[humanser] The Wars Come Home: The Traumatic Brain Injury Epidemic

Thu Jun 23 01:11:26 UTC 2011

We know this.  thank you for posting the article. Last year we had our 
Human Services Division Program about returning Veterans who are blinded 
and their needing positive rehabilitation.

On 6/22/2011 8:45 PM, Susan Tabor wrote:
> Thank you so much for posting this; incredibly, incredibly sad! Yet another
> of the spoils of war is the tendency of society to deal with discomfort
> concerning war by attempting to put those who fought it out of sight and out
> of mind.--Susan
>
> -----Original Message-----
> From: humanser-bounces at nfbnet.org [mailto:humanser-bounces at nfbnet.org] On
> Behalf Of Mary Ann Robinson
> Sent: Wednesday, June 22, 2011 7:21 PM
> To: Human Services Mailing List
> Subject: [humanser] The Wars Come Home: The Traumatic Brain Injury Epidemic
>
> The Wars Come Home: The Traumatic Brain Injury Epidemic
>    By Conn Hallinan
>    Dispatches From The Edge
>    June 18, 2011
>    "We are facing a massive mental health problem as a result of our wars in
> Iraq and Afghanistan.  As a country we have not responded adequately to the
> problem.  Unless we act urgently and wisely, we will be dealing with an
> epidemic of service related psychological wounds for years to come."
>    Bobby Muller, President Veterans for America
>    "The multiple nature of it [multiple tours and longer deployments] is
> unprecedented.  People just get blasted and blasted and blasted."
>    Maj.  Connie Johnmeyer, 332nd Medical Group
>    According to official Defense Department (DOD) figures, 332,000 soldiers
> have suffered brain injuries since 2000, although most independent experts
> estimate that the number is over 400,000.
> Many of these are mild traumatic brain injuries (mTBI), a term that is
> profoundly misleading.
>    As David Hovda, director of the Brain Injury Research Center at the
> University of California at Los Angeles, points out, "I don't know what
> makes it `mild,` because it can evolve into anxiety disorders, personality
> changes, and depression." It can also set off a constellation of physical
> disabilities from chronic pain to sexual dysfunction and insomnia.
>    MTBI is defined as any incident that produces unconsciousness lasting for
> up to a half hour or creates an altered state consciousness.  It is the
> signature wound for the wars in Iraq and Afghanistan, where roadside bombs
> are the principal weapon for insurgents.
>    Most soldiers recover from mTBI, but between five and 15 percent do not.
> According to Dr.  Elaine Peskind of the University of Washington Medical
> School, "The estimate of the number who returned with symptomatic mild
> traumatic brain injury due to blast exposure has varied from the official VA
> [Veterans Administration] number of 9 percent officially diagnosed with mTBI
> to over 20 percent, and, I think, ultimately it will be higher than that."
>    Serious consequences from mTBI are increased when troops are subjected to
> multiple explosions and "just get blasted and blasted and blasted," in the
> words of Maj.  Connie Johnmeyer.
> Out of two million troops who have served in Iraq and Afghanistan, over
> 800,000 have had multiple deployments, many up to five times or more.
>    But mTBI is difficult to diagnose because it does not show up on standard
> CAT scans and MRI's.  "Our scans show nothing," says Dr.  Michael Weiner,
> professor of radiology, psychiatry and neurology at the University of
> California at San Francisco and director of the Center for Imaging
> Neurodegenerative Disease at the Veteranbs Administration Medical Center.
> They do now.
>    An MRI set to track the flow of water through the brainbs neurons, has
> turned up anomalies that indicate the presence of mTBI.  However, the
> military has blocked informing patients of results of the research, and if
> history is any guide, the Pentagon will do its best to shelve or ignore the
> results.
>    The DOD has long resisted the diagnosis of mTBI, as it has avoided paying
> for a successful -- but expensive -- way to treat it.  The price of that
> resistance is escalating suicide rates and domestic violence incidents among
> returning soldiers.  In 2010, almost as many soldiers committed suicide as
> fell in battle.
>    MTBI is hardly new.  Some 5.3 million people in the U.S.  are currently
> hospitalized or in residential facilities because of it, and its social
> consequences are severe.  A Mt.  Sinai Hospital study of 100 homeless men in
> New York found that 80 percent of them had suffered brain trauma, much of it
> from child abuse.  A study of 5,000 homeless people in New Haven discovered
> that those who had suffered a blow that knocked them unconscious or into an
> altered state were twice as likely to have alcohol and drug problems and to
> be depressed.  It also found mTBI injuries were correlated with suicide
> attempts, panic attacks, and obsessive-compulsive disorders.  And a recent
> study by Dr.
> Elaine Peskind of the University of Washington School of Medicine found that
> mTBI is a risk factor for developing Alzheimerbs disease.
>    In spite of the documented consequences of mTBI, the military has been
> extremely tardy in dealing with it.  Part of the problem is military culture
> itself.  The Pentagon found that 60 percent of the soldiers who suffered
> from the symptoms of mTBI refused help because they feared their unit
> leaders would treat them differently.  Many were also afraid that if they
> reported their condition it would prevent them from getting jobs as police
> and fire fighters after they got out of the service.
