited cyclophilin’s actions and the Alzheimer’s symptoms were reversed,” according to the company. While NeuroVive is not targeting Alzheimer’s, the study shows the potential future importance of so-called cyclophilin inhibitors in treating many neurodegenerative diseases.

NeuroVive is conducting a Phase II/III trial in conjunction with the European Brain Injury Consortium and hopes to win regulatory approval in the United States and Europe within the next three to five years.

Finally, Neuren Pharmaceuticals and the Department of Defense are developing their own drug to prevent brain injuries from progressing into degenerative brain diseases. Called NNZ-2566, it’s basically an anti-inflammatory.  “The drug is based on a very similar chemical that occurs naturally in the brain, but it has been altered in such a way that it stays in the body longer,” Neuren said. “NNZ-2566 was discovered by scientists at the University of Auckland in New Zealand who found that it had an ability to protect nerve cells from damage. Since 2004, scientists from the U.S. Army Walter Reed Army Institute of Research have been involved in research to show how NNZ-2566 reduces brain damage and seizures after TBI.”

It’s currently being tested in a 260-patient Phase II clinical trial at 13 hospitals in the United States, so it’s still several years out from approval.

If approved at all…. While drugs from all three companies show promise, more than 30 once-promising TBI pharmaceuticals have reportedly failed to show benefit in human Phase III studies and not won FDA approval. No TBI pharmaceutical has ever received approval for use in humans, but these three are closest to being the first.

With three recent studies linking concussions to future degenerative brain diseases, there’s one big question that combat vets, athletes and other brain-injury victims have to be asking themselves: “What may happen to our brains?”

It’s a critical question because we have to know how this disorder develops in order to know how to prevent it from progressing.

Unfortunately, all we have are theories at this time. But they are at least a starting point.

John Medina, author of the best-selling book, “Brain Rules,” has written extensively about some of the theories of chronic traumatic encephalopathy (CTE), and much of this column will be devoted to summarizing his findings in a 13-part series of posts on his blog site “Brainstorm”: http://blog.spu.edu/brainstorm/

Originally, we believed that the original brain injury was the cause of CTE. When our brains are shaken by roadside bombs in Iraq or head-on collisions with an oncoming linebacker, there is damage because the inside of our skull is just as hard as the outside.  Nerve tissue is sheared by the blow or scraped against the inside of the skull, causing permanent damage.

But even permanent damage doesn’t explain the progressive nature of CTE, starting with headaches and leading to cognitive impairment and ultimately to dementia and death. What’s causing that?

One of the hallmarks of CTE is that the brain contains tangled knots of a protein called tau. This protein is a normal component of neurons. In fact, it has been compared to a food supply line that provides nutrients to the brain cells. When the supply line is interrupted, according to one theory, the brain cells begin to die from lack of nutrition.

But tau has another function, which is holding together the cell walls of neurons. When the tau begins to lump up, the cells walls lose their form and begin to collapse, then to leak. That allows a salty brine outside the neuron to invade the cells, damaging and ultimately killing them, according to a second theory.

A third theory involves a specialized group of cells called microglial cells. These are damage control officers that can migrate around your entire brain searching out problems like foreign organisms, damaged cells or localized injuries.  Then they provide damage control by unleashing a whole host of chemical molecules, some of which destroy the invaders and some of which promote healing.  However, the problem comes with the repeated injuries, according to this theory. The microglial cells, which had been partially activated from a previous injury, spring into action again and again. Finally, they adapt to repeated injuries by remaining partially activated all the time, a status known as “priming.”  This may be a part of degenerative brain diseases.

Finally, a fourth theory involves mitochondria, the tiny energy centers within each brain cell. There’s some speculation that when the cells begin to leak after an injury, calcium comes seeping in. Mitochondria, which are tiny beanlike structures surrounding the cell’s nucleus and dotting its cell walls, begin trying to eat the calcium until they eventually fill up and pop. Without those tiny energy centers (you could think of them as batteries), the cell begins to die.

Obviously, researchers have much more work to be done. CTE could be a result of any of these processes, it could be a combination of any or all of them, or it could be a new mechanical function that we haven’t recognized yet.

So that complicates the next – and most critical – question: What, if anything, can we do to prevent CTE from progressing?

Words can’t convey the horror of the shootings at Sandy Hook Elementary School in Newtown, Conn.  Every parent grieves for the lost lives, particularly those of the children, and is overwhelmingly sorry for their parents.

But it’s not only the deaths. Everyone in that school – teachers, aides and particularly the children – has been traumatized to some degree by this tragedy.

Early reports indicate that some of the children were told to close their eyes as they were led out of the school. That was an excellent idea. The less they saw and heard, the less damage there is likely to be.

The extent of that damage will vary from child to child. Some children are unusually sensitive, while others are more resilient to stress. Some children may have experienced previous trauma and be more susceptible to stress. Obviously, those who lost friends will be among the more devastated.

So these kids are going to need counseling for post-traumatic stress disorder because they have now seen the kinds of things that a combat vet sees. They may have only seen them once, but they’ve seen them at an unusually impressive age.

Parents will need to watch their children very carefully in the days and weeks to come, looking for changes in behavior.

One likely manifestation will be nightmares, or as some soldiers call them, “night terrors.”  Keep your children close, keep them safe, and comfort them. Talk about their dreams and their fears and their feelings.

Watch for avoidance, not wanting to go near the school or even not wanting to go outside. Watch for unusual reactions to loud noises or sirens or uniforms.

Many victims of PTSD can’t handle the emotions, and they become numb or desensitized. It’s important … gently … to talk about those emotions because it’s dangerous to let them become bottled up. Bottling up bad emotions may result in bottling up good emotions, as well.

Another common symptom of PTSD is hyperarousal.  For these kids, that would mean that they’re constantly alert to the possibility that something similar will happen again. They may be checking the hallways regularly to make sure that another guy with another gun isn’t coming back to finish the job.

Depression is common, as is anger. That’s a product of fear that comes from being in danger, espeially in a frightening situation over which they have no control.

This would be a good time to check the household for toys that might bring back bad memories. Guns and ambulances come to mind.

And it’s critical not to re-traumatize a child by allowing him or her to watch violence television shows, movies or video games. Children shouldn’t see those things anyway, but it’s important now to make sure children aren’t exposed to them.

Finally, understand that this is likely to be a problem that unfolds. It will take a while for kids to process what they’ve been through, so symptoms of PTSD may not show up for days or perhaps even weeks.