thedrifter
10-07-07, 11:23 AM
Traumatic brain injury is the signature war ill
JENNIFER HLAD
October 7, 2007 - 12:54AM
DAILY NEWS STAFF
During his time in Iraq with 1st Battalion, 8th Marine Regiment, 1st Sgt. G. Russell Hill was exposed to multiple explosions. The most damaging was when a rocket-propelled grenade landed about 3 feet away from him - throwing him 8 to 10 feet and injuring both his legs.
Hill knew his legs were hurt. But he didn't realize that - although he had no visible scars above his waist, except for some shrapnel in his hands - the blast may also have injured his brain.
Traumatic brain injuries are "really as old as human history," said Capt. Tom Johnson, Camp Lejeune Naval Hospital's neurologist. "Blast-related TBIs have been around since the invention of gunpowder."
But until recent years, many did not realize a person could sustain a traumatic brain injury without any visible damage to the skull.
Hill is one of thousands of Iraq veterans suffering from what medical officials call the war's signature health problem: a traumatic brain injury. At least 14 to 20 percent of surviving combat casualties in prior conflicts had a TBI, but experts estimate the numbers from Iraq are much higher, according to the Defense and Veterans Brain Injury Center.
A traumatic brain injury is caused by "a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain," according to the Centers for Disease Control and Prevention.
Hill isn't completely sure what caused his TBI. He didn't even realize he had a TBI until about a year after the blast he believes caused it.
"I didn't know anything had happened to me in my head," he said. "I had headaches, but, you know, you have a headache, you drink more water. ... I never put the two together."
Hill stayed in Iraq with his unit, and when it returned, he went through all sorts of emotions. He also went through all sorts of symptoms: headaches, dizziness, ringing in his ears. But he figured it was just part of the postdeployment process.
"A lot of the things I was feeling, I just put off to being back," he said.
But in summer of last year, he was still having headaches.
"When I read, or when I'm trying to really think ... try to get that right word or try and figure something out, I get a lot of burning in the top of my head," he said.
He went to see Johnson at the Naval Hospital.
Diagnosing the injury
All Marines and sailors are screened for mental and physical health problems before, immediately after and 90 days after returning from a deployment. Capt. Vince Arnold, head of Camp Lejeune's deployment health services, said officials hope the screening process catches everyone.
But, he said, much of the process relies on self-reporting.
That can be difficult with traumatic brain injury, said Cmdr. Tim LaVan, the Naval Hospital's director of medical services. After all, a person with changes in thought patterns may not recognize that symptom in himself, he said.
"The severe cases are not the ones that are hard to pick up," he said.
It's those like Hill - exposed to a blast but without a visible head injury - who are the challenge, LaVan said.
"A person with a TBI can look - even immediately after the blast - can look perfectly fine," said Capt. Mark Olesen, commanding officer of the Naval Hospital.
One of the reasons there has been a seeming surge in TBIs from combat, Johnson said, is simply that technology and medical care have increased. Now, he said, patients who may have died of their injuries in another war are living to fight another battle.
Plus, LaVan said, this is the first war in which nondirect explosives are the weapon of choice.
"Now, we see guys get knocked down and get back up," LaVan said. "Then, two months later, they (have symptoms of TBI)."
Often, Johnson said, patients with mild or moderate TBIs don't have a lot of structural damage to the brain. But the medical officers and corpsmen are trained to recognize the symptoms, he said.
Once Hill read the literature and the list of symptoms, he said he realized that it was exactly what he was experiencing. Still, he said, hearing that he had a TBI came as a shock.
"When he told me that ... it was almost like saying, 'You've got cancer' or something," Hill said.
Treating symptoms
Severe TBIs generally require surgery, Johnson said. But for mild and moderate cases, identification, education and therapy are effective, he said.
Hill went through a litany of tests - including brain scans and a sleep study - before going for cognitive rehabilitation at New Hanover Regional Medical Center in Wilmington.
There, he said a therapist would give him a list of things to do, then walk through the tasks and ask questions about what they had done.
"That's when I became conscious of the problems I was having," he said.
