The Mission: To Diagnose & Treat Troops Suffering From TBI

July 25, 2008

One of the most common injuries to be seen coming out of the combat zones of Afghanistan and Iraq are Traumatic Brain Injuries. Because of the complexity of the injury and the fact that it’s not an injury that can been visually seen, in the past, our Troops haven’t been treated for this injury. Many have also been sent back to the combat zone, due to the hidden nature of the injury, putting them at more risk of further injury. The problems that can be caused by a traumatic brain injury, if not diagnosed and treated appropriately, can be life changing and possibly career ending.

Now, with new aggressive screening being done on Soldiers who are injured and flown to Landsthul Army Medical Center in Germany, more and more of this injuries are being diagnosed and Troops are receiving the treatment the injury requires. Because our Troops in the combat zone risk being exposed to sometimes multiple blasts , the concussion type effect can cause severe injury to the brain, as it’s effects causes the brain to slam against the skull.

The Pentagon has now mandated that all military branches begin to screen Troops for Traumatic Brain Injury. Some bases are even testing Soldiers prior to deployment and again after they return, in hopes that by comparing the two test results, they’ll be better able to identify Troops who have suffered a TBI.

When Troops are wounded or injured in Afghanistan and Iraq, one of their first stops is at the Army’s Landstuhl Regional Medical Center. There, an aggressive screening program is conducted. Even if they aren’t there for a possible brain injury, the screening is conducted and many previously missed TBI’s are being discovered.

“One of the things we’ve learned here at Landstuhl is you have to be actively looking for this to find it,” said Col. Stephen Flaherty, who oversees the TBI screening process at Landstuhl.1

If doctors have even the slightest indication that a service member has suffered from TBI, it’s almost a certainty that they won’t be returned to combat. In the past 6 months, several hundred Troops were diagnosed with mile TBI. Only two of them have been allowed to return to the combat zone. The hopes are that the aggressive screening process at Landstuhl will provide caregivers with valuable information that will help them learn how to best spot and treat brain injuries.

“If I have a hint of a whiff of suspicion – no matter how vehemently you want to go back downrange ( to Iraq) – that you will be compromised, then I’ve got to be the black hat and say, ‘No you’re not going back,’” says Major Shawna Scully, a neurologist who directs TBI recovery. “I’m sure there are some commanders downrange,” she added, “who are furious with me because I didn’t take X Soldier and send them back.”2

In Landstuhl, the TBI screening program began in 2006, but was expanded in the past year. As new patients arrive, they are asked about the way they were hurt and any symptoms that they might have, such as headaches, nausea, dizziness, light sensitivity and balance problems. Memory skills are also tested, such as short-term memory and problem-solving skills. A neurophysical exam, MRI and eyesight evaluations are also performed. Since 2006, doctors at Landstuhl have been able to identify 2,391 brain injuries in Troops. Most of them received that injury from exposure to a blast. According to their numbers, TBI injuries make up about 15% of all the patients who arrive at the hospital.

Two such Soldiers at Landstuhl, SPC Kyle Thompson and PFC Chad Williams are still being treated for the effects of TBI. Just looking at them, an observer might not even realize that they’re injured. These Soldiers are two example of what Scully calls her “ghosts.”

“They’re the ones who are walking and talking. They look fine. But you spend a little bit of extra time with them and you realize that something isn’t right,” she said. “They’re the ones who are easy to miss.”3

Both Thompson and Williams were injured by the same blast, a 2,000 pound bomb that explode, sending shock waves out from it. They were two, among 18 other Soldiers who were injured when a suicide bomber detonated the explosives at the gate of a patrol base in Kirkuk. One other Soldier was killed in the blast. Both were about 50-60 feet from the blast, when it was detonated. Thompson was walking across the compound and the force of the blast left him unconscious. Williams was in his room packing gear when the explosion happened. He was thrown across the room from the force of the blast and was struck by a heavy door. He blacked out for a short period of time.

“We may seem normal,” Thompson said, “But we get headaches that are crazy. Neither of us can get a wink of sleep unless we’re heavily medicated. First couple of days after the incident, I couldn’t walk. I didn’t have the ability to stand up on my own without help. My balance is still very disoriented.”4

Both say that they are frustrated by their injuries …. Ones that can’t been seen with the naked eye. They say that they’d have rather been shot, as they feel that cuts and scars eventually heal. With TBI’s it’s unknown if they’ll recover and be able to return to duty, or if they’ve have to be medically retired, because the TBI has caused them to be disabled. Both are adamant that they don’t want to be discharged because of a disability stemming from their head injury.

