Sunday, April 22, 2007

This Is Your Brain On Iraq

Appearing at The Blogging Curmudgeon, My Left Wing, and the Independent Bloggers' Alliance.

I could feel a huge concussion wave,
and then I couldn’t hear anything.

I told my sergeants my ears were hurting

and that I felt really weird.

My vision was acting all strange.

-- Spc. Paul Thurman

Paul Thurman was not supposed to be deployed. His brain had been damaged before he even left Ft. Bragg; a training accident in which a log was dropped on his head. Brain scans showed evidence of lesions. Yet, inexplicably, he was sent to Iraq. There he sustained a second head trauma; another training accident. An IED simulator went off three feet from his head.

Soon he was having dizzy spells, was losing his balance and couldn’t sleep.

His company sent him to Landstuhl Army Regional Medical Center in Germany, where the doctors, he said, told him he shouldn’t have been deployed to Iraq. They forwarded him on to Walter Reed Army Medical Center in Washington, where he said he spent “eight hours with the USO ladies eating cookies” before being packed off to Fort Carson. He said he was not examined while at Walter Reed.

Since the injuries, Thurman said he blacks out, has seizures that last up to 40 minutes, has short-term memory loss and maintains a constant headache. Once, in front of his Army lawyer, he started throwing up and having a seizure, he said.

But Thurman's Kafkaesque journey through the Army system continues. Instead of proper treatment, he has received disciplinary actions for problems resulting from his injury; an Article 15 for leaving a formation to take anti-seizure medication and a bad counseling statement for refusing to attend an 80 hour driving course. His medical file says he cannot drive. Today he is hoping for a court martial hearing so that his story can heard farther up the chain of command.

Brain trauma is the signature injury of the Iraq war. As increasingly elaborate body armour protects the torso, and even the limbs, the brain is still vulnerable to shock waves that helmets cannot deter.

For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries.

Here's why IEDS carry such hidden danger. The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front.

It is these sudden and extreme differences in pressures — routinely 1,000 times greater than atmospheric pressure — that lead to significant neurological injury. Blast waves cause severe concussions, resulting in loss of consciousness and obvious neurological deficits such as blindness, deafness and mental retardation. Blast waves causing traumatic brain injuries can leave a 19-year-old who could easily run a six-minute mile unable to stand or even to think.

Referred to as "the silent injury," in many cases the damage caused by concussive waves is not immediately apparent. And these "closed-head" injuries are harder to treat than even those commonly suffered by motorcyclists.

Traumatic brain injuries from Iraq are different, said P. Steven Macedo, a neurologist and former doctor at the Veterans Administration. Concussions from motorcycle accidents injure the brain by stretching or tearing it, he said. But in Iraq, something else is going on.

"When the sound wave moves through the brain, it seems to cause little gas bubbles to form," Macedo said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes."

Indeed it appears that even those troops who are not at close proximity to IED blasts can be affected. It is estimated that one third of our combatants may be suffering brain injuries, many who don't even know that damage has occurred. This has prompted the VA to start screening all Iraq and Afghanistan veterans who enroll. That will still leave roughly two thirds unexamined, as most never apply for veteran's health benefits. More tragic, the Pentagon has demonstrated far less vigilance than the VA in addressing these pernicious injuries.

What's baffling is the Pentagon's failure to work with Congress to provide a steady stream of funding for research on traumatic brain injuries. Meanwhile, the high-profile firings of top commanders at Walter Reed have shed light on the woefully inadequate treatment for troops. In these circumstances, soldiers face a struggle to get the long-term rehabilitation necessary for treatment of a traumatic brain injury. At Walter Reed, Macedo said, doctors have chosen to medicate most brain-injured patients, even though cognitive rehabilitation, including brain teasers and memory exercises, seems to hold the most promise for dealing with the disorder.

In fact, last summer the Pentagon reacted to the startling numbers of brain injuries by cutting it's funding request for treatment and research of the problem in half; from $14 million to $7 million.

That maneuver seems consistent with a larger agenda of minimizing treatment funds to troops across the board. As reported by NPR, troop disabilities are being pencil-whipped down to nothing. Lieutenant Colonel Robert Parker USA (Ret.) found that the Pentagon is now providing disability payments to fewer veterans than they were before the war.

