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Chilean President Sebastian Pinera poses with the 33 rescued miners inside the Copiapo Hospital where they are undergoing full medical exams, in Copiapo October 14, 2010.HO

The miners have returned to the warm embrace of family and friends, but they won't return to life as they once knew it. Already, many are unable to sleep, one was treated for pneumonia, two needed dental work, and another has had a difficult time adjusting and seemed depressed. The 33 men will remain under the watchful eye of doctors and medical specialists.

Dehydration and lack of sunlight

They worked with a trainer to keep fit, and one miner reportedly ran each day through the winding shafts. 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 feeding off adrenalin during the rescue effort. But 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," she said. "Probably after that extended period of time, in both a confined space and in relative darkness, they've also probably experienced some bone loss."

Exposure to poor air quality

Doctors worry about the effect of air quality on the lungs. "Was there methane gas? Was there carbon monoxide? Were there any other toxic chemicals?" asked Dr. Siegel. "That's 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. There could an issue with their lungs from inhaling dust, but Dr. Siegel said he doesn't believe that there will be any permanent damage from the air quality.

Symptoms of post-traumatic stress disorder

Sleep disturbances, anxiety attacks and nightmares may occur in the days after being lifted from the mine. The miners will receive counselling. But symptoms of post-traumatic stress disorder may not be present initially, only to be triggered in a few months by entering a dark room or a mine, for example. That could set off anxiety and phobic reactions, even for a miner who is usually 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 post-traumatic stress disorder because it can appear immediately or even weeks or months after they return," Dr. Kanas said.

Returning home and fame

Research has shown that men who leave their families behind for long periods of time may have trouble reinserting themselves. That, in many cases, has resulted in depression or marital strife. Dr. Kanas said that care needs to be taken with these miners "to get them back into things in a slow way, without a lot of heavy intrusion from the media or politicians." 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," Dr. Kanas said. "It can be fun, but it can be stressful. Moderation has to be the key here."

Post-traumatic growth

Their triumph 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 the veterans are less likely to have trouble returning to their jobs. "Sailors who have been shipwrecked, for example … many of them go back to sea," he said. "They'll feel that they can cope with anything that comes up."

With a report from Associated Press

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