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Army vice chief of staff: "We Just Don't Know"

The Army vice chief of staff explains why inconclusive science is complicating the treatment of wounded warriors.

If there's a member of the brass who's taken mental-health issues in the military head on, it's four-star Gen. Peter Chiarelli. On his second deployment to Iraq, he served as commander of all coalition ground forces. Since then, he's gone before Congress to explain the Army's work on the invisible wounds of war and created a suicide-prevention task force. When word got out that NEWSWEEK was investigating the science of battlefield concussions, his office lined up an interview with articles editor Andrew Bast.

Excerpts:

How well do we understand the short- and long-term effects of mild traumatic brain injury (MTBI), or battlefield concussions?

I don't think we do. The vast body of medical understanding of these wounds will show you that we just don't understand. It's science that's just not that well developed. I use the example of open-heart surgery. You can go to two doctors for the same problem, and one may use different antirejection drugs and different postoperative requirements, but it is all a very well-developed science. The science of the brain, however, is not. That's what causes the huge issues we've got here.

What are the issues, exactly?

The comorbidity issue between post traumatic stress [PTS] and TBI are huge. One of the biggest problems we have is that every soldier who is in a blast, and has some kind of a behavioral-health issue after the fact, thinks they have TBI. Some of them do, but some don't. They may have PTS or some other behavioral-health issue. And the drug regimen for the two is very different. So if a doctor makes a mistake and diagnoses someone with PTS who has TBI, the drug regimen would be different.

Can you explain that term, comorbidity?

Comorbidity is the sharing of symptoms. The symptoms are much the same for PTS and TBI. So when you have similar symptoms, it's very difficult to make a diagnosis. We're not being criticized for the way we're working with soldiers who've lost arms or legs. If you were at the Army 10-miler the other day, there were hundreds of wounded warriors on prostheses. These are mechanical injuries, and we're very good at treating those. But [on brain injuries] what has been hard is that people really feel we are letting them down. The problem is that we just don't know. You'll find a lot of people who will come to you with the answers, but I think if you were to talk to the specialists, they will tell you that very little that's come to their attention that they have researched has proven to be effective.

So where are we in treating wounded warriors and where does it go from here?

What I'm most excited about are these proteins we've found that we believe are biomarkers that will allow us at the point of injury to take a simple prick of the finger with an instrument—we think we'll have three years from now—that would be much the same as what's used by a diabetic to check blood sugar. It would give a combat medic certainty that these proteins associated with concussion or TBI are present in a body. This research is looking extremely positive. It would allow us to ascertain almost immediately whether the individual has or doesn't have a concussion on the battlefield.

The Army reported about 80,000 cases of MTBI from 2000 to 2010; do you think that's accurate?

The numbers I talk about are 60,000, but I don't think we totally know. It's very difficult for us to be able to tell you with any certainty because the stigma associated with these things has been so great that soldiers don't want to admit that they've got that problem. In January I was at the All-American Bowl and I had the opportunity to present a Purple Heart as part of the awards banquet to a young soldier who was in two explosions four days apart. He was an E-6 filling in for a platoon sergeant, and after the first blast the medic tried to evaluate him. He said, "No, I am the acting platoon sergeant, I have to stay with my soldiers." Four days later he gets into another explosion and the next time he remembers anything he's waking up in a bed in Landstuhl, [Germany]. He has TBI and is now working his way out of the Army. These are sad, sad cases. Many are also preventable. That's why I'm excited about the protocols we've put in downrange so when an individual like that sergeant suffers a blast, we evaluate him immediately after the combat action, but then we hold him out of the fight for 24 hours to evaluate him a second time.

If battlefield concussions and PTS are in visible wounds of war, as the definition of wounds widen, do you run the risk of service members gaming the system?

Sure you do. And you just have to forget that. You have to let the science progress. I'll forget 99 of them if there's one who I can help. That's how I feel about it. I feel it's absolutely essential, and I think the number that might game the system is a small group of individuals. And because we have immature science, it's always going to be difficult. We'll get better and better; however, until we get there, we've got to treat every single one of them that displays themselves with those symptoms as having the problem.

In the long term, there's a responsibility in treating these service members that goes on for decades. What does the future look like to you?

