thedrifter
06-08-06, 07:15 AM
Even mild injuries to brain add up
Updated 6/7/2006 6:21 PM ET
By Gregg Zoroya, USA TODAY
After a land mine exploded under his armored vehicle last October in Barwana, Iraq, Marine Sgt. Devon Bradley remembers a deafening noise and a flash. Then nothing.
Seconds later, when he came to, Bradley grabbed his weapon and went back into the fight. He led his team for the next two months in efforts to clear insurgents from Barwana.
"We're hard dogs, and I kept pushing to be with my Marines," says Bradley, 29, who was on his third combat tour.
But something was wrong. In the weeks that followed the blast, he began forgetting what other Marines had just told him. He struggled to handle more than one task at once. Taste and smell disappeared. Worst of all, so did the name of his soon-to-be-born daughter, Addison. Bradley says he had to dig through letters from home to remember it.
He was eventually flown to a battlefield hospital where he was diagnosed with a concussion — his second in the Iraq war and the third of his life. Bradley learned that what he thought was post-nasal drip was actually leaking spinal fluid.
By January, he was back at Camp Pendleton in California. Doctors told him his brain may never fully recover, and his career in the Marine Corps is in doubt
After more than three years of war in Iraq, where bombs are the biggest threat to U.S. troops, military doctors are seeing a growing number of brain injuries among soldiers and Marines caught too close to a blast. The vast majority are mild concussions that cannot be detected even with a CT scan or MRI.
In danger of permanent damage
Mild brain injuries can heal in days or even months. Additional concussions can cause permanent damage. "This is a real issue, and people are ... taking it very seriously," says Deborah Warden, director of the Defense and Veterans Brain Injury Center, a research arm of the Department of Veterans Affairs and the Pentagon.
RISK: Troops suffering from undetected injuries
The ramifications are broad. How do field surgeons and medics diagnose a wound they can't see? What can be done when soldiers and Marines try to shake off the blast effects, unaware of the concussion, and keep fighting? Should the Pentagon keep tabs on how many concussions each servicemember suffers? And if so, how many concussions is too many before someone is kept from combat?
"We're not at the Star Trek point where we can run a phaser over everybody and determine their exact problem. Closed-head injuries are very hard to assess," says Michael Kilpatrick, deputy director of deployment health support for the Pentagon.
The number of concussions keeps rising. Almost 30% of the patients admitted to Walter Reed Army Medical Center in Washington, D.C., have brain injuries.
Doctors fear that thousands of others go undiagnosed. A two-question survey developed by the Brain Injury Center shows that about 10% of troops returning from Iraq and Afghanistan suffered a concussion during their combat tour.
About half still had symptoms that could be related to a concussion, including slowed thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits, and irritability, says Air Force Lt. Col. Michael Jaffee, a neurologist with the center. More than 500,000 soldiers and Marines have served in combat since Sept. 11, 2001, many more than once.
During the screening, troops are first asked whether they were hurt in a blast, fall or vehicle accident. Then they are asked whether they felt dazed, were confused or saw "stars" afterward; do not remember what happened; or lost consciousness. If any of those symptoms occurred, the servicemember probably suffered a concussion, Warden says.
The screening offers a way to document brain injuries. The ability to count the injuries also has prompted disagreement about what to do with the information.
Warden urges that all returning troops be screened to build a concussion database. But today the screenings — which began about two years ago — are done at only a few military installations, including the Marine Corps' Camp Pendleton and the Army's Fort Carson in Colorado, Fort Bragg in North Carolina and Fort Irwin in California.
Kilpatrick, the Pentagon official, questions the accuracy of the screening. "Multiple head injuries can lead to permanent brain damage that is irreversible, and you want to avoid that," he says. "But we don't have any criteria today that if you get X number of concussions, that you can't serve anymore."
Neurologist Jaffee says settling on one number that applies to every servicemember is impossible because of the many variables, among them the size of the blast and the severity of the concussion. That's why concussion histories and better battlefield diagnoses are needed, he says.
Developing diagnostics
The military is developing ways to diagnose with tests that examine short-term memory, reaction time and attention deficit, key indicators of concussion. The tests are similar to those used on athletes who suffer head injuries. The Brain Injury Center is also creating a short exam Kilpatrick says could soon be introduced into war zones.
Computerized testing programs, used to monitor combat troops at Fort Bragg, are being tested for the battlefield. In April, the military approved a battlefield study by Air Force neurologist Gerald Grant for developing an online test for troops in Iraq.
During preliminary field tests, about 60 soldiers and Marines exposed to blasts were examined. In one case, a 25-year-old man caught near a roadside bomb struggled to process information and quickly answer questions. Two weeks later, before returning to combat, he continued to score below average or worse in both areas.
A second man, age 37, took the exam 15 hours after a rocket exploded on the other side of the wall from where he was standing guard. He showed attention-deficit problems and scored poorly in short-term memory.
"We need a field test to be able to practically assess the safety of sending people back to duty," Grant says.
Marine Sgt. Bradley says he suffered his first concussion in high school sports. His second concussion came during a rocket-propelled grenade attack in Iraq. After his third brain injury, doctors told him a fourth could kill him.
He and his wife, Megan, have three young daughters and say they face an uncertain future leaving the military. Bradley still experiences dizzy spells, bad headaches and back problems.
