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Brain injuries common for Iraq war vets
Thanks to body armor, thousands survive combat but face lengthy rehab
By Robert Bazell
Chief science and health correspondent
NBC News
 
Updated: 6:44 p.m. ET April 26, 2006
PALO ALTO, Calif. - More injured troops are surviving the war in Iraq than any other. But because of the terrible force of IED explosions, more are surviving with brain injury than in any other war.  Jason Poole was on his third tour in Iraq when, as he puts it, he got “blasted.”  “I was unconscious for two months,” Poole says. “And then I woke up in Bethesda, in Washington, D.C.”

That was at the Naval Medical Center. For two years now Jason has been treated at the Palo Alto VA Hospital — one of four specialized centers for rehabilitation of the huge numbers of brain injured troops. The program uses intense, individualized physical and mental rehabilitation.  Dr. Harriet Zeiner is a clinical neuropsychologist in the hospital’s polytrauma unit. “Every hour of the day something is done,” Zeiner says, “And we're very careful to keep within the envelope of what someone is capable of doing and pushing it just a little.”

Angel Gomez is learning to walk again.  Frank Sandoval is struggling to eat on his own.  Most of the patients treated in the brain rehabilitation program go back in the community, but about 10 percent wind up in nursing homes or other long-term assisted living facilities on a permanent basis.

Jason Poole already is living in his own apartment — even taking driving lessons in a simulator and starting remedial reading classes at a community college — as he continues the rehab.  “Motivation isn't usually an issue,” Zeiner says, “Awareness that you're not gonna be that same person is the problem.”

Poole says he accepts that he will always have difficulty with speaking and memory.  “From the day I was born I've always been happy,” Poole says. “I know I got blasted and basically I came alive, you know, but basically it's just that I'm still happy.”  Thousands of other vets are facing the same challenge of accepting their new selves.

© 2006 MSNBC Interactive

URL: http://msnbc.msn.com/id/12482733/


The Iraq war’s hidden wound
Brain injuries are common in combat, but they’re not always apparent
By Robert Bazell
Chief science and health correspondent
NBC News
 
Updated: 7:51 p.m. ET April 26, 2006
PALO ALTO, Calif. - Alec Geiss, a sergeant in the Army National Guard, broke several bones when his truck overturned in Iraq. Months after he was home and healed, his wife Shana began to notice changes in his personality.  “He was very quick to temper,” she says, “[He] would get irritated at things that never bothered him before, sleeping all the time.” 

Alec did not perceive a problem.  “I thought there wasn't anything wrong with me,” he laughs. “Everybody else was screwed up.”  Dr. Henry Lew of the Palo Alto VA Hospital says it is a very common scenario.  “You don't see shrapnel or bullets or open injuries,” Lew says. “But the inside of the brain has been damaged to a point that it affects the daily function.”

Veterans Affairs psychologist Harriet Zeiner says that often people will think a brain-injured vet is depressed or suffering from post-traumatic stress.  “It's really important,” Zeiner says, “that individuals out in the public know that it's entirely possible for someone who's been in the combat theater to have a head injury and not know it.”  Geiss finally had his problem diagnosed. He's been through months of rehabilitation, but he still has occasional emotional outbursts and memory problems. 

“Sometimes, a new memory will stick in there, like, I don't know why,” he says. “And then other times — there's nothing.”  Before the war, Geiss ran a construction business. Now, even though he looks fine, he knows that he can't do that again.  “The hardest thing,” he says, “is to tell yourself you're not fine. You're not... It's real hard to keep everything together when you're not together yourself and you don't even know that something is wrong.”

Like thousands of other returning Iraq vets, Alec Geiss faces an uncertain future, because of a hidden wound.

© 2006 MSNBC Interactive

URL: http://msnbc.msn.com/id/12501855/


THE SIGNATURE WOUND OF THE IRAQ WAR

Posted by Robert Bazell, Chief Science & Health Correspondent (06:34 pm ET, 04/26/06)

Robert Bazell, Chief Science & Health Correspondent

Many troops in Iraq with brain injuries may be returning to duty. That’s right -– they’re  not getting treatment –- not even getting a break –- but going right back into the field. We've been reporting on the enormous numbers of brain injuries among Iraq vets for the past two nights. (Read part one here; part two here.) I'll reiterate the numbers and the reasons below. We could not fit this aspect of the story in these two reports, so I want to point it out here. 