That's exactly why we're working so much research with the Department of Veterans Affairs, at the Cincinnati veterans' hospital, at UCLA, at Emory. If you talk to the experts, you see that no one's trying to not help these soldiers. The fact of the matter is, the science is such that we can't help them in every case because we don't know what to do.

Read the complete article.

Books

  • Until Tuesday
    By Luis Carlos Montalván

    Until Tuesday is a book about a highly decorated seventeen-year veteran and former captain in the U.S. Army. He sustained a TBI in Iraq followed by Post Traumatic Stress Disorder upon returning home from combat. In increasing pain and limitations, he became withdrawn from loved ones and society in general. Then he met a dog named Tuesday, a beautiful and sensitive golden retriever trained to assist the disabled. Golden retrievers are truly Man's best friend and make the best service dogs because of their even temperament. This is a story about how a dog like Tuesday can make a brain injury survivor whole again.

Caregivers

Despite the enormous effort to provide articles, webinars, PSA's, and more on the Invisible Injuries of PTSD and TBI, it seems that there are still too many families (and medical staff) that feel many of the symptoms are "in your head". A very good TBI blog post addresses Neuroendocrine Dysfunction in TBI by the Defense Centers of Excellence for Traumatic Brain Injury that may resonate with you and your warrior or veteran.

Undiagnosed http://r20.rs6.net/tn.jsp?e=001jLVuG5Ye2HFPOW9QfWuY_ICMWfyNZ5eeRayhStpatuvJQv1TFoy05DzpKO_mSjGb9xcRrEw1-x4Hb-ua44oaDqhb0GNqQ_0VeLUBjvycUFUvUQjdk0Dg6yOzt_a4rOlGTBI can lead to devastating outcomes for relationships. Many families talk about the "lack of verbal filters", the short-term memory loss, mood swings, paranoia, and the agitation that TBI may present. And, if you or your veteran is unfortunate enough to not receive care for your TBI because the doctors say "you look fine; just adapt", you may need to persist and document the symptoms to obtain care. Be alert to support those fighting to make sense of their lives when they suddenly can't keep it together, but don't understand what their list of symptoms may mean.

The military is taking notice and working diligently to identify and treat TBI beginning in-country. A new blast exposure technical tool is in use for measuring blast exposure and potential injuries. Protocols exist for first, second, and subsequent concussive events. But, the families must be aware to bring specific behaviors to the attention of the warrior or veteran, as symptoms can manifest long after the last event.

Consider the increased suicide risk without diagnosis and treatment of even mild TBI in this article: Diagnosis of Traumatic Brain Injury Key to Preventing Military Suicide. Traumatic brain injury is serious, but there are options. Continually learn about new research and treatment alternatives – and do not give up the quest for diagnosis and management.

Coming home a different person

Traumatic Brain Injury featured in the Washington Post:

  • Read a feature article, "Traumatic brain injury leaves an often-invisible, life-altering wound."
  • View videos of three soldiers and two marines with TBI to hear their stories and see how their recoveries are progressing.
  • Read transcripts from online discussions by Dr. David Williamson, medical director of the inpatient Traumatic Brain Injury Unit at the National Naval Medical Center and Cheryl Lynch, mother of a TBI patient and founder and executive director of American Veterans with Brain Injuries.
  • Find resources to connect with organizations that support traumatic brain injury survivors and their families.

House Committee Adopts Platts Amendment to Ensure Better Treatment of Troops Suffering from Brain Injuries

May 12, 2011

The U.S. House of Representatives Armed Services Committee (HASC) approved an amendment Wednesday to the Fiscal Year 2012 National Defense Authorization Act (H.R. 1540) which was sponsored by Congressman Todd Platts (PA-19) to direct the U.S. Department of Defense to establish guidelines for post-acute rehabilitation of moderate to severe traumatic brain injuries (TBI) for our military personnel. Congressman Platts sponsored the amendment on behalf of the office of U.S. Congresswoman Gabrielle Giffords (D-AZ-8). H.R. 1540 was adopted by the HASC by a vote of 60 to 1 and Congressman Platts' amendment, which was voted on as part of a larger amendment package, was approved by voice vote.

"Congress has acknowledged that traumatic brain injuries from blast exposures are the signature injury of the wars in Iraq and Afghanistan," said Platts, a member of the Armed Services Committee and co-chair of the bipartisan Congressional Brain Injury Task Force. "It is more important than ever that we do right by the men and women in our military who serve in harm's way to ensure that they receive the highest quality of medical treatment available in order to lead meaningful and productive lives post-injury."

