Troops with brain injuries face other possible problems
December 5 2008
Traumatic brain injuries have become the signature wound of the wars in Afghanistan and Iraq and troops who sustain them face a daunting array of potential medical consequences later on, says a report on the issue commissioned by the U.S. Department of Veterans Affairs.
The report from the Institute of Medicine – a body that advises the U.S. government on science, medicine and health – said military personnel who sustain severe or even moderate brain injuries may go on to develop Alzheimer’s-like dementia or symptoms similar to Parkinson’s, a neurodegenerative disease.
They face a higher risk of developing seizure disorders and psychoses, problems with social interactions and difficulty holding down a job. Troops who sustain even mild brain injuries are more likely to develop post-traumatic stress disorder (PTSD). And all are at a higher risk of experiencing aggressive behaviour, depression and memory problems.
The report urged the U.S. government to ramp up research in the area, saying there isn’t enough evidence in the medical literature – especially as relates to mild brain injuries – to determine what today’s troops face and how best to help them recover from or cope with the health problems they may develop.
“The more severe the injury, the more likely there are to be bad long-term outcomes,” Dr. George Rutherford, chair of the panel that produced the report, acknowledged in an interview from Washington.
But Rutherford said that brain injuries don’t have to be severe or involve penetration of the skull to set up a soldier for significant health consequences.
“If you have a traumatic brain injury – especially if it’s moderate or severe – you have some chance of developing a disease down the line that you would not have developed otherwise,” said Rutherford, an epidemiologist at the University of California, San Francisco.
“For mild brain injuries, which is a much bigger group of injuries and it has a much broader scope, what we can say is for those kinds of injuries that there’s a probable association between having one of those – especially with loss of consciousness – and having depression, having aggressive behaviour … or having persistent post-concussive symptoms.”
“Like memory loss, like headaches, like dizziness.”
The panel read 1,900 studies on brain injuries looking for evidence of what troops who suffer brain injuries might face. But most of the studies relate to injuries suffered in car crashes and sports. The report says the injury picture could look different for troops who may also develop post-traumatic stress disorder from experiences in combat and that more research is needed.
The report noted that as of January 2008, more than 5,500 U.S. military personnel had suffered traumatic brain injury in Iraq and Afghanistan as a result of the widespread use against them of improvised explosive devices, or IEDs.
A similar Canadian figure for troops deployed to Afghanistan is not available, Maj. Andre Berdais, a senior public affairs officer with the Canadian Forces Health Services Group, said via email.
Berdais said that kind of data is not tracked by the Department of National Defence, as it isn’t “essential in supporting our primary responsibility of patient care.”
But New Democrat MP Dawn Black, who has pressed the issue as a member of the House of Commons’ defence committee, said these injuries are a growing problem among Canadian troops.
“The rates are going up,” Black said from Ottawa. “Intuitively we know. But we also know from anecdotal evidence from people in the field.”
Black said the problem was put on her radar by soldiers and their families. “I’ve met with some of them and seen it. I’ve met with some of the families and seen it.”
The force of an explosion can induce what is essentially a concussion in the brain, sending it ricocheting around within the confines of the skull.
The damage caused by even a mild brain injury can take six months to heal, said Dr. Donald Stuss, a brain expert and vice-president of research at the Rotman Research Institute of Toronto’s Baycrest Centre for Geriatric Care.
Injury can be done to different parts of the brain, triggering a variety of problems. But Stuss stressed that after-effects – or whether there are any long-term problems – will vary from person to person.
“So you may end up having somebody with a head injury who recovers perfectly and then afterwards has tinnitus (ringing in the ears) and dizziness from inner ear problems…. You may have some who end up with long-term memory problems,” he said.
Stuss said the key is to identify people with the problem and start treating them quickly.
The Forces’ Berdais said troops who have been exposed to explosions and may have suffered blast-induced injuries are screened for traumatic brain injury. Those found to be suffering from it are removed from active duty while they are symptomatic to prevent the risk of a repeat injury that could compound the insult on the brain.
And he said the Canadian Forces’ new physical rehabilitation program is in the process of developing policies and procedures for troops who continue to show symptoms of traumatic brain injury despite having received care.
Psychologist Gerrit Groeneweg, executive director of Calgary’s Brain Injury Rehabilitation Centre, said people suffering lingering problems from traumatic brain injuries can benefit from being taught coping techniques – strategies for improving memory and training to help overcome problems with attention.
But finding out how to best treat traumatic brain injuries among troops remains a challenge, said Dr. Greg Passey, a psychiatrist with Vancouver Coastal Health Services who spent 22 years in the Canadian Forces and who now specializes in treating PTSD.
“We don’t have a really clear understanding of what the potential long-term effects are,” Passey said.
“Because some of our soldiers have been exposed – they’re getting blown up more than one time. And although they don’t have significant outward physical injuries, you can certainly develop things like post-traumatic stress disorder or other types of psychological or psychiatric disorders.”
Those who go to war can suffer so many different problems.
Troops can be exposed to so many things. If or when they come home they need the best treatment and deserve it.
They should not be ignored as the ones from the First Gulf war. It took 17 years for the US to say well yes they are sick. There is such a thing as Gulf War Syndrome. Well 17 years is too long for any soldier to wait.
Other countries are in the process of eliminating these weapons however. Those who refuse to stop using them are the ones, who need to be pressured into stopping their use.
Of course troops going to war in any country with the US will be exposed to these types of weapons. What a shame.
If I am not mistaken the first two British soldiers to die in Kosovo were killed by a cluster bomb. If they had not been used those two soldiers may still be alive today.
In the Old Days they had something called Shell Shock
“By 1914 British doctors working in military hospitals noticed patients suffering from “shell shock”. Early symptoms included tiredness, irritability, giddiness, lack of concentration and headaches. Eventually the men suffered mental breakdowns making it impossible for them to remain in the front-line. Some came to the conclusion that the soldiers condition was caused by the enemy’s heavy artillery. These doctors argued that a bursting shell creates a vacuum, and when the air rushes into this vacuum it disturbs the cerebro-spinal fluid and this can upset the working of the brain.
Some doctors argued that the only cure for shell-shock was a complete rest away from the fighting. If you were an officer you were likely to be sent back home to recuperate. However, the army was less sympathetic to ordinary soldiers with shell-shock. Some senior officers took the view that these men were cowards who were trying to get out of fighting.”
Well many today are still called Cowards because, they become mentally ill. When will that ever change?
Many are still being sent back to war, that should not be sent back. War caused problems mental and physical. It always has and it always will. This problem is not new, but very old indeed.
They are still exposed to many dangers. They are not cowards they are sick. War makes people sick.
They need all the understanding and help they can possibly get.
They should never be ignored. Their needs are very real.
Governments cannot hide the truth forever. Someone is always watching.