>    Even if soldiers wanted treatment, there are few resources available to
> them.  "There are two things going on regarding vets," says Col.  (ret) Will
> Wilson, chair of the American Psychological Associationbs Division 19
> (Military Psychology).
> "One, there are not enough care providers available, and, two, there are not
> enough people focusing on the problem outside the military."
>    Indeed, there are not enough military psychologists to treat the problem,
> and since the military pays below-market rates for civilian psychologists,
> up to 30 percent of private psychologists are unwilling to take on soldiers
> as patients.  The cheapest and easiest solution is to shoot up the vets with
> drugs.  A study by Veterans for America found that some soldiers were taking
> up to
> 20 different medications, many of which canceled out the effect of others.
>    The situation appears to be even worse for National Guard and Reserve
> units, who make up almost 50 percent of the troops deployed in Iraq and
> Afghanistan.  The Veterans for America found that such troops "are
> experiencing rates of mental health problems 44 percent higher than their
> active duty counterparts"
> and that their health care is generally inferior.
>    A Harvard study found that 1.8 million vets under 65 have no health care
> or access to the Veterans Administration.  "Most uninsured veterans are
> low-to-middle income workers who are too poor to afford private coverage but
> are not poor enough to qualify for Medicaid or free VA care," the study
> found.
>    Treating mTBI injuries is difficult, but by no means impossible.  Dr.
> Alisa Gean, chief of Neuroradiology at San Francisco General Hospital, who
> has worked with wounded soldiers at U.S.  Armybs Regional Medical Center at
> Landstuhl, Germany says the old conventional wisdom that brain damage was
> untreatable is wrong.  "We now know that the brain can heal.  It has an
> intrinsic plasticity that allows it to recover, and this is particularly
> true for the young brain." A recent study by the Massachusetts Institute of
> Technology found that "neurons in the adult brain can remodel their
> connections," thus "overturning a century of prevailing thought."
>    One method that has worked effectively is cognitive rehabilitation therapy
> (CRT) that retrains patients for tasks like counting, cooking, and memory.
> But CRT takes time and it can be expensive, ranging from $15,000 to $50,000
> per patient.
> However, the DOD-BS health program -- Tricare -- refuses to endorse CRT,
> because it says there is no scientific evidence that justifies the expense
> involved.
>    However, an investigation by T.  Christian Miller of ProPublica and Daniel
> Zwerdling of National Public Radio found that the vast majority of
> researchers, even those associated with the DOD, sharply disagreed with
> Tricarebs evaluation of CRT.  According to the two reporters, "A panel of 50
> civilian and military brain specialists convened by the Pentagon unanimously
> concluded that cognitive therapy was an effective treatment and would help
> many brain damaged troops." The therapy is also endorsed by the National
> Institutes of Health, the National Academy of Neurophysiology and the
> British Society of Rehabilitative Medicine.
>    Instead of accepting the advice of its own researchers, however, Tricare
> hired ECRI- a company which had already done a study concluding that CRT was
> ineffective-to examine the therapy.
> But critics charge that the study was so narrow, and the assumptions behind
> it so loaded, that it was almost a given that the study would conclude the
> benefits of cognitive therapy were "inconclusive." Outside researchers
> blasted the ECRI study, one of them describing it as "hooey" and "baloney."
> In spite of the criticism, then Deputy Secretary of Defense Gordon England
> concluded, "The rigor of the researchbandhas not met the required standard."
>    However, Miller and Zwerdling concluded that Tricare's resistance to CRT
> was not about science, but the bottom dollar.
> According to the reporters, a Tricare-sponsored study found "that
> comprehensive rehabilitative therapy could cost as much as
> $51,480 per patient.  By contrast, sending patients home from the hospital
> to get a weekly phone call from a therapist amounted to only $504 a
> patient."
>    Defense Secretary Robert Gates has already made it clear that he intends
> to cut the military's $50 billion annual health budget.  No matter how
> effective CRT is, it's not likely to get past the brass, who would rather
> spend the money on weapon systems than on healing the men and women who they
> so casually put in harmbs way.
>    So far, the military has put the clamps on the new MRI technique.  Dr.
> David L.  Brody, an author of the study, told the New York Times that
> researchers were blocked from giving the MRI results to patientsdd"We were
> specifically directed by the Department of Defense not to so," adding, "It
> was anguishing for us, because as a doctor I would like to be able to help
> them in any way.  But that was not the protocol we agreed to."
>    Given that mTBI is so difficult to diagnose, and sufferers are many times
> told there is nothing wrong with them, that seems an especially cruel
> protocol.  "Many of them [the doctors] were hoping we could give results to
> their care providers to document or validate their concerns."
>    In the end it will come down to treatment, and whether the wounded vets
> will get the care they need, or sit by a phone and wait for their once a
> week call from a therapist.
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-- 
Each day is a precious gift
David R. Stayer LCSW-R