Wednesday, August 18, 2010

Mild Traumatic Brain Injuries: Soldiers, Roadside Bombs & Military Policy


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Use of the deforestation chemical Agent Orange in Vietnam opened our eyes to new types of injuries among war veterans when they began to suffer mysterious ailments that were traced back to exposure to this substance. During our current war in Iraq there has been a growing realization that exposure to roadside bombs and IEDs (improvised explosive devices) are causing mild traumatic brain injuries in our soldiers.

Traumatic brain injury has been referred to as the signature wound of this war. It may seem as though service members didn't suffer any ill effects from explosions if they don't have any outward signs of injury. But many of them experience troubling symptoms like confusion, migraines and headaches, mental fog, dizziness, vertigo, delayed reaction time and memory loss. Most people exposed to explosions who experience these symptoms will fully recover within a few weeks. But as many as 5 to 15% never recover and continue to experience these debilitating symptoms for years leaving them unable to continue their military service, fully interact with their families or hold a job. (ProPublica offers a detailed explanation of these wounds complete with graphics on their website: Traumatic Brain Injury in Theater: When Blasts Damage the Brain.)

Doctors typically diagnose a moderate or severe brain injury in someone who is unconscious for 30 minutes or longer. MRIs of their brains will show damage, which makes diagnosis fairly straightforward. In contrast mild traumatic brain injuries, the kind experienced by soldiers exposed to IEDs, are difficult to diagnose. They do not usually show up in any kind of testing. Unless doctors know to ask a soldier about symptoms and monitor the soldier after the incident, it is easy for these injuries to fall through the cracks. Soldiers may not realize their symptoms are attributable to a brain injury and doctors may not realize the patient has one since the injury is so difficult to diagnose.

The military's handling of soldiers with these injuries has been a major source of controversy. NPR and ProPublica started a joint investigation of the frequency, diagnosis and treatment of brain injuries among soldiers to find out what was going on and what might need to change to adequately serve the needs of the active service members and veterans living with these injuries. As a result of their findings Congress called senior military leaders to a hearing of the Senate Armed Services Committee to discuss the huge numbers of soldiers returning with serious brain injuries and to explain why so many soldiers said they had not been able to get treatment for brain injuries they suffered in the line of duty. A group of Congressional leaders also asked them to address reports that Fort Bliss in Texas, the third largest base in the United States, was doing an especially inadequate job of diagnosing and caring for soldiers who have experienced brain injuries.

Military leaders are making a concerted efforts to adopt new policies that better serve the solider affected by mild traumatic brain injuries. All soldiers involved in a blast or exposed to head trauma will be evaluated. This is intended to avoid the inherent problems of relying on self-reporting of these injuries. Any soldier who is within 50 yards of a blast is now required to take a 24 hour rest period before returning to the field. The new policy also requires soldiers who experience three or more mild traumatic brain injuries to have a complete neurological exam before returning to the field.

In addition to the more practical changes, the military is also instituting better practices for tracking brain injuries. The new policy requires the establishment of a database to track each injury and the details surrounding it. This is intended to help with the problem of a soldier's medical record not containing anything about the mild traumatic brain injury, which has made it difficult for soldiers to get the medical treatment they need when they are still experiencing symptoms months or years later.

In another significant step to provide the best care for soldiers living with mild traumatic brain injuries, the Department of Defense and Department of Veterans Affairs have teamed up to open a national treatment center on the National Navy Medical Center grounds in Bethesda, Maryland. Active duty soldiers from all across the country who are not recovering through current therapies will come to the center for treatment. They and their families will spend two weeks at the facility for multidisciplinary assessment and care. They will return home with a new treatment plan and will continue to be followed by the center. The center will also research traumatic brain injuries, develop new treatments and learn about how the chronic stress of combat affects the brain. They are also working to develop an objective measure of mild traumatic brain injury using neuroimaging.

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DISCLAIMER: Nothing on this site constitutes medical or legal advice. I am a patient who is engaged and educated and enjoys sharing my experiences and news about migraines, pain and depression. Please consult your own health care providers for advice on your unique situation.