MEDICAL ADVANCES: UNDERSTANDING TRAUMATIC BRAIN INJURIES (TBIs)
By Texas Vet, First Cavalry
Decades ago, I got blown up—literally outside a tin can sh*t and shower hut while guarding one our military’s several DMZs (de-militarized zones)—Wild West-like territories separating two or more or warring factions. I suffered first, second and third degree burns along with head injuries, aptly named decades later as TBIs. The soldier, marine, sailor, or airman operating in or near Wild West lands is just as injured as when the war was declared ‘still alive’. Injured is injured. Death is just as dead. Two years from now, ask the 50,000 troops still left in Iraq.
If a warrior survives a TBI encounter, I can almost guarantee it will hurt for decades. It will have a major influence on the warrior’s life, and the lives around him or her. Make no mistake about that. Society and politicians will attempt to abandon the TBI warrior with nasty side-effects that include epilepsy, constant headaches, major depression, PTSD, fuzzy thinking, cancer, diabetes, etc. Suicide appears rampant amongst military ‘rejects’ with TBIs of various levels and intensities. Along with the appearance of side-effects comes total rejection by Society. Ancient superstitions run rampant and deep.
At latest official counts, over 115,000 of our country’s men and women in uniform have suffered TBIs of varying degrees in Iraq and Afghanistan. That number was never counted in Gulf War I, Viet Nam, Korea or WWII. It was totally ignored. Of the 2.6 million who served in combat and combat exposed duties in Nam, only 700,000 are alive today. How many died young from TBIs and their multiple side-effects? Medical science is at last struggling with understanding this long-buried phenomena.
TBIs are of two major categories, penetrating and non-penetrating.
Penetrating TBIs are the easiest to recognize when a projectile penetrates the skull bone, smashing through brain matter. Or a flying mass hits the skull and crushes the bone which itself causes brain injury and often, death. External blood, skin and bone damage is easily recognizable, easily understandable.
A non-penetrating TBI happens when the force of an explosion blasts the body one way and the brain is slightly delayed in catching up. Internal bony protuberances normally used to secure the brain in place actually penetrate, slice and damage the slopping brain mass. This is called the coup (coo) effect. When the head finally slams to a halt, the trailing, sloshing brain rams into the protuberances on the other inside of the skull, further mutilating brain tissue. This is called the contracoup effect. The net effect of both is called by science, the coup-contracoup event.
See: www.neuroskills.com/swfcoup.html for a simplified video.
Blast waves easily penetrate armored vehicle walls, often causing minor to major TBI injuries and often deaths. If a blast wave can travel through heavily armored metal, what is there to say about the much more delicate skull bones? The answer is pretty obvious.
Dr. R. Joseph, PhD www.brainmind.com states it succinctly, “Usually the force of the impact will force the brain to shift and/or bounce against and strike the inner bony prominences of the skull. When the brain has been contused, severely compressed or subjected to rotational shearing forces, axons are often severed and cells crushed. Thus, widespread cellular damage, varying in severity, is a likely consequence of head injury.”
The Neuroscience Doctor continues, “After a few months time, these (dead) cells are reabsorbed by the body leaving behind glia scars and small cavities… …that can in turn become a source of abnormal activity and may cause a development of seizures.”
In my case, as in the case of so many others, the blast threw me through the air causing a coup injury. When I slammed to the ground, the other side of my head hit a walkway, causing measurable contracoup damage. This was followed by more brain sloshing, banging and rattling around inside my skull.
It was the middle of a winter night. I staggered to my feet in absolute pain, clothes and skin on fire, to warn and try to protect my buddies by extinguishing the flames. Then, I collapsed. I lost all memory for several months. I remembered nothing until one blazing hot, late spring day. Because of the burns on my head and face, I had no x-rays as they would have served only to further any damage. I was diagnosed with shell shock (or its equivalent). That was the explanation for TBIs from antiquity into the 1990s.
Once my skin healed, I looked semi-okay, and I must have acted semi-normal to outsiders. I knew I was different, changed. But I was just a grunt in a politically declared “no war” scenario ( again, the politicians forgot to tell the insurgents). I was put back on duty riding shotgun in trucks delivering supplies to “secluded” outposts. I suffered numerous, short “spells” but was told this was normal. I was punch drunk, the doctors said, but I would get better in time.
Today, we know it takes typically two years and up to even 15 years for brain scar tissue to form and spread around brain injuries. Each new seizure event can increase the spread of cell damage and scar tissue. The growing scar tissue often creates as much or more havoc than the original injury(ies).
Within months after leaving the Army I suffered my first grand mal seizure and ended up in a civilian hospital. The Veterans Administration of the day wanted nothing to do with me. I spent the following decades at my own expense, visiting neurology ‘experts’ at the Universities of Washington, MIT/Harvard. Stanford, UCLA, and Texas. It was all to no avail, other than learning the benefits and limitations of the latest seizure control medicine. I had no other option.
Ultimately, my medical history got shared with the insurance world. By the mid-1990s I could no longer buy standard medical insurance. I could no longer hold standard employment—who wants a high risk proven epileptic as an employee, no matter how educated and smart he or she is?
I had no option but to turn back to an updated VA medical system. That proved to be a good thing.
This brings me to this past week. Magically, after years of bureaucratic hemming and hawing, groaning and sniveling, babbling and ignoring, whining and declining, claiming my records burned in the great St. Louis fire and on and on, some semblance of my military records and history of the explosion showed up in the summer of 2010.
Suddenly, after decades of being forced to “doing it on my own”—at least trying—the Inpatient Neurology Care Center at the Houston VA scheduled me to spend a week being live monitored 24 hours per day for five days, with 28 wires glued to my head. They led to a super computer that monitored activities in my brain, looking for electrical sparks and storms that coincide with injuries and seizures.
These 28 metal wires aid the doctors in trying to assess the activity of billions of “organic wires” that compose an active brain. For the first time in decades, I witnessed a positive step in the right direction.
The Houston VAMC is one of the half dozen Epilepsy Centers of Excellence and a major research center for TBIs. The doctors, nurses, nurses aides, technicians on down to the daily cleaning personnel (mostly Vets with fascinating personal stories) were professional and outstanding. The advances and dedication of the practitioners to solving this common military and civilian TBI problem versus what I’ve been dealing with alone for decades was a shock to observe. The bad news is they have only four beds.
Some friends asked why I would subject myself to this sleep-deprivation, seizure inducing environment. The answer is fairly simple. Tens of thousands of younger Americans are now stumbling down my path, attempting to survive moment to moment, day to day. I owe them this for their sacrifices, so similar to mine when I was their age. For the first time, I know, I really believe, I’m not alone.