It’s been a year since the anti-Semitic massacre at the Tree of Life building, but physicians with patients from Squirrel Hill and surrounding neighborhoods are still treating physical symptoms associated with the trauma.
“We’ve had patients with both emotional and physical responses to the Tree of Life shooting,” said Dr. Michael Finikiotis, a primary care physician who treats patients from Squirrel Hill. “We’ve had patients that have had fatigue, insomnia, difficulty with headaches, back pain, abdominal pain, diarrhea, any number of symptoms that are probably anxiety-induced.”
Many of his patients tell him they believe their symptoms are related to the shooting.
“Some can’t identify it, but most of them have a sense that there is a connection,” he said, adding that symptoms “seem to be exacerbated” when news breaks about other mass shootings.
“So, for instance the shooting in El Paso, I’ve had patients come in and say ever since that shooting, ‘I haven’t felt well. It brings back recollections of the Tree of Life shooting and I’m having more fatigue or more headaches, any number of physical or emotional symptoms.’”
Not all of his patients suffering from Oct.27-related symptoms have a personal connection to a victim of the massacre.
“Some of them have family members that were involved, but many of them had no personal connection,” Finikiotis said. “They may have had a connection to the synagogue, they may have been members of one of the congregations. But a lot of them aren’t even Jewish.”
Finikiotis estimates that he has seen dozens of adult patients of all ages with physical symptoms associated with the Oct. 27 attack, and is anticipating more coming to his office with these symptoms as the one-year mark of the massacre triggers feelings and memories.
Although Finikiotis has seem some improvement in some of his patients as the year has progressed, and he anticipates continued improvement for some, he knows that won’t be the outcome for everyone.
“For some people it will never go away,” he said. “For some people it will be in the rearview mirror and behind them, but for some I think this is always going to be below the consciousness and part of their life experience.”
Dr. Jonathan Weinkle, a general internist and general pediatrician at the Squirrel Hill Health Center, agrees.
“It will fade with time, for some people,” Weinkle said. “It will be in the background until something triggering happens for other people. And it will be in it for the long haul for still others.”
Many of Weinkle’s patients are not part of the Jewish community, but are nonetheless “allies who quite literally feel our pain,” he said. “We also see a lot of people who have gone through other trauma and for whom the shooting here was a trigger for them to sort of re-live stuff.”
Sleep, Weinkle said, is the health aspect most commonly affected by the trauma.
“And there is a whole cascade of things that happen after that,” he said. “Their concentration decreases, they get headaches, those are the two main things that usually follow from that.”
When sleep is the issue, Weinkle usually recommends “unplugging,” especially from “emotionally charged content.”
“Not being on Twitter, not being on Facebook, not engaging in heated political discussions the hour or so before you go to sleep is a really good thing,” he said.
Weinkle has also seen preexisting health conditions worsen for some patients following a traumatic event.
“People’s blood sugar goes up, people’s blood pressure goes up, people who have tremors, their tremors get worse,” he said.
Deviating from one’s usual routine, such as neglecting exercise, also can cause health issues. Those at risk include people who were “actively engaged in the response” to the attack, and put their normal regimen on the back burner.
“The healers also need help,” Weinkle stressed. “Part of the reason we are in such a bind as a community is because so many of us are internally hurting and helping others simultaneously, and it’s really hard to do both. The more you take on somebody else’s pain, the more difficult it is.”
Dr. Adam Rothschild, a cannabis medicine and family medicine physician, also has seen several patients suffering from anxiety and posttraumatic stress disorder at his cannabis practice in Pittsburgh’s East Liberty neighborhood since the Oct. 27 attack.
“The two conditions where the events of Oct. 27 would really play out with respect to medical cannabis and conditions that are approved for medical cannabis in Pennsylvania are PTSD and anxiety disorders,” he said, adding that ‘anxiety disorders was only added a couple of months ago.”
He estimates that he has seen about a dozen patients who have mentioned the Oct. 27 as exacerbating their symptoms.
Although he would not necessarily recommend medical cannabis as either a “first line or second line treatment” for anxiety — it can actually make anxiety worse for some people, he said — it can work well for PTSD.
“Patients usually use cannabis for PTSD in the evening in order to put a stop to the invasive thoughts that are hallmark to PTSD,” Rothschild explained. “For those patients, cannabis can work amazingly well, help them calm their mind, help them get to sleep.”
In fact, he has certified people for medical cannabis who were directly affected by the massacre here, he said.
When treating patients with physical manifestations of trauma, it is important to rule out other causes, according to Finikiotis.
“These are diagnoses of exclusion,” he said. “You have to exclude other physical causes before you can be assured it is not any other physical disease or condition that caused it.”
Often, patients simply want to be reassured their symptoms are not indicative of something else, he said. For other patients, he recommends talking to a mental health expert.
“Different patients have different treatments,” Finikiotis said. “Sometimes you treat the symptoms — if somebody has abdominal pain there are medications and diets you can use to treat the abdominal pain. But sometimes you have to get to the bottom of the anxiety.” pjc
Toby Tabachnick can be reached at