According to the VA doctors who run the rehabilitation programs for brain injuries, when troops are wounded in the field they are evacuated immediately if they have any obvious wounds. But the signature enemy weapon of this war has been the roadside bomb – the IED.  The human brain is the consistency of gelatin and the force from the explosion shakes it ferociously. Many thousands of troops in Iraq have felt the blast of an IED. If they are knocked unconscious, according the VA docs, they too are evacuated to a field hospital for evaluation. But if they are not and if they do not complain of a problem, they remain on duty.

Specialists in brain injury know all too well that people can suffer brain problems without losing consciousness. One of the most frightening aspects of brain injury is that brain-injured people often lose the ability to know something is wrong.

Dr. Harriet Zeiner, a VA psychologist and brain injury specialist, was recently on a conference call with medical officials at several military  treatment facilities including hospitals in Iraq. "One of the things commanders are trying to determine," she says, "is that after someone has been exposed to five and six concussive blasts are they still battle ready? Frankly, that floored us. You could have very significant effects from one exposure, and now they're trying to figure out if people who've been exposed five and six times should be going back into battle."

To follow up on those comments, I called the Pentagon several times to request an interview with someone who would explain the policy of what field commanders do to determine if troops are suffering brain injury, and what is the policy for returning them to duty. My requests were denied repeatedly.

But beyond that problem, as we have been reporting, the toll of brain injury in this war is enormous. Almost 18,000 troops have been wounded according the Department of Defense. The VA doctors say that two-thirds of them have been injured by IED blasts and two-thirds of those exposed to blasts suffer some brain injury -- ranging from a mild concussion to permanent damage. Brain injuries -– thousands of them –- could be the legacy of this war just as much as post-traumatic stress and problems from exposure to Agent Orange persisted among many of the troops who served in Vietnam.


The story has now officially broke, these critical centers for the treatment of our wounded soldiers with traumatic brain injury are to close due to the funding of the these brain injury centers being cut to dysfuncitonal levels.
PLEASE INVESTIGATE THIS CRIME THAT IS ABOUT TO BE COMMITTED ON OUR HEAD INJURED SOLDIERS WHO CANNOT DEFEND THEMSELVES AGAINST THIS COWARDLY ACT! THIS IS AN EMERGENCY THAT REQUIRES THE LIGHT OF PUBLIC OUTRAGE TO CORRECT THE SITUATION!
http://www.usatoday.com/news/washington/2006-08-08-brain-center_x.htm

 

I know Traumatic Brain Injury - only too well. My daughter sustained a severe TBI in August 2004. Nothing - NOTHING changes a person or their entire family more! Her life and ours will never be the same. Unlike many, we are blessed, her physical injuries have not affected her function BUT the cognitive and emotional deficits reach into ALL aspects of life and affect every minute of every day.
It is a documented fact that record numbers of TBI are a result of this illegal, immoral war in Iraq. Yet--------President Bush has cut ALL grants (they were only $9 million a year) that fund state TBI programs from his 2007 budget. Where, who, when, how will these poor victims find the rehabiliation and support they need to live????
How dare he send our boys to suffer these horrible injuries and THEN cut the funding they need to recover to their maximum potential.
This is a disgusting commentary on our administration! The American people need to know. Please continue broadcast the story of TBI. Thank you.
And yes Mr. Briseno, we, (TBI survivors and families) do believe nothing is impossible!! Many of us have seen accomplishments far beyond the doctors predictions. That is my wish for ALL!

 

My son Joseph Briseno, Jr, we call him Jay, 23 years old, was severely injured in Baghdad, Iraq on June 2003. He was shot in the back of his neck. He sustains Spinal Cord Injury (C3), two Cardiac Arrests, and Anoxic Brain Injury.  On April 30, 2006, I was invited to make a testimonial in Washington DC Symposium & Rally (Christopher Reeve Paralysis Act Foundation organization). I thought I would share with you a of my speech title 'Think of Jay'.

My speech: Think of Jay

Good afternoon. My name is Joseph Briseno, and I am here on behalf of my son, Jay Briseno. Three years ago, Jay was a 20-year-old Army Reservist who was called up to active duty. He was happy to serve his country in the Iraq War, and worked, along with the rest of his Civil Affairs unit, Baghdad. His job entailed to rebuild Iraq after the war, delivering food, and goods to the Iraqi citizens. It wasn’t considered a dangerous position. Until late June of 2003, when Jay’s life was changed by a single bullet to the back of his neck. An Iraqi bystander shot my son, and that single bullet severed Jay’s spinal cord. As a result, Jay suffered two cardiac arrests, which cut off his oxygen supply for several minutes, and because of this, he sustained an unknown amount of anoxic brain injury. We were told that Jay would die – that it would be BEST for all of us if he were to die. That it would be impossible for Jay to live with his injuries.  It is now almost 3 years later, and Jay is very much alive. He is STILL, to date, considered by the Department of Defense and the Department of Veterans Affairs to be the most critically injured soldier to have survived the war in Iraq.  And the Briseno family has taken the word “Impossible” out of our vocabulary.

