Thursday, September 13, 2007

Ain't nobody home

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Traumatic Brain Injury Is Major Iraqi War Injury

Thousands of returning soldiers are unable to do simple tasks -- go to the store for milk, remember to take out the trash, drive a car. They have Traumatic Brain Injury.

And the problem is getting worse.

Washington Post

Thousands of troops have been diagnosed with traumatic brain injury, or TBI. These blast-caused head injuries are so different from the ones doctors are used to seeing from falls and car crashes that treating them is as much faith as it is science.

"I've been in the field for 20-plus years dealing with TBI. I have a very experienced staff. And they're saying to me, 'We're seeing things we've never seen before,'" said Sandy Schneider, director of Vanderbilt University's brain injury rehabilitation program.

Doctors also are realizing that symptoms overlap with post-traumatic stress disorder, and that both must be treated. Odd as it may seem, brain injury can protect against PTSD by blurring awareness of what happened.

But as memory improves, emotional problems can emerge: One of the first "graduates" of Vanderbilt's program committed suicide three weeks later.

"Of all the ones here, he would not have been the one we would have thought," Schneider said. "They called him the Michelangelo of Fort Campbell" - a guy who planned to go to art school.

As more troops return from the war, brain injuries are a growing burden - for them, for the few programs to treat them, and for taxpayers who pay for their care and disability if they cannot hold jobs.

Most TBIs are mild, and most of these patients recover within a year. But one-fifth of the troops with these mild injuries will have prolonged or lifelong symptoms and need continuing care, the military estimates. Nearly all of the moderate and severe ones will, too.

Though the full number of those suffering from TBI is still unknown, the problem is straining the U.S. Department of Veterans Affairs. Until now, "they were dealing with a cohort of aging veterans with diabetes, heart disease, lung disease," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and a VA adviser.

Now, these young, brain-injured troops need highly specialized care, and how much it will help long-term is unknown, he said.

People with TBI have frequent headaches, dizziness, and trouble concentrating and sleeping. They may be depressed, irritable and confused, and easily provoked or distracted. Speech or vision also can be impaired.

Gen. Peter Pace, chairman of the Joint Chiefs of Staff, said the military was "much smarter about this now," and urged troops to watch for signs of TBI and post-traumatic stress.

"They are every bit as much battle injuries as is a bullet or shrapnel. It is OK, it is OK to seek help for those kinds of war wounds, and I ask you all to help your buddies understand what you see in them," he said.
Journalism Now

“I went home - R&R for 10 days - and the day I got back is the day I got hit,” Bryan Malone said.

“It was two weeks, you moron. It was 15 days,” scolded his friend, Eric O’Brien, adding to others: “The problem with him is he’s as dumb as a box of rocks to begin with. We’ve got no baseline on him.”

Their jokes and sarcasm mask a serious worry.

These guys forget names, directions, appointments, where they put their keys, what they need at the store - things that are innocent memory lapses when they occasionally happen to normal people.

But their minds do not work like most people’s minds do. Not since an explosion left them with the “silent epidemic” of the Iraq war: traumatic brain injury, or TBI.

Some brain-injury cases have been misdiagnosed as personality disorders. Some with brain injury have lost jobs because of unrecognized and untreated symptoms.

“It’s the so-called invisible injury. It’s where a troop takes 10 times the normal time to pack his rucksack ... a complicated injury to the most complicated part of the body,” said Dr. Alisa Gean, a neurosurgeon at the University of California at San Francisco.
One of the interesting things about war is the advances made by medicine. From field sanitation to malaria, from trauma surgery to dustoff, trying to keep soldiers alive in the long run helps keep civilians alive as well.

A study reported in the New England Journal of Medicine points at possibly treating one of the causes of TMI. The typical combat soldier "gets their bell rung" once every 4-6 weeks. Concussion is one of the apparent precursors to TMI.
The Canadian Press

An unusual study by doctors treating blast victims at a field hospital in Iraq has found that ruptured eardrums may help reveal which troops are at risk of hidden brain injury.

The finding is important because many such brain injuries have been missed in the past, especially when more severe or obvious wounds demanded attention.

Researchers report their observation in a letter in Thursday's issue of the New England Journal of Medicine.

Diagnosing brain injury, especially mild damage, is based largely on subjective symptoms like irritability and forgetfulness. Imaging tests like CAT scans do not help, and neurological function tests are not very useful without baseline information.

Researchers led by Air Force Lt.-Col. Dr. Michael Xydakis checked all troops brought for treatment from roadside bombs and other explosions to the Air Force Theater Hospital in Balad, Iraq, during the last three months of 2005.

The study focused on the 210 surviving U.S. troops who were evaluated for eardrum rupture and loss of consciousness. Of those, 35 per cent had ruptures and 36 per cent had lost consciousness; the two were closely linked.

Those with ruptured eardrums had a nearly threefold greater risk of concussive brain injury.

The eardrum is only half a millimetre thick - thinner than a contact lens - and ruptures easily, Xydakis said. It is only half an inch from the brain, so "whatever hits the eardrum is going to hit the brain," such as the pressurized shock wave that follows an explosion, he explained.
At least a fifth of these soldiers will need lifetime care. At least.

Every day more and more soldiers are killed. More and more soldiers are injured. We can not win. Can't do it.

It's time to go. Now.