The not-so Invisible Injury

The tag-line to this blog is “Ensuring that no Veteran is left behind.”  Too bad the military medical system doesn’t follow this motto for all our active and veteran service men and women.

Today in the daily news headlines that our PR person sends out at our office, I saw an article titled, “Military Still Failing to Diagnose, Treat Brain Injuries” by T. Christian Miller and Daniel Zwerdling on NPR.  I began reading this rather lengthy, detailed and well researched article and found myself getting quite fired-up.  This is a topic, as Dan can confirm, that really irks me.

To give you a little background, my mom is a speech therapist and from the time I was old enough to ride a bicycle, I heard stories about people suffering from brain injuries because they were not wearing helmets on their bikes and motorcycles or they fell off of something and hit their head.  Never once did I think that all those stories and pieces of information and treatment I heard, and overheard her talk about, would be useful to me today.

As Dan has shared with all of you, he has been blown up more than just a few times.  But what he hasn’t shared is that after each explosion, even after the worst ones, no one ever said to him “let’s get your head checked out.”  In fact, even Dan just sort of shook it off- “no big deal, I’m alive” he would tell me.  Of course I was always emphatically telling him that he needs to go see a doc to get his head checked out (especially after the worst one).  All I could think about were the stories I heard my mom tell when I was younger.  “My patient has lost almost all his motor skills/cognitive abilities/long term memory/short term memory/complete and total memory loss, there is not much I can do for them except help them re-learn basic skills.”

The thing about any brain injury, especially a MTBI,  is that often they go undiagnosed and the problem, which is at the cellular level, gets worse and worse and goes un-noticed until it is “too late.”

The NPR article says that the MTBI is “one of the wars’ signature wounds. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.”

I want to point out that the above quote says “no visible scars” and while that is technically true, can you tell me that there are no visible scars to a family who has essentially lost their loved one due to an MTBI?  Is there not pain and frustration scrawled across the faces of their family members?  In the article they feature a woman who was involved in two roadside bomb attacks in Iraq several years ago.  The effects of those attacks have had a severe impact on her life, and the life of her father who looks after her, “the joyful, bright child he raised…is gone, forever gone.”

Dan and I have also gone through our own pains of dealing with what is thought to be symptoms from an MTBI, but would you believe it, has not been officially diagnosed.  The physical he went through during his out-processing from the Army almost a year after coming home from Iraq, just chalked up his numerous concussions to a “diagnosis” of a MTBI.  No MRI was ever performed.  That’s right, no MRI.  You want to know how he is finally getting an MRI?  He’s getting an MRI because he signed up to be part of a medical study on veterans who were involved in explosions.

Dan isn’t the only one who has been in this position, most of the time, as the NPR article found, “the military’s doctors and screening systems routinely miss brain trauma in soldiers.  One of the military tests fails to catch as many as 40 percent of concussions…”  My response to this is “WHAT?!”  As I continued to read the article from NPR, I saw that they found many others who were outraged at the entire situation…

“This is an issue which is causing real harm. And the senior levels of leadership that should be responsible for this issue either don’t care, can’t           understand the problem due to lack of experience, or are so disengaged that they haven’t fixed it.” – Maj. Remington Nevin, an Army                             epidemiologist who served in Afghanistan and has worked to improve documentation of TBIs and other brain injuries.

“Talk is cheap. It is easy to say we honor our servicemen…I don’t think the services that we are giving to those servicemen honors those                      servicemen.” – Dr. Keith Cicerone, who works in neuropsychology and cognitive rehabilitation at the JFK-Johnson Rehabilitation Institute in           New Jersey. All of his patients have suffered traumatic brain injuries.

“We are not doing service to our bravest…There needs to be a sense of urgency on this issue. We are not doing justice.” – Rep. Bill Pascrell Jr.,             D-N.J., who has led efforts to improve the treatment and study of brain injuries.

But then, as the NPR article sites, you get people like retired Army psychiatrist Charles Hoge, who has been more than critical of the diagnosis of MTBI.  He wrote this in an email to a colleague in an email in April 2010- “What’s the harm in missing the diagnosis of mild TBI?”  He claims doctors could treat patients’ symptoms regardless of their underlying cause.

The thing is I think PTSD and MTBI’s do share a few similar symptoms.  The issue I see is that the military’s medical institutions are failing to take the time to distinguish between the two.  When Dan returned home from Iraq (and Afghanistan for that matter) he should have received a thorough medical evaluation, including a MRI or CAT scan, especially if it was documented that he had been blown up.  –As a side comment, for those in country at the moment or heading that direction, NPR’s article shared that often times medical records are lost, thrown out and burned in country, which is why it is important to keep your own form of documentation as well as making a point to document it with your chain of command in any way, shape or form. (More information is in the article about this issue)- Basically I had to beg Dan to bring it up during his out-processing physical and make sure that the doc wrote it down.  He even asked for an MRI, but as I said before, the doc just said, oh I’m sure it’s a MTBI based on your records.  But the funny part is, he never once suggested Dan go through cognitive therapy, which is used to treat MTBI’s.  The NPR article references the importance of cognitive therapy stating, “Such therapy can retrain the brain to compensate for deficits in memory, decision-making and multitasking.  A soldier whose injuries are not diagnosed or documented misses out on the chance to get this level of care – and the hope for recovery it offers…”

Sometimes I wonder if when Dan forgets where our favorite restaurants are located, if it is related to his MTBI or the lasting symptoms of PTSD.  Does he zone out on the TV because he can’t multitask due to MTBI or is it because he is a guy? (Sorry guys, you know it’s true).  Does he forget that Sunday, Tuesday and Thursday night the trash has to go out on the side walk because of a MTBI or does he forget because he just doesn’t care and knows I’ll tell him anyway?

I have to say that I am thankful my mom has been a good support system for us, especially when it comes to questions, tips and thoughts dealing with his “MTBI” and PTSD.  I’m also thankful that Dan does recognize the issues now (there was a time when he didn’t) and has worked to overcome a lot of them.

Someone once asked us, “do you think PTSD is contagious?”  Now, a similar question bothers me me, I wonder if the effects of undiagnosed and untreated brain injuries are contagious.  I often forget little things that I need to do because I feel the need to remember a lot of things for Dan because I’m worried he doesn’t remember. I often feel guilty when I forget to remind him of something that I know he needed me to remind him of.  The reason I feel guilty is because I am in control of remembering things- I haven’t been blown up- I should be able to remember.

The silly part is Dan feels like he should be able to remember too.  Why? Because the Army doesn’t classify his injury the same way they do for someone who lost an arm.  They are told to suck it up and keep moving.  What is going to happen (or is happening) when half their men and women have a hard time remembering orders, can’t focus long enough to complete a task, or start slurring their speech?  Are they going to attribute that to PTSD too?  Or are they going to recognize that there is a bigger issue at hand?

I’m disappointed with our military’s way of dealing with a lot of things right now- especially when our men and women in uniform always put the military first, above their friends and family.  But why does the military not put our Veterans and those suffering from brain injuries at the top of the list?  I think many families and friends of service men and women may feel the same way and wonder the same thing.  And I would bet that those who served would agree with a quote from the woman featured in the article, “I served my country.  Now what’s my country doing for me?”

~Allison (Dan’s not-so-silent rank)


5 responses to “The not-so Invisible Injury

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