Jay still has a long way to go to make a full recovery, but he has also progressed more than doctors ever thought possible since he was injured. Jay remains a C-3 quadriplegic who is paralyzed from his chin down. He cannot eat, move, speak, or breathe on his own. Although Jay is conscious, his ability to communicate is severely limited – he can only blink, smile or grimace in response to voices and other noises. Since Jay’s return home in December of 2003, Jay’s mother, two sisters, and I have transformed our basement into an intensive care unit for Jay. This is where we have spent our days, nights, holidays, birthdays for the past three years, watching over Jay’s breathing, vital signs, and the multitude of tubes, wires and monitors that labor to keep our son alive. Jay requires 24-hour-a-day nursing care, and his mother, sisters, and I sleep, eat, and live at his bedside, caring for him around the clock. He must be hooked up to a machine that helps us lift and turn him 12 times a day, every day, so that he won’t have bedsores. A slight shift in the temperature in the house, something as small as a bug or some dust, or a loose wire on his tubing, are more than dangerous for Jay – they hold the power of life or death. Neither my wife, nor I, has slept for more than 3 hours at a time in the past 3 years. My daughters have given up their outside activities, and like my wife and me, they devote themselves to spending hours and days and months on end at Jay’s bedside, talking with him, reading to him, or just being near him. We have hired nurses to help us care for our son, but with the widespread nursing shortage in our country, it is not unusual that we must go without a nurse for Jay – caring for him by ourselves. At times, I have quit my job to care for Jay full-time, my wife has quit her job to care for Jay other times, and there have been long periods of time during which neither of us has been able to work, because Jay needed us. Retirement is no longer an option at any age. Family vacations are out of the question. Even a trip to the grocery store for one of us requires a careful coordination of my family’s schedules.

And we have not a single regret. We are only thankful, that our Jay is with us, that he is alive and living and with us, in our home, every moment of every day. And little by little, step by step, Jay has regained abilities we were told would be “impossible,” given the extent of his injuries. Jay does not believe “impossible” – and neither do we.

Jay was in a coma when we arrived at the German hospital that he’d been taken to after he was shot. The doctors told us to start planning his service – that it would be impossible for him to live with his injuries. They told us he’d never regain consciousness – but then Jay let us know differently. When his sister started talking to him about their birds had died, Jay began to cry – though he was STILL IN A COMA! He came out of the coma immediately afterwards. Still, the doctors told us, “It is impossible for Jay to live with such severe injuries” – but he HAS. They said, “It is impossible for Jay to be able to swallow again” – but after working with the wonderful therapists at the Tampa VA hospital, he passed the swallow test. Now a day is not complete if Jay doesn’t eat his Mom’s cooking, or his Godiva ice cream. We know that he will one day be able to eat completely on his own, because NOTHING is impossible.

Some doctors told us that we MUST put Jay in an institution, but we said, “He is our son, and he is coming home with us.” These doctors said, “It will be impossible for him to live at home,” but that was more than two years ago, and Jay has done more than just live at home – he has and continues to THRIVE.

In the beginning, it took a while for Jay to begin to communicate because of his traumatic brain injury. He learned, over months, with the help of his wonderful, devoted therapists, to smile, giggle, and even to grimace to show us what he likes and doesn’t like. He makes it clear which singers MUST GO from the American Idol competition. He even laughs at my bad jokes.

It was one baby step at a time until he got the point of where he is now. Even his doctors couldn’t believe what they were seeing – they have no explanation for the way he has been able to regain some of his abilities. But our family knows that there is no such thing as impossible.

Recently, when Jay had an infection on his foot – which is paralyzed and without any sensation – he flinched and KICKED out when he received a shot in that foot. Does that sound IMPOSSIBLE to you?

The word “Impossible” is no longer a part of the Brisenos’ vocabulary. We have another “I” word – it’s called “IMAGINABLE.” As I stand here in front of you – our many scientists, researchers, doctors, and others dedicated to finding a cure for spinal cord injuries – I feel a kinship. I know that YOU all will not, and HAVE NOT, accepted the “Impossible” for an answer, either. YOU are our hope of overcoming some of the most devastating injuries suffered in this county – spinal cord injuries. But you do not consider the challenge to overcome Spinal Cord Injuries to be “IMPOSSIBLE.” You can imagine and you believe and you know, that in the future, spinal cord injuries will be a thing of the past!

