| It has been nearly three years since the first real research on Traumatic Brain Injury was released and the realization that we really are dealing with a new kind of injury that doesn't leave visible scars and the effects of which may not be evident for months, or even years, began to sink in. In TBI, the Johns Hopkins study found, the cellular metabolism changed. Metabolic changes lead to a cascading effect, cells experience premature aging, and the result is neuronal death. Neurons do not replicate. Once a neuron is lost, it is gone forever. Brain damage at the cellular level is likely permanent - and will almost certainly lead to further neurological degradation over time. Put bluntly, G.I.'s afflicted by TBI are not likely to get better, and in fact will almost certainly get worse.
The effects of this cellular demise are symptoms, which range from vertigo, memory deficits and headaches to disorders of affect, such as anxiety, lethargy, and apathetic demeanor, that may not be evident for months, or even years. Making the diagnosis trickier is the fact that damage at the cellular level can't be seen with imaging techniques. Diagniostic criteria instead consists of a battery of tests of memory and motor skills and the diagnosis is made when the results of a sufficient number of the tests performed fall within certain parameters.
TBI differs from the concussions that many of us experienced playing sports - or just playing - when we were kids in very specific ways. A concussion is basically a bruise of the brain which heals over time. TBI is caused by percussive waves from explosions as the shockwaves pass through the body, and literally every person who has survived a violent explosion is at risk to develop symptoms of TBI, and the seriousness of the situation has been known for three years.
So why is the military still failing our service personnel nearly three years and hundreds of millions of dollars later?
- From the battlefield to the homefront, 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 One of the military tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded. A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.
- Even when military doctors diagnose head injuries, that information often doesn't make it into soldiers' permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.
- Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.
Even as healthcare professionals and even the NFL grapple with the importance of head trauma and the problems it can cause down the road, the military culture steadfastly resists dealing with the facts. Commanders at the highest levels refuse to accept that brain injuries are responsible for soldiers' troubles with memory, concentration and mental focus, let alone more serious problems.
"It's obvious that we are significantly underestimating and underreporting the true burden of traumatic brain injury," said Army epidemiologist Maj. Remington Nevin, who has served in Afghanistan and has pioneered work to improve the documentation of TBIs and other brain injuries. "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." [emphasis added.]
The Army is so intent on covering their ass here that General Eric Schoomaker, the Army's top doc, initially fired off an email ordering medical commanders not to talk to NPR or ProPublica when he found out they were asking questions about TBI and brain injuries. "We have some obvious vulnerabilities here as we have worked to better understand the nature of our soldiers' injuries and to manage them in a standardized fashion," he wrote. "I do not want any more interviews at a local level."
Later, when confronted with facts and reality, he 'fessed up to the shortcomings in diagnosis and documentation of head trauma. "We still have a big problem and I readily admit it.That is a black hole of information that we need to have closed."
That, Sir, is the understatement of the year.
There is no excuse for this.
Advances in battlefield medicine means that we bring a lot fewer kids home in boxes in this war than we have in wars past. That also means that we have survivors of trauma that would have died in the past who have to deal with that trauma the rest of their lives.
They deserve appropriate and adequate treatment and if their life and livlihood are threatened or compromised, they deserve disability benefits. The previous president and Rumsfeld treated our military like their personal plaything. That is a lot to overcome, and a good place to start would be with cashiering every fucking commander who scoffs at brain trauma as a cause of problems in soldiers' lives.
It is time to declare victory in both wars and come home. They are costing too much time, blood and treasure and they have broken our military in a very profound way. The rebuilding we faced after Vietnam was nothing like what we face now.
But don't just bring them home. Take care of them once they are back.
It isn't just an obligation, it's a duty. |
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