It is estimated that more than 300,000 American soldiers deployed to Iraq and Afghanistan have experienced a possible TBI. These injuries can include those caused by shrapnel that penetrate the skull, but also injuries with no visible signs caused by shockwaves from improvised explosive devices and mortars. Due to significant scientific and medical advances by the military, more service members are surviving the acute stages of blast injuries, said Congressman Platts.

To build upon that, however, it is critical that guidelines for post-acute rehabilitation of moderate to severe TBI be established for our military personnel. Such medical guidelines would make certain that our service members have access to treatment that works, while saving taxpayer funds in long-term care costs and making post-injury lives as productive and fulfilling as possible.

H.R. 1540 now advances to the full House of Representatives for approval. Since 2005, Congressman Platts has served as co-chair, along with U.S. Congressman Bill Pascrell (D-NJ-8), of the bipartisan Congressional Brain Injury Task Force, which has fought to improve medical services for soldiers suffering from TBI, while also educating the public about such injuries.

Resources

  • Veterans in Need of Pro Bono (free) LEGAL SERVICES
    Contact Mike Monahan, Pro Bono Director, State Bar of Georgia . . . mikem@georgiabar.org . . . (404) 527-8762
  • Coping with TBI to improve quality of life
    Veterans who have experienced TBI, including some who didn't know they had a traumatic brain injury until later, talk about their experiences. Listen as they describe the signs and symptoms of TBI and its effects on their families. By reaching out for help, they were able to overcome these obstacles and live better lives.
  • Expert Interviews About Brain Injury
    In its Summer 2011 newsletter, BrainLine features interviews with experts on traumatic brain injury. Donald Marion, MD, MSc, Director of Clinical Affairs at the Defense and Veterans Brain Injury Center (DVBIC) discusses therapeutic hypothermia for people with brain injury. Dr. Marion, an expert on this topic, defines therapeutic hypothermia and explains how it can help people with severe traumatic brain injuries immediately after the injury.
  • TBI: The Invisible Injury (PDF)
    U.S. Department of Defense primer on how traumatic brain injuries affect active duty military personnel.
  • The War's Invisible Wounded
    This Men's Journal article is about our current wars and how brain injuries are occurring to our brave men and women who are fighting to protect our freedom.
  • Scientists: Brain Injuries From War Worse Than Thought
    Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.
  • Can Brains Be Saved?
    By Lee Woodruff, wife of Bob Woodruff of ABC News
  • The Journey Back From Brain Injury
    Rehabilitation and recovery is a gradual and uncertain process.

SHARE - Shepherd Center's Military Program

SHARE Military Initiative at Shepherd Center is a comprehensive rehabilitation program that focuses on assessment and treatment for service men and women who have sustained a mild to moderate traumatic brain injury and PTSD from the Afghanistan and Iraqi conflicts.

SHARE Military Initiative provides assistance, support, and education to service members and their families during their recovery treatment and beyond. In addition, the program compiles data that is beneficial to policy and legislative change to provide for unfunded services.

Read some of the Shepherd's SHARE men's stories and watch videos.

Stories: Shepherd Center & SHARE Military Initiative

SYNERGY Home Care May 2010 Newsletter

Read articles on:

  • Driving While Demented
  • Resources for Soldiers, Vets and Families
  • Americans losing confidence in healthcare
  • Senator: Caregiver benefits an empty promise

See Resources for Soldiers, Vets and Families listed in this same Synergy Newsletter.

Traumatic Brain Injury Doubles Risk of Dementia

New research shows that older war vets who suffered traumatic brain injury (TBI) during their lives had more than two times the risk of developing dementia.

"A diagnosis of a concussion, post-concussion syndrome, a skull fracture or some non-specific head injuries are considered TBIs," the lead researcher said.

The risk of dementia in those with a TBI diagnosis was 15% compared with almost 7% in those who had never had a TBI.

Source: The Amen Newsletter

Veterans Survivor Stories

Marcus Abbott

Marcus Abbott was in Kandahar province in Afghanistan, when an IED exploded and knocked him unconscious, giving him a traumatic brain injury. He returned to his unit to continue his service several months later, receiving the Purple Heart for his valor. Marcus returned home to Port Arthur, Texas in 2013, when he left the army. He decided to go to Lamar Tech college, and he also joined Lamar's college football team. He has the goal of pursuing a career in the NFL. Marcus says, "After everything I've been through, I'm (still) alive. What's going to stop me?" Read his story here.