While he's able to remember things he's known for a substantial period of time, Hill often has trouble remembering things he's just been told.
For example, he said, if he were told to meet someone at a location he knew at a specific time, he would likely be able to remember. But if he were not familiar with the location, concentrating on that could make him forget the designated time.
Now Hill keeps a notepad with him to scribble reminders as needed, and he immediately types things into his phone when he can. Everything from his phone goes directly to his computer.
He said he also uses tricks he learned during sniper training earlier in his career to keep things in his mind. And he avoids situations he knows could cause trouble - like concerts, where too much stimulation would cause a sort of information overload, he said.
Though most of the treatment for TBIs is symptom-based, the goal "is not just to treat the symptoms," but to help the patient regain his former skills and functionality, Johnson said.
And the good news?
"The vast majority of people with mild to moderate TBI get better," he said.
Moving forward
Hill sometimes has trouble finding the right word - something he compares to a non-native English speaker searching for the correct term. But his TBI has not held him back at work, he said.
If it weren't for recurring problems with his leg, Hill would be deployed right now. Instead, he's on crutches after his third surgery and is transferring to the Wounded Warriors Battalion until he can heal.
The Army and the Navy separately are working on baseline tests to gauge the cognitive ability of service members before they deploy - and help diagnose TBI when they return, military officials said. The challenge, LaVan said, is finding a test that is accurate and reproducible over time.
Military officials also are "aggressively collecting" data about those with mild and moderate TBIs, LaVan said, to find out more about long-term effects and general trends.
The CDC estimates 1.4 million people sustain a TBI each year in the United States. At least 5.3 million Americans have a long-term or lifelong need for daily help as a result of a TBI, the CDC estimates.
But the Department of Defense is on the cutting edge of defining treatment, Olesen said. And what the military learns about how to diagnose and treat TBIs can benefit everyone, he said.
"Our civilian counterparts are going to greatly benefit from what we're learning," he said.
Contact military reporter Jennifer Hlad at jhlad@freedomenc.com or 353-1171, ext. 8449. To comment on this story, visit www.jdnews.com.
Ellie
JENNIFER HLAD
October 7, 2007 - 12:54AM
DAILY NEWS STAFF
During his time in Iraq with 1st Battalion, 8th Marine Regiment, 1st Sgt. G. Russell Hill was exposed to multiple explosions. The most damaging was when a rocket-propelled grenade landed about 3 feet away from him - throwing him 8 to 10 feet and injuring both his legs.
Hill knew his legs were hurt. But he didn't realize that - although he had no visible scars above his waist, except for some shrapnel in his hands - the blast may also have injured his brain.
Traumatic brain injuries are "really as old as human history," said Capt. Tom Johnson, Camp Lejeune Naval Hospital's neurologist. "Blast-related TBIs have been around since the invention of gunpowder."
But until recent years, many did not realize a person could sustain a traumatic brain injury without any visible damage to the skull.
Hill is one of thousands of Iraq veterans suffering from what medical officials call the war's signature health problem: a traumatic brain injury. At least 14 to 20 percent of surviving combat casualties in prior conflicts had a TBI, but experts estimate the numbers from Iraq are much higher, according to the Defense and Veterans Brain Injury Center.
A traumatic brain injury is caused by "a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain," according to the Centers for Disease Control and Prevention.
Hill isn't completely sure what caused his TBI. He didn't even realize he had a TBI until about a year after the blast he believes caused it.
"I didn't know anything had happened to me in my head," he said. "I had headaches, but, you know, you have a headache, you drink more water. ... I never put the two together."
Hill stayed in Iraq with his unit, and when it returned, he went through all sorts of emotions. He also went through all sorts of symptoms: headaches, dizziness, ringing in his ears. But he figured it was just part of the postdeployment process.
"A lot of the things I was feeling, I just put off to being back," he said.
But in summer of last year, he was still having headaches.
"When I read, or when I'm trying to really think ... try to get that right word or try and figure something out, I get a lot of burning in the top of my head," he said.
He went to see Johnson at the Naval Hospital.