Parker started digging through Pentagon data, and the numbers he found shocked him. He learned that the Pentagon is giving fewer veterans disability benefits today than it was before the Iraq war — despite the fact that thousands of soldiers are leaving the military with serious injuries.

"It went from 102,000 and change in 2001... and now it's down to 89,500," says Parker. "It's counterintuitive. Why are the number of disability retirees shrinking during wartime?"

One of the Pentagon's disappearing tricks is assigning injured veterans drastically lower disability ratings than their injuries demand. Tim Ngo who suffered a traumatic brain injury was rated by the Pentagon as only 10 per cent disabled.

Tim Ngo almost died in a grenade attack in Iraq. He sustained a serious head injury; surgeons had to cut out part of his skull. At Walter Reed Army Medical Center in Washington, D.C., he learned to walk and talk again.

When he got back home to Minnesota, he wore a white plastic helmet to protect the thinned-out patches of his skull. People on the street snickered, so Ngo's mother took a black marker and wrote on the helmet: U.S. ARMY, BACK FROM IRAQ. On this much, everyone agrees.

But here is the part that is in dispute: The Army says Tim Ngo is only 10 percent disabled.

"I was hoping I would get at least 50 or 60 or 70 percent," Ngo says. "But they said, 'Yeah, you're only going to get 10 percent'... And I was pretty outraged."

Even a 30 per cent rating would have guaranteed him a monthly check and enrollment in the military's health-care system. As it was he was given a medical discharge and a small severance payment; leaving him adrift, with no coverage, until he had matriculated into the VA system.

Instead, Ngo enrolled with the Department of Veterans Affairs. Typically, there's a waiting period for the VA.

In October, while he was uninsured, Ngo had a seizure, caused by his war injury. He remembers being outside and blacking out; he fell to the ground on the driveway.

"My girlfriend was freaking out because she didn't know what to do," Ngo says. "She didn't know if I was going to die because I had hit the wrong side of my head."

An ambulance took Ngo to the nearest emergency room for treatment. It cost him $10,000. Ngo says that today, the bills for the incident are still unresolved.

Since then, Ngo's injuries have been acknowledged by the VA as so serious that he has been granted 100 per cent disability. In fact, more than half of disabled veterans who transfer into the VA system have their disabilities uprated from 10-20 per cent to over 30 per cent. The Senate is currently investigating concerns that the DOD is simply punting their disabled veterans to the VA to improve their own bottom line.

What we have is a military system near the breaking point. Our troop levels are stretched so thin that we are redeploying injured, even broken, troops, and a chronically underfunded VA is left to clean up the damage. Ironically, the very resources that are keeping more of our troops alive on the battlefield, are returning them to a living hell of inadequate treatment.

These are the war's injured who once would have been the war's dead. And it is the unexpected number of casualties who in a previous medical era would have been fatalities that has sunk the outpatient clinics at Walter Reed and left those in the VA system lost and adrift.

In Iraq and Afghanistan, the ratio of wounded service members to fatalities is 16 to 1, if the definition of "wounded" is anyone evacuated from a combat zone. During the Vietnam War, according to the VA, the ratio was 2.6 to 1.

So we are bringing back more of our troops alive but to what kind of life?

Marine Lance Cpl. Brian Vargas was a high school football player. Now, even though he looks fit, he cannot toss the football with his buddies, let alone be part of pickup games with other off-duty Marines.

“I can't catch anything,” he said. “I can't remember any plays."

Vargas, 20, was subjected to innumerable mortar and roadside bomb blasts while patrolling the insurgent stronghold of Hit in the Euphrates River Valley. In mid-January he was shot in the hand and cheek by a sniper and airlifted to Germany and then the United States for treatment.

He has the classic signs of post-concussive injury.

“My thinking has gone down,” he said. “I can't remember what I did this morning. I have trouble putting memory and speaking together. I'm trying to learn to speak as clearly as possible.”

Lance Cpl. Keene Sherburne, 20, who was injured when a bomb exploded under his Humvee in Fallujah, is frustrated at the slow pace of his recovery.

“I can't read,” he said. “I used to love it, but now I hate it. I pick up a snowboard magazine and I get so mad because I don't understand it.”