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Thousands of soldiers live with 'silent epidemic'
Troops struggle to cope after suffering traumatic brain injuries
 Mark Humphrey / ASSOCIATED PRESS Bryan Malone, 22, an Army specialist from Haughton, La., was injured during a rocket attack in Baghdad. He works with speech pathologist Sara Granberry at Vanderbilt Medical Center in Nashville, Tenn. |
NASHVILLE, Tenn. - “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 rewired their circuitry and left them with the “silent epidemic” of the Iraq war — traumatic brain injury, or TBI.
Several thousand troops have been treated for it, and thousands more are believed to be suffering undiagnosed.
As more young men and women return from the war, TBI is a growing burden — for them, for the too-few doctors and programs available to treat them, and for taxpayers, who pay for their care and disability if they cannot hold jobs or make their way in the world.
Memory improves, emotional trauma starts
People with TBI have frequent headaches, dizziness, trouble concentrating and sleeping; are depressed, irritable and confused, and may be easily provoked or distracted. Speech or vision also can be impaired.
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Many symptoms overlap with those of post-traumatic stress disorder, or PTSD. Odd as it may seem, brain injury sometimes protects against PTSD by blurring awareness of what happened. But as memory improves, emotional problems can emerge: One of the first “graduates” of Vanderbilt University’s brain injury rehabilitation program committed suicide three weeks later.
“Of all the ones here, he would not have been the one we would have thought,” said the program’s director, Sandy Schneider. “They called him the Michelangelo of Fort Campbell” — a guy who had plans to go to art school, she said.
Some brain injury sufferers have been misdiagnosed with personality disorders. Others 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, San Francisco.
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Mark Humphrey / AP Eric O'Brien, 32, an Army staff sergeant, tries to remember tasks he needs to perform as he prepares to take a walk with occupational therapist Jenny Owens at Vanderbilt Medical Center in Nashville, Tenn. |
Most TBIs are mild, and most recover within a year. But one-fifth of troops with these mild injuries will have prolonged or lifelong symptoms and need continuing medical care, the military estimates. Nearly all of the moderate and severe ones will, too.
Diagnosing TBI is imprecise — damage rarely shows up on CAT scans or other tests. Treating it is a crapshoot, because little is known about the brain injuries from blasts in Iraq versus the ones from falls and car crashes that doctors are used to seeing.
“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,”’ Schneider said.
The usual approach is to work on specific symptoms and deficits — headaches, anxiety, vision problems, attention span — rather than try to cure the injury itself, since no one really knows how to do that.
But many troops with mild TBIs do not get care. Malone and O’Brien feel lucky to have had other wounds. Otherwise, government and private doctors say, they may have been sent back to fight with their brain injuries undetected.
Many injuries not obvious
“It’s hard to get treatment unless you get hurt,” Malone said.
“I had no antibiotics, no pain medication or anything. They just sent me on my way,” O’Brien said.
Malone’s brain injury was obvious. O’Brien’s took longer to be noticed even though it happened at the same time. O’Brien, a 32-year-old Army staff sergeant from Iowa’s Quad Cities, was teasing Malone, 22, a specialist from Haughton, La., in a Baghdad gym last summer.
“I told him and his workout partner: ’Put some more weight on it,” and they got up. Seconds later, a rocket hit where they had sat. They survived, but a pressure wave from the blast coursed through their brains.
“I patted myself down head to toe, making sure I wasn’t missing a limb,” and felt odd, like “I must be missing a chunk of my head,”’ O’Brien said. A guy yelled, “I’m hit,” and O’Brien saw him covered in blood. He remembers little else except walking through debris to pick up his iPod and sunglasses.
A ceiling air conditioning vent had fallen on Malone’s head and he had shrapnel wounds.
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“I remember coming to and thinking: Why was it so bright, and why was it so sandy, with all the light coming through the roof?” Malone said.
He had multiple surgeries, spent several months in Walter Reed Army Medical Center, and now has titanium mesh reinforcing the back of his skull.
O’Brien, however, had shrapnel removed from his scalp and was sent back to his unit. When he later complained of pain, doctors gave him Motrin. When he discovered a trickle of blood from his hip, they said he would be fine. Six weeks later, when he could barely walk, tests revealed shrapnel in his hip. By then, he was having headaches and trouble sleeping.
O’Brien had been through multiple previous explosions — on average, troops in Iraq experience one a month, one study found — and each blast raises the risk that the next one will do harm. Troops are proud and reluctant to go “off mission” just because “they get their bell rung,” said Dr. Michael Kilpatrick, a top Defense Department physician.
“Most of the treatment is explaining the situation and giving the tincture of time — giving it time to heal,” he said. If no big symptoms appear in eight to 12 hours, “they’re probably ready to go back.”
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