Diagnosing the injury
All Marines and sailors are screened for mental and physical health problems before, immediately after and 90 days after returning from a deployment. Capt. Vince Arnold, head of Camp Lejeune's deployment health services, said officials hope the screening process catches everyone.
But, he said, much of the process relies on self-reporting.
That can be difficult with traumatic brain injury, said Cmdr. Tim LaVan, the Naval Hospital's director of medical services. After all, a person with changes in thought patterns may not recognize that symptom in himself, he said.
"The severe cases are not the ones that are hard to pick up," he said.
It's those like Hill - exposed to a blast but without a visible head injury - who are the challenge, LaVan said.
"A person with a TBI can look - even immediately after the blast - can look perfectly fine," said Capt. Mark Olesen, commanding officer of the Naval Hospital.
One of the reasons there has been a seeming surge in TBIs from combat, Johnson said, is simply that technology and medical care have increased. Now, he said, patients who may have died of their injuries in another war are living to fight another battle.
Plus, LaVan said, this is the first war in which nondirect explosives are the weapon of choice.
"Now, we see guys get knocked down and get back up," LaVan said. "Then, two months later, they (have symptoms of TBI)."
Often, Johnson said, patients with mild or moderate TBIs don't have a lot of structural damage to the brain. But the medical officers and corpsmen are trained to recognize the symptoms, he said.
Once Hill read the literature and the list of symptoms, he said he realized that it was exactly what he was experiencing. Still, he said, hearing that he had a TBI came as a shock.
"When he told me that ... it was almost like saying, 'You've got cancer' or something," Hill said.
Treating symptoms
Severe TBIs generally require surgery, Johnson said. But for mild and moderate cases, identification, education and therapy are effective, he said.
Hill went through a litany of tests - including brain scans and a sleep study - before going for cognitive rehabilitation at New Hanover Regional Medical Center in Wilmington.
There, he said a therapist would give him a list of things to do, then walk through the tasks and ask questions about what they had done.
"That's when I became conscious of the problems I was having," he said.
While he's able to remember things he's known for a substantial period of time, Hill often has trouble remembering things he's just been told.
For example, he said, if he were told to meet someone at a location he knew at a specific time, he would likely be able to remember. But if he were not familiar with the location, concentrating on that could make him forget the designated time.
Now Hill keeps a notepad with him to scribble reminders as needed, and he immediately types things into his phone when he can. Everything from his phone goes directly to his computer.
He said he also uses tricks he learned during sniper training earlier in his career to keep things in his mind. And he avoids situations he knows could cause trouble - like concerts, where too much stimulation would cause a sort of information overload, he said.
Though most of the treatment for TBIs is symptom-based, the goal "is not just to treat the symptoms," but to help the patient regain his former skills and functionality, Johnson said.
And the good news?
"The vast majority of people with mild to moderate TBI get better," he said.
Moving forward
Hill sometimes has trouble finding the right word - something he compares to a non-native English speaker searching for the correct term. But his TBI has not held him back at work, he said.
If it weren't for recurring problems with his leg, Hill would be deployed right now. Instead, he's on crutches after his third surgery and is transferring to the Wounded Warriors Battalion until he can heal.
The Army and the Navy separately are working on baseline tests to gauge the cognitive ability of service members before they deploy - and help diagnose TBI when they return, military officials said. The challenge, LaVan said, is finding a test that is accurate and reproducible over time.
Military officials also are "aggressively collecting" data about those with mild and moderate TBIs, LaVan said, to find out more about long-term effects and general trends.
The CDC estimates 1.4 million people sustain a TBI each year in the United States. At least 5.3 million Americans have a long-term or lifelong need for daily help as a result of a TBI, the CDC estimates.
But the Department of Defense is on the cutting edge of defining treatment, Olesen said. And what the military learns about how to diagnose and treat TBIs can benefit everyone, he said.
"Our civilian counterparts are going to greatly benefit from what we're learning," he said.
Contact military reporter Jennifer Hlad at jhlad@freedomenc.com or 353-1171, ext. 8449. To comment on this story, visit www.jdnews.com.
Ellie