Sunday, August 22, 2010

TBI and PTSD are not new wounds

TBI and PTSD are not new wounds. Traumatic brain injury is a relatively new diagnosis only because researchers are studying the damage done in recent years but look back at the history of warfare and find this wound under the skin.

WWII hearing loss for example

Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present
Type: Consensus Study
Topics: Veterans Health
Boards: Medical Follow-Up Agency
Activity Description
A congressionally mandated study by the Institute of Medicine assessed noise-induced hearing loss and tinnitus associated with military service from World War II to the present, the effects of noise on hearing, and the availability of audiometric testing data for active duty personnel.

The expert committee was charged with providing recommendations to the Department of Veterans Affairs (VA) on the assessment of noise-induced hearing loss and tinnitus associated with service in the Armed Forces.
The committee was asked to;

review staff-generated data on compliance with regulations regarding audiometric testing in the services at specific periods of time since World War II,
review and assess available data on hearing loss,
identify sources of potentially damaging noise during active duty,
determine levels of noise exposure necessary to cause hearing loss or tinnitus,
determine if the effects of noise exposure can be of delayed onset,
identify risk factors for noise-induced hearing loss, and
identify when hearing conservation measures were adequate to protect the hearing of service members.

Hearing loss was not something that could be seen but it was there anyway.

It was not a matter of it not happening, but more a matter of no one doing anything about it.

It was the same story for PTSD and TBI

Shell Shock and Mild Traumatic Brain Injury: A Historical Review
Edgar Jones, Ph.D., D.Phil., Nicola T. Fear, D.Phil., and Simon Wessely, M.D.
Mild traumatic brain injury is now claimed to be the signature injury of the Iraq and Afghanistan conflicts. During World War I, shell shock came to occupy a similar position of prominence, and postconcussional syndrome assumed some importance in World War II. In this article, the nature of shell shock, its clinical presentation, the military context, hypotheses of causation, and issues of management are explored to discover whether there are contemporary relevancies to the current issue of mild traumatic brain injury.

When shell shock was first postulated, it was assumed to be the product of a head injury or toxic exposure. However, subsequent clinical studies suggested that this view was too simplistic, and explanations soon oscillated between the strictly organic and the psychological as well as the behavioral. Despite a vigorous debate, physicians failed to identify or confirm characteristic distinctions. The experiences of the armed forces of both the United States and the United Kingdom during World Wars I and II led to two conclusions: that there were dangers in labeling anything as a unique "signature" injury and that disorders that cross any divide between physical and psychological require a nuanced view of their interpretation and treatment. These findings suggest that the hard-won lessons of shell shock continue to have relevance today.

By reporters taking the easy way out on doing stories like this, they have allowed the myth of PTSD and TBI to be viewed as something totally different than what humans exposed to combat situations have had to endure all along. Humans still have the same basic design as they have had since the beginning. The flesh still gets cut and burnt. Bones still break and limbs still get blown off. What is under the skin is still just as fragile as ever and the organ that controls the whole person, the human brain, is the same as it was all along. The difference between what we now know and what was thought of throughout history does not change the reality of being human.

Whenever PTSD and TBI are the topic of any report, it would benefit all of us if they would do their research and stop treating these as if they are just now happening to the veterans of today's military campaigns. That would be a helpful thing to do and get this nation past the notion this is anything new. It may all be news but it is far from new.

Soldiers' survival rates on rise, but so are challenges presented by brain injuries

12:00 AM CDT on Sunday, August 22, 2010
By DAVID TARRANT / The Dallas Morning News
Thanks to advances in combat gear and battlefield medicine, more troops survive injuries that would have killed them in previous wars.

This is good news, but it also presents some long-term challenges. The soldiers are "surviving, but with things like post-traumatic stress disorder and traumatic brain injury," said Dr. Carol Tamminga, professor of psychiatry at UT Southwestern Medical Center.

Traumatic brain injury, or TBI, is caused by a blow or jolt to the head, or a penetrating head wound, that disrupts the function of the brain. Because of its prevalence, TBI has been called one of the "signature injuries" of today's wars, along with PTSD.

An estimated 19 percent of the 1.8 million troops who have served in Iraq or Afghanistan – about 342,000 – may have experienced a traumatic brain injury during deployment, according to Rand Corp., a California-based nonprofit research organization.
read more here
Challenges presented by brain injuries

We do have more surviving horrific wounds and this contributes to the rise in brain injuries, which in reality is what PTSD is. It does not come from within but begins with an outside force, the traumatic event itself. What we are seeing in terms of numbers is more a reflection of what is known now and the awareness of the afflicted as well as the numbers of wounded surviving what used to kill them. It also has to do with the repeated exposures to traumatic events during combat and the practice of redeploying troops increasing the risk of PTSD by 50%. They also have to have the notion of being wounded or killed added to what they already had to endure.

Take a survivor of a hurricane. Here in Florida we all remember the summer of 2004. Four hurricanes hit Florida. Charlie, Francis, Jeanne and Ivan. The first three hit Central Florida. It was also the summer we moved to Florida just outside of Orlando. Every summer we cringe remembering what happened that year. You'd think that with 6 years between then and now we'd be over it, but no matter how much time goes by, we still remember it. I couldn't imagine if Central Florida got hit over and over and over again every single summer. There would be the memory of other hurricanes piled onto the fear of the ones coming. It is this way for combat forces being sent back over and over again. It is not just the matter of what happened before but the fear of what can happen next that weighs heavily on their minds.

Before Afghanistan and Iraq they were not redeployed into combat unless it was their choice. Most had a year during Vietnam but some had more than one tour. Even with the years of the Vietnam war going on, the military was careful of how many tours someone would be safely expected to be able to do. What we see today is some on their 5th and 6th tour. These are not pleasant tours of duty but they are dangerous ones. This is something else reporters seem to not comprehend when they write about PTSD and TBI. It also supports the notion that somehow these new veterans are slackers when they seek help for PTSD and TBI, or as some have suggested, criminals making fraudulent claims for compensation, because they cannot explain the increase in the numbers seeking help.

For heaven's sake! Given all the facts, all the years of research, we should be more fearful of fewer seeking help when statistics indicate there should be more of them seeking help by now.

One tour of duty in Vietnam translated into over 500,000 with PTSD by 1978. This did not include veterans with TBI because the studies were not being done enough by then. It was not that there were only 500,000 cases, but only that many sought any kind of help. There were more and the problem is, there are still more without seeking help. Think of all the years they went without help to heal but because there was awareness, they begin to think it was possible to get better.

148,000 Vietnam Veterans Sought Help in 18 Months
In the past 18 months, 148,000 Vietnam veterans have gone to VA centers reporting symptoms of PTSD "30 years after the war," said Brig. Gen. Michael S. Tucker, deputy commanding general of the North Atlantic Regional Medical Command and Walter Reed Army Medical Center. He recently visited El Paso. 10/08/07

The wonderful thing is, it was not too late to help them but a lot of what could have been reversed had they been helped early on, had become permanent. This is the fear we should have today. Getting them help now will reduce the problems associated with PTSD in the long run but too many are getting false information leading them to prolong seeking help today. If you think the numbers are bad now, you have to consider how much work went into getting to this point as well as how many others are out there needing help but not getting it.

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