Major Scully says that at Landstuhl, she emphasizes that the brain is allowed to begin healing. The start of that process, is to help ease the headaches that many suffer and helping to reestablish their sleeping patters. Another key is to reduce the patients anxiety, by providing them with knowledge about their injury. Prior to arriving at Landstuhl, not knowing what is going on with them, many Soldiers are frightened and lost.

“When these folks come to me, there is one thought on their mind. And that is, ‘What the heck is going on?’” said Major Scully. “When you brain is hit that hard, you can’t depend on you anymore. That has them upset. That has them scared. And that has them wondering, ‘Where do I go from here?”5

As wounded soldiers with TBI undergo treatment, their future is unclear. Many of them want nothing more than to be released by their doctors to return to the combat zone. Often they don’t know if that will happen, or if they’ll even be able to remain in the Army. For some of them, those who chose to make the military their career, the possibility of not being able to continue serving is devasting. Currently there is no set policy in the military on how many brain injuries is too many, to continue serving. When they appear to score well on the problem solving and short term memory tests, they are determined to be fit for combat again.

TBI’s are being compared to concussions that football players might receive during a game. It has been a topic of intense discussion and debate. In football, sideline physicians will usually allow a player to return to the game once their symptoms subside, sometimes within a few days. There is however, growing concern in football that multiple concussions could possibly leave permanent brain injury. Boxing is another sport in which competitors are subject to repeated concussions. Military officials are being advised and working closely with physicians from both sports, due to the similarities of the injuries.

Because of their desire to stay in the fight and not leave their comrades in arms, often Soldiers who receive blast injuries won’t report their symptoms to anyone. They then return to combat. If exposed to a blast again, before their brain has had the opportunity to heal, they’re risking sometimes permanent brain injury. Many will have problems, seemingly unrelated, at the time, to the blast injury, such as stumbling and injuring an ankle. When they get to Landstuhl, they all go through the screening process and their TBI is discovered.

“I can’t make up for the fact that a lot of these guys never got the care they needed,” Major Scully said. “But when they come to me, I can take care of them now.” 6

(Army Lt. Col. (Dr.) Margaret Swanberg, checks the pupils of Army Spc. Michael Woywood, of San Antonio, for dilation during a military acute concussion evaluation demonstration at Forward Operating Base Hammer, Iraq, July 18, 2008. U.S. Army photo by Pfc. Michael Schuch, 2nd Brigade Combat Team, 1st Armored Division)

The Military is also attacking the problems of TBI on the battlefield as well. Soldiers are being trained as far as symptoms to look for in their fellow Soldiers after a blast. The Army has also deployed an Army Neurologist, in fact Lt. Col. (Dr.) Margaret Swanberg the only Army Neurologist who is currently deployed. She is the officer in charge at the Sgt. Robertson Aid Station at FOB Hammer and part of her job is to train medics all across Iraq, on the military acute concussion evaluation (MACE). Because she’s the only Army Neurologist in Iraq, she has a huge responsibility. However, she takes that job in stride, knowing that what she’s doing in Iraq, can help to ensure that those who need treatment can receive it as soon as possible and those who are ‘good to go’ can return to their units. 7

This is a very real injury. It’s an injury, that if not diagnosed and treated can have lasting effects. With our Troops facing the situations they do in the combat zone, if they ignore those symptoms and stay ‘in the fight’ and are exposed to more blasts, they are putting themselves at risk for an injury that could be permanent and effect their careers, their lives and their health.

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2 Responses to “The Mission: To Diagnose & Treat Troops Suffering From TBI”

  1. HUHEY PEEBLES on October 29th, 2008 8:59 am


  2. Terri on October 29th, 2008 2:46 pm

    Mr. Peebles, I would suggest going to the closest VA hospital and have them do evaluations for TBI. During the time you were in the military, TBI’s weren’t recognized as a service related problem. However now with it being recognized, hopefully you can get help. Please keep us up to date on what happens.

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