As the rescue unfolds in Chile, the hard work begins above ground

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As they reach the surface one at a time, entering into the warm embrace of family and friends, the miners leave behind the darkness and isolation of the past 69 days in a Chilean mine. But they won't return to life as they once knew it.

The 33 men will be under the watchful eye of doctors and medical specialists who will study them for any signs of mental or physical stress, as the world looks on. Mind you, the results of their experience deep underground won't all be negative to their health.

Dehydration and lack of sunlight

The miners were trapped in stifling heat, without any sunlight. They worked with a trainer to keep fit with exercise, and one miner reportedly ran each day through the winding shafts of the mine. But doctors wonder if that was enough.

Marc Siegel, an associate professor of medicine at the NYU Langone Medical Center, said a lot of them were likely running on adrenaline during the rescue effort. But when fatigue catches up, dehydration can exasperate other health problems and cause damage to internal organs, such as the kidneys, the liver and the brain. "I don't know the exact details of how much fluid they got, but they clearly had to be dehydrated," Dr. Siegel said. "The chances that they got enough hydration, it's not possible."

Dehydration, coupled with a lack of sunlight, could potentially cause problems with muscles, bones and other organs. Jane Aubin, scientific director of the Institute of Musculoskeletal Health and Arthritis at the Canadian Institute for Health Research, said the miners will have to be monitored closely. "They haven't been as physically active as you would want to be, so they have undoubtedly experienced some muscle loss. Probably after that extended period of time, in both a confined space and in relative darkness, they've also probably experienced some bone loss," she said.

Exposure to poor air quality

Even the physically fit can't help but feel the negative effects of being trapped underground for two months. Doctors worry about air quality and the effect it has had on the lungs of the 33 men. "Was there methane gas? Was there carbon monoxide? Were there any other toxic chemicals?" asked Dr. Siegel. "That all going to have to be screened for very carefully."

It didn't appear the miners were suffering as they were pulled to the surface. And Dr. Siegel said that if anything, he doesn't believe that their bodies will experience any permanent damage from the air quality in the mine.

Symptoms of post-traumatic stress disorder

Sleep disturbances, anxiety attacks and nightmares will become all too common in the days after being lifted from the mine. The miners will receive counselling. But symptoms of post-traumatic stress disorder may disappear for a while, only to be triggered in a few months when one of the men enters a dark room or a mine, for example. That could set off anxiety and phobic reactions, even for a miner who is seen as physically fit and psychologically strong.

Nick Kanas, a professor of psychiatry at the University of California, San Francisco, who has studied the psychology of astronauts, said that critical evaluations need to be conducted on the miners over a long period of time. "They should be evaluated carefully for that because it can appear immediately or even weeks or months after that," Dr. Kanas said.

Returning home and fame

Research has shown that men who leave their families behind to go off on tour have trouble reinserting themselves back into the family unit. That, in many cases, has resulted in depression. Dr. Kanas said that care needs to be take to re-integrate these miners, and "to get them back into things in a slow way, without a lot of heavy intrusion from the media or politicians."

International fame needs to be balanced, as well. Too much stimulation can be stressful, doctors say. "Fame and glory is not easy even for people who are used to it. It can be fun, but it can be stressful. Moderation has to be the key here," Dr. Kanas said.

Post-traumatic growth

For the miners, life underground has not been all negative to their well-being. Their struggle in a highly challenging environment will likely increase their self-confidence and strengthen bonds with each other and with their families.

"When people are deprived ... it can be really adverse, it can really mess up a person. With these guys, they were together," said Charles Nelson, a psychologist with the operational-stress-injury clinic at Parkwood Hospital in London, Ont.

Peter Suedfeld, a professor emeritus at the University of British Columbia, said many, especially the veterans, won't have trouble returning to their jobs in time.

"People in other occupations who have a parallel disastrous experience, like sailors who have been shipwrecked, for example, if they are professional sailors with a lot of experience, many of them go back to sea," he said. "So they'll feel that they can cope with anything that comes up."