Think for a moment of the great scientists, doctors, and researchers in history, and of how many of these men and women were told their research goals were IMPOSSIBLE. That a vaccine for polio, or a treatment for diabetes, or the miracle of PENICILLIN, would never happen. Yet, here we are, more than 100 years later, and these treatments are not only possible – they’re the norm. And HOW did the researchers and scientists from decades, centuries ago, discover these medical miracles of their time? They DIDN’T have the word “Impossible” in their vocabularies. They didn’t give up. And they had faith that such vaccines, medications, and treatments were all IMAGINABLE.

Jay is counting on me, and on his mother, to take care of him, to be his voice. Jay, our son, is our hero. A true American hero. You do not have to take a bullet in the spine to be a hero. You do not have to go to Iraq and fight for our country’s freedom. You do not have to serve in the Army. You do not have to be Superman. Christopher Reeve knew that. And he knew that YOU, the doctors, the researchers, the scientists, are our hope, our faith, and our steadiest advocates. You go beyond the call of duty. You go on in spite of the dead-ends and legislative barricades, hour after hour, day after day, and year after year. You are perseverance personified. You are more than our hope for the future – more than a group of nameless scientists who devote your lives to giving US and our loved ones a greater quality of life.  You are our HEROES.  Until the day my son, Jay, can stand up here and speak for himself, I thank you and I salute you, our true American heroes.

I ask one small favor, if I may, and that is for you to think of Jay, and remember that NOTHING is impossible. When this event is over, and it is weeks, months, years down the road, I ask that you think of Jay. When you hit that dead-end, when you feel like the break-through will never come – think of Jay. He is counting on you. And he is here to remind you that nothing is impossible, and everything is imaginable.  May God Bless Us all - The Briseno
Joseph Briseno, Manassas Park, Virginia (Sent May 4, 2006 1:55:05 PM)

 

I wrote a book about my son ,a Navy Seal :during an exercise sky diving a new guy went into his space and went through his open parachute at 180 miles an hour hitting him in the head with his feet sending my son twirling down 3000ft to the ground ,he was in a coma followed by vegetative state with a lot of broken bones but most severe brain injury he was in rehab for month ,I was his care giver for 5 years he had to relearn every thing but his determination and attitude saved him .I learned every thing about BI by watching him ,by talking to others with a BI.  When we found out about the guys from Iraq coming home we both knew how long it takes to get better even if it is without passing out, sending them back is not only criminal but dangerous for the other soldiers I feel like going to Washington and tell them about it.  The name of my book is "The Green Room, A Mother's Truth". Thank you for writing about it. Liliane Colburn

 

Thank you so much for doing this story. The press has done a great job of telling many stories of the injuries created by our involvement in Afghanistan and Iraq. They are bits and pieces of lives after service to country, but the stories of people like Alec Geiss and Jason Poole are just the tip of the iceberg. There are hundreds maybe thousands, hurt in the line of duty who do not have the press or an advocate speaking out for them. They are the forgotten ones.

I speak from experience of what it is to deal with the results of a TBI and the Military / VA bureaucracy. My son suffered a traumatic brain injury in 2000 while on a training mission in France with the Army. Right from the beginning there were many problems that the Military and VA were not prepared to handle, and sadly they’re not prepared now either! Honestly my son is one of the lucky ones, I was capable of helping him then with the system and over the past 5plus years with his recovery, but what would have happened to my son if he had not had an advocate? And what’s happing to the thousands of soldiers who don’t have one now?

I keep thinking back to the time when my son was at Walter Reed for the second time, after nearly 9 months of medical treatments, brain injury rehabilitation and therapies we were waiting for the medical board to make a decision about his medical retirement. We had met another soldier, Eric, who had also suffered a brain injury; his Para-shoot had gotten caught in a helicopter blade during a training mission. I watched this young soldier for weeks, he would dress each morning in his BDU’s and tattered beret to stand in front of the hospital entrance, waiting for the opportunity to salute officers as they entered the hospital. I asked him one day what he was doing, his response was “manning my post, ma'am”. The results of his brain injury had left him without a mission and the bureaucracy of paperwork left him on Medical Hold in the grips of a system that didn’t know what to do with him. Since so little has changed in the past 6 years I have to wonder, where are the ones like Eric? And who’s taking care of them?
 

