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Friday, March 17, 2006

Newsweek Covers Combat PTSD and Brain Trauma

Newsweek today runs a web exclusive (why it's not in the print edition, I'll never know...) dealing with the hard realities facing our returning troops coping with brain injuries coupled with PTSD. Take a glimpse inside their world through one soldier's experience.

Click on 'Article Link' below tags for more...

Newsweek offers us the story of Sam Reyes, a Marine who was severely wounded in a Fallujah suicide bomb attack in September of 2004. He was one of the fortunate ones to have survived that day (12 others weren't as lucky); but, injuries he most likely would not have survived in previous wars have left his life radically changed. Following a painful 18 months of recovery, he's still struggling to piece his life back together.

Although his physical wounds have largely healed—save for scattered scars across his forehead and his sense of taste, which has yet to return—the bomb blast left Reyes, now 21, with a less visible, but devastating injury to his brain. Like many Iraq vets who survive the concussive force of an improvised explosive device, or IED, Reyes is now sometimes unable to recognize his friends or family, to recall what he just read or heard, to concentrate or to read faster than the average second-grader. ...

Like more than 1,700 military personnel wounded in Iraq and Afghanistan in recent years, Marine Cpl. Samuel Reyes Jr. is suffering from traumatic brain injury, known in military jargon as TBI, which leaves survivors unable to perform the most basic cognitive functions. According to officials at the Walter Reed Army Medical Center in Washington, TBI affects more than 25 percent of bomb-blast survivors like Sam Reyes, making it the signature injury of the Iraq war.

In fact, military officials say that were it not for advances in body armor, helmets and drastically improved battlefield medicine, the majority of survivors being treated for TBI would not have even survived their injuries as recently as the first gulf war 15 years ago. The increasing number of TBI survivors and the vexing limitations they face has become an enormous challenge for both military medicine and for the Department of Veterans Affairs, which will treat these survivors for life.

"In the military, the question is 'are you battle ready?'" says Dr. Harriet Zeiner, a clinical neuropsychologist for the VA in Palo Alto, Calif., where Reyes is being treated. "Our criteria at the VA [are], are you going to be able to hold down a job, sustain a relationship, get married, have kids or do you have something that's going to impair you?"

For Reyes, and hundreds of others suffering from TBI, the answers to these questions are still far from clear. The diffuse but debilitating symptoms of traumatic brain injury—which sometimes are not apparent until months after the bomb blast—can leave veterans with festering psychological problems and anger that often lead to failed relationships and careers, substance-abuse problems and the inability to adapt to civilian life.

Many TBI patients, like Reyes, are also suffering from posttraumatic stress syndrome (PTSD), a psychological condition affecting many combat veterans and other trauma survivors that is marked by flashbacks, nightmares, anxiety and irritability. The combination of TBI and PTSD, says the VA's Zeiner, "is pretty deadly." Reyes suffered damage to the frontal lobe of his brain, the area that helps a person calm himself after a stressful or frightening experience and where problem-solving takes place.

When Reyes becomes anxious, he quickly escalates to a state of agitation. It's not uncommon, says Zeiner, for those suffering from TBI and PTSD to "either drink themselves into a stupor," in an effort to self-medicate, or to become agoraphobic, afraid to go out where they may have to contend with overwhelming stimuli.

Reyes goes on to explain how his memory loss frustrates himself and others around him. He also explains his journey receiving care for his PTSD.

Soon after he arrived at the brain-injury center, Reyes's doctors began trying to convince him to go for treatment at the VA's PTSD center in nearby Menlo Park, where Vietnam veterans work side by side with active-duty Marines and soldiers, trying to find ways to deal with the lingering trauma of their respective wars. At first, Reyes resisted, worried that his fellow Marines might think he was weak. Meeting the other men in the PTSD treatment center had a big impact on him.

"Some of them are real tough, big guys, real smart, and that made me feel better. It showed me I wasn't the only one in the whole world who would have it." Reyes says his fellow Marines who haven't gotten help are suffering. "I tried to let some guys know who I thought could use help, and they said, 'Nah, I don't need that. I take sleep medicine and I drink, so I'm doing pretty good'." Although the Marine Corps is sending some mental-health workers into the field, Reyes says he didn't have any discussions about combat-related stress.

He got a brochure about PTSD at one point, but says it didn't explain the symptoms. "It scares me that all these guys could be just like me, having the same problems, and they're getting ready to ruin a whole lot of their life."

As the population of wounded Iraq veterans increases, the military is also trying to raise awareness about TBI, especially the less severe cases like Reyes's, which can easily be misdiagnosed or overlooked in the chaos of battlefield medicine. The Defense Department is developing a training course for medics to teach them how to screen for TBI in the field. Any injured combatant who has lost consciousness is a candidate for TBI diagnosis.

The military is also making plans to station a TBI expert at medical facility in Germany where the U.S. wounded are first evacuated after leaving Iraq. "I'm sure people do get misdiagnosed , says Dr. Warren Lux, deputy director of the Defense and Veterans Brain Injury Center at Walter Reed. "That is why we are trying to get education out there."

Read the rest of the piece, and then let Newsweek know you appreciate the coverage on this topic -- and perhaps they might even run it in the print version next time, too.

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