"Most of them are pretty much every day," he says. "I have one right now."
Ellie
Updated 6/7/2006 6:21 PM ET
By Gregg Zoroya, USA TODAY
After a land mine exploded under his armored vehicle last October in Barwana, Iraq, Marine Sgt. Devon Bradley remembers a deafening noise and a flash. Then nothing.
Seconds later, when he came to, Bradley grabbed his weapon and went back into the fight. He led his team for the next two months in efforts to clear insurgents from Barwana.
"We're hard dogs, and I kept pushing to be with my Marines," says Bradley, 29, who was on his third combat tour.
But something was wrong. In the weeks that followed the blast, he began forgetting what other Marines had just told him. He struggled to handle more than one task at once. Taste and smell disappeared. Worst of all, so did the name of his soon-to-be-born daughter, Addison. Bradley says he had to dig through letters from home to remember it.
He was eventually flown to a battlefield hospital where he was diagnosed with a concussion — his second in the Iraq war and the third of his life. Bradley learned that what he thought was post-nasal drip was actually leaking spinal fluid.
By January, he was back at Camp Pendleton in California. Doctors told him his brain may never fully recover, and his career in the Marine Corps is in doubt
After more than three years of war in Iraq, where bombs are the biggest threat to U.S. troops, military doctors are seeing a growing number of brain injuries among soldiers and Marines caught too close to a blast. The vast majority are mild concussions that cannot be detected even with a CT scan or MRI.
In danger of permanent damage
Mild brain injuries can heal in days or even months. Additional concussions can cause permanent damage. "This is a real issue, and people are ... taking it very seriously," says Deborah Warden, director of the Defense and Veterans Brain Injury Center, a research arm of the Department of Veterans Affairs and the Pentagon.
RISK: Troops suffering from undetected injuries
The ramifications are broad. How do field surgeons and medics diagnose a wound they can't see? What can be done when soldiers and Marines try to shake off the blast effects, unaware of the concussion, and keep fighting? Should the Pentagon keep tabs on how many concussions each servicemember suffers? And if so, how many concussions is too many before someone is kept from combat?
"We're not at the Star Trek point where we can run a phaser over everybody and determine their exact problem. Closed-head injuries are very hard to assess," says Michael Kilpatrick, deputy director of deployment health support for the Pentagon.
The number of concussions keeps rising. Almost 30% of the patients admitted to Walter Reed Army Medical Center in Washington, D.C., have brain injuries.
Doctors fear that thousands of others go undiagnosed. A two-question survey developed by the Brain Injury Center shows that about 10% of troops returning from Iraq and Afghanistan suffered a concussion during their combat tour.
About half still had symptoms that could be related to a concussion, including slowed thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits, and irritability, says Air Force Lt. Col. Michael Jaffee, a neurologist with the center. More than 500,000 soldiers and Marines have served in combat since Sept. 11, 2001, many more than once.
During the screening, troops are first asked whether they were hurt in a blast, fall or vehicle accident. Then they are asked whether they felt dazed, were confused or saw "stars" afterward; do not remember what happened; or lost consciousness. If any of those symptoms occurred, the servicemember probably suffered a concussion, Warden says.
The screening offers a way to document brain injuries. The ability to count the injuries also has prompted disagreement about what to do with the information.
Warden urges that all returning troops be screened to build a concussion database. But today the screenings — which began about two years ago — are done at only a few military installations, including the Marine Corps' Camp Pendleton and the Army's Fort Carson in Colorado, Fort Bragg in North Carolina and Fort Irwin in California.
Kilpatrick, the Pentagon official, questions the accuracy of the screening. "Multiple head injuries can lead to permanent brain damage that is irreversible, and you want to avoid that," he says. "But we don't have any criteria today that if you get X number of concussions, that you can't serve anymore."
Neurologist Jaffee says settling on one number that applies to every servicemember is impossible because of the many variables, among them the size of the blast and the severity of the concussion. That's why concussion histories and better battlefield diagnoses are needed, he says.
Developing diagnostics
The military is developing ways to diagnose with tests that examine short-term memory, reaction time and attention deficit, key indicators of concussion. The tests are similar to those used on athletes who suffer head injuries. The Brain Injury Center is also creating a short exam Kilpatrick says could soon be introduced into war zones.
Computerized testing programs, used to monitor combat troops at Fort Bragg, are being tested for the battlefield. In April, the military approved a battlefield study by Air Force neurologist Gerald Grant for developing an online test for troops in Iraq.
During preliminary field tests, about 60 soldiers and Marines exposed to blasts were examined. In one case, a 25-year-old man caught near a roadside bomb struggled to process information and quickly answer questions. Two weeks later, before returning to combat, he continued to score below average or worse in both areas.
A second man, age 37, took the exam 15 hours after a rocket exploded on the other side of the wall from where he was standing guard. He showed attention-deficit problems and scored poorly in short-term memory.
"We need a field test to be able to practically assess the safety of sending people back to duty," Grant says.
Marine Sgt. Bradley says he suffered his first concussion in high school sports. His second concussion came during a rocket-propelled grenade attack in Iraq. After his third brain injury, doctors told him a fourth could kill him.
He and his wife, Megan, have three young daughters and say they face an uncertain future leaving the military. Bradley still experiences dizzy spells, bad headaches and back problems.
"Most of them are pretty much every day," he says. "I have one right now."
Ellie