Bob Woodruff

In January 2006, Bob woodruff was injured in Iraq by a roadside bomb while covering the war for ABC News. Hundreds of pieces of rock shrapnel became embedded in his face, neck, and back, and his skull was shattered.

Websites

  • American Veterans with Brain Injuries (AVBI)
    American Veterans with Brain Injuries (AVBI) was organized in 2004 as a grassroots effort whose mission is to offer support to the families of American Service Members and Veterans who have suffered brain injuries. AVBI.org went live on the Internet in 2006 to provide a web-based peer support network and information resource.
  • Atlanta Regional Commission
    A coordinated system of partnering organizations that are dedicated to:
    • Providing accurate information about publicly and privately financed long-term support and services
    • Offering a consumer-oriented approach to learning about the availability of services in the home and community
    • Supporting individuals and family members who are aging or living with a disability
  • Brain Injury Resource Center
    Has a lot of information on brain injury, as well as numerous links to other informative websites.
  • Brain Line Military
    Provides military-specific information and resources on traumatic brain injury to veterans, service members in the Army, Navy, Air Force, Marines, National Guard, Reserve, and their families.Note the free apps being offered for veterans who are smart phone users!

    Check out 45 life-changing iPhone and iPad apps for people with brain injury covered on the website (note some are free, some have a fee).

  • Centers for Disease Control and Prevention (CDC)
    Also Injury and Violence Prevention and Control and Injury Prevention & Control: Traumatic Brain Injury
    Has a wide variety of information about prevention of mild traumatic brain injury, and information and statistics about brain injury.
  • Defense and Veterans Brain Injury Center
    The mission of the Defense and Veterans Brain Injury Center (DVBIC) is to serve active duty military, their beneficiaries, and veterans with traumatic brain injuries (TBIs) through state-of-the-art clinical care, innovative clinical research initiatives and educational programs.
  • Discover Magazine
    An interesting article from Discover Magazine, called "Dead Men Walking: What Sort of Future Do Brain Injured Vets Have?"
  • Georgia's Aging and Disability Resource Connection (ADRC)
    (800) 676-2433
  • Health Resources and Services Administration
  • National Brain Injury Research Treatment and Training Foundation
  • National Institute on Disability and Rehabilitation Research
  • National Center for Medical Rehabilitation Research (NICHD, NIH)
  • National Institute of Neurological Disorders and Stroke (NIH)
  • North American Brain Injury Society
  • Social Security Administration
  • "To Iraq and Back: Bob Woodruff Reports"

    The story of ABC news anchor, Bob Woodruff, who sustained a serious life-threatening brain injury when his Humvee was hit by an Improvised Explosive Device (IED) while covering a story in Iraq (as one of the many embedded reporters). The ABC News special "To Iraq and Back: Bob Woodruff Reports" is available on DVD here.

  • VA Polytrauma System of Care
    VA recently launched a campaign to increase awareness about traumatic brain injury (TBI) and the services provided to Veterans and service members recovering from TBI and co-occurring complex injuries.

    The campaign debuted with a 25-minute documentary highlighting individual stories of recovery for some of the most severely injured and wounded Veterans through the VA Polytrauma System of Care at the Hunter Holmes McGuire VA Medical Center in Richmond, Va. "The stories of true courage and determination are an inspiration to all who watch this documentary," said Secretary of Veterans Affairs Eric K. Shinseki. "The stories go beyond their injuries resulting from combat or vehicle accidents by highlighting their heroic roads to recovery, aided by VA's system of care. I encourage everyone to take the opportunity to watch the video." The stories highlight the fact that effects of TBI can range from mild to severe, lasting for a brief or prolonged period of time. Treatment is available and VA provides specialized services to support Veterans and service members through evaluating and diagnosing TBI, related problems, and enabling their recovery.

  • Veteran CareGiver
    This website was launched in the spring of 2010 to help veterans and their caregivers find and connect with valuable, supportive resources and talent to aid in rehabilitation and recovery. Traumatic Brain Injury is one of the "signature wounds" of the Iraq and Afghani wars, and many veterans are initially treated and then return to their home communities.