Robert Bazell: Thank you very much for these articles regarding TBI. I, like Deb Davis above, have also been frequenting the TBI board she mentioned ( www.tbihome.org ), ever since my head injury in September, 2002. The other TBI survivors have kept me trying in life when I would have otherwise given up!  I am one of the "lucky ones" who has been able to "return to work", albeit in a way very different than before. The impact on one's self-esteem, confidence in performing daily activities, and attempts to not feel humiliated and ashamed because of the mistakes you make, are so profound with TBI. It is impossible to describe. That is why I agree with all the other "TBIers'" posts which implore more media networks to get involved and at least provide the contact information of the TBI care facilities that ARE available.  This injury is life-changing, and your "old" life will never return. It is about adjusting to your "new" life, and trying to make the best of it. Thank you very much for your articles...it helps to get the word out about TBI!
 

My husband is a tbi survivor as well as a disabled vet. He was injured on the job after leaving the Air Force. I am saddened to hear of all the injuries suffered by our soldiers. Thank you for shining a light on brain injury and on the dedication and sacrifice of our men and women in the armed forces. Brain injury is a hard thing to deal with for suffers and their families they are said to be the walking wounded. Some part of the person has died and what is left continues. I pray when they return to us we will embrace them, and care for them. They will certainly need it. Please continue to work for brain injury to let people know of its heartbreaking results so that people like my husband Phillip and the many others will have a life that is worth living.

As a Vietnam Era Veteran, I want to answer the question that the government is avoiding:
Standard Field test for brain injury used to be: NAME & LOCATION, RECITE THE ALPHABET AND COUNT BACKWARDS FROM A DESIGNATED NUMBER. MAYBE A LITTLE MORE PERSONAL INFORMATION IS TESTED DURING THE QUESTIONING.  Sadly this does not cover swelling complications. They need bodies to fill the line! This may be the explanation of "friendly fire incidents". Memory of daily code words is critical.  Jim
There are only 4 head-injury centers in the VA that do any re-habilitation in the whole country. For 15,000 disabled head-injuries from the Irag War that is a death sentence. They will be over-medicated with anti-depressents, that will make the nightmares worse and they will be addicks. In a few years, they will be gone, the victims of heart-attack or stroke. Thank-you Mr. Bazell. DO NOT GIVE UP ON THIS STORY! Many brave men face a dredfull future because the VA has no plan for the worst combat injuries.
 

I belong to an online support group for TBI. Two of the people are soldiers with TBI who have offered repeatedly to meet with returning wounded soldiers to provide peer support and encouragement, but Walter Reed and the Pentagon and whoever else they are contacting have ignored all their offers.  Then I read that the Pentagon would not talk to the reporter about soldiers returning with TBI either and it makes me wonder why? These soldiers need more support than anyone BECAUSE their injuries are invisible and yet affect every aspect of their lives.  Mr. Bazell, please pursue this story and find out why we are not allowed to know or help our soldiers with TBI. I have TBI from a rollover car accident. I know there is little support because even well-meaning people don't see the injury so have no idea how much you are struggling. Also we survivors need to see how others are able to adapt and find a new way of living. TBI is very isolating, and the emotional losses are incredible. But we are able to reach out and help each other.  Here is my online support group, run by volunteers with TBI. www.tbihome.org The TBI survivors I have met there have made a huge difference in my ability to accept and adapt. I wish that for our soldiers. I also wish they had better helmets to minimize the impact of IEDs. See Operation-Helmet.org Only $99 to minimize TBI from explosions. Why can't our government provide that? What exactly is supporting our troops?

Unfortunately, I have personal experience with traumatic brain injury and rehabilitation spanning some thirteen years. When I first read about brain injuries from IED's, I became quite concerned about diagnosis, treatment, rehabilitation and any plans to assist veterans returning to their communities. The Brain Injury Association still struggles to educate the public and professionals about the sometimes hidden cognitive deficits associated with brain trauma. Living in Kansas, I was able to receive services through a Home and Community-Based waiver which provides support beyond the typical medical insurance coverage. I am now able to work with other survivors of TBI teaching and modeling strategies for independent living. Many states now have similar waivers funded through Medicaid which is facing budget cuts. With the unexpected numbers of soldiers returning with TBI, increased funding for community-based services is critical. I hope someone is listening!
 
This practice of returning back to duty those soldiers who have been exposed to IED's that destroyed their vehicles or injured them is insane; much less returning them repeatedly to the same scenario. The Iraqi's need to take control of their own security and our guys need to come home.
I wish more folks knew about this! I suffered a closed head injury and now have a brain stem injury..
3 years of hell with L and I and STILL no one gets it!
If you don't have a cast or a band aid there is obviously nothing wrong with you.
I just want "me" back...and THAT will NEVER happen.
 

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