PART 4: When the Bad Gets Worse

“He was a very good and caring person.  He was just never the same when he came back, because of all the things he saw.  He tried to seek treatment, but it didn’t work.” 

-Matina Dwyer, wife of Army SPC. Joseph Patrick Dwyer 

who died in 2008 by accidental overdose.

“When people asked how John was, it was kinda like, ‘I don’t know.  I don’t know how John is because John’s not here anymore.  It’s somebody else.” 

-Mike Needham Jr., brother of veteran John Needham 

who is accused of killing his girlfriend.

“This was a guy who was doing all the right things, it seems like, and we lost him.  If it can happen to Clay, then it can happen to anyone.  This should be a wakeup call for America.” 

–Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, 

speaking of Clay Hunt, Marine who pushed suicide prevention 

that took his own life in 2011.

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It’s a familiar story being played out in the lives of veterans across the country.  GI Joe returns home from war a completely different person.  His friends and family are confused by the change in attitude and behavior, but are at a loss as to what to do or say to help.  He begins to drink to numb his emotions, which causes more problems with family and work, if he was able to find a job at all when he returned back home.  Relationships are strained at best, and even his spouse struggles to understand what he is going through.  Anger and rage caused by PTSD leads to domestic violence.  They end up divorced, possibly in an ugly custody battle, which causes him to self-isolate.  Substance abuse, either by drinking, recreational drugs, or from dependence on prescription pain medication for injuries sustained in war land him in a legal system which has little knowledge of how to work with veterans.  With his world crashing down around him, he feels like he has no way out and ends his life, possibly in a very public way.  The media swarms and interviews family and friends who speak of a great guy who was proud to serve his country and help others.  Rarely does it come out of left field and shock those closest to him.  “He was never the same since he got back from Iraq/Afghanistan,” they say.  You might also hear: “He tried to get help, but fell through the cracks.”

In the first article in our series, I explained what PTSD is, how it can affect the brain and body, and common misconceptions and stereotypes associated with PTSD.  Next, I shared what PTSD was like for veterans on an everyday basis, including common triggers and reactions our veterans face daily.  Last week, I talked about Traumatic Brain Injuries and their possible complications with PTSD.  While it is very important to veterans receiving treatment for their PTSD not to be labeled or seen as monsters, I would do my readers a disservice if I didn’t go into what can happen when PTSD is left untreated and things go from bad to worse.

SUBSTANCE ABUSE

One “symptom” of PTSD is substance abuse.  Many veterans with PTSD try to numb emotions or avoid dealing with them at all.  Some will turn to drinking, others to street drugs, and others can find themselves addicted to the strong, narcotic pain medications doled out by their doctors to help with physical wounds.  Some do it because they can’t fall asleep at night, so they feel that “passing out” is their only option.  Unfortunately, this adds fuel to an already dangerous fire.  With their inhibitions lowered, the veteran now has a higher chance of acting out their anger and rage than when they try to stuff down their emotions when sober. 

For those with PTSD and Traumatic Brain Injuries, it is a double-edged sword.  TBI can affect the way the brain and body react to alcohol consumption or drug use.

“Alcohol will now have a double or triple whammy effect,” says Marilyn Lash, brain injury specialist, author, and advocate.  “It affects the brain differently after injury.  They will get higher, quicker and more intensely with fewer drinks.  One drink can have the effects of three.”

Many veterans with TBIs have reported a lower tolerance to alcohol than before injury.  Whereas before they could easily go through a 12-pack and still be considered “the life of the party”, they can now only handle about 3 or 4 before becoming totally inebriated and sometimes full of rage.

“Alcohol is a depressant.  It loosens inhibition, lowers judgment, increases risk-taking, and affects balance and coordination,” says Lash.  “For those having problems with TBI in these areas, alcohol will only magnify them.”

“This is also one of the hardest for the veterans to give up,” Lash explains.  “Drinking is welcomed and sometimes encouraged at military get-togethers.”

Friends and family members might pick up on the substance abuse problems and encourage their veteran to attend support groups like AA.  While AA is a good program and can be helpful with those who suffer from PTSD, nixing the drinking altogether most likely will not solve the problem.  Many vets cannot successfully become sober until the underlying issues of sleep problems, nightmares, emotional numbing, etc. are addressed.  What else will the veteran turn to if there are not equipped on how to handle their emotions sober?  Alcohol and substance abuse do not mean they are a bad person; it means they are hurting and desperately trying to self-medicate.  You wouldn’t focus on treating JUST a runny nose when a patient has the flu.

RELATIONSHIP PROBLEMS

When veterans feel like they are misunderstood by their friends and loved ones, they can tend to isolate themselves, causing confusion, hurt feelings, and even anger for their loved ones.  Since their time in a warzone caused them to stifle all emotions except for anger to get the job done, they have a harder time expressing positive feelings and emotions when they return home.  It may seem to their loved ones that they just don’t care anymore.

One VA study examined the connection between the cluster of avoidance symptoms, specifically emotional numbing, interfere with intimacy (for which the expression of emotions is required) and contribute to problems in building and maintaining positive intimate relationships.

Extended family members might not understand when a veteran continually turns down invitations to family gatherings.  The veteran might be trying to avoid being triggered, but the family member or friend might feel slighted and bitter towards the unreciprocated invites.

Loved ones might also feel like they are walking on eggshells around their veteran, which in itself can be exhausting.  This can also cause bitterness to build up between loved ones and veterans, causing the vet to pull away even more.  They want desperately to help, but just don’t know how.

DOMESTIC VIOLENCE

Domestic violence is one of the touchiest subjects for families struggling with PTSD and one of the main reasons some choose not to go public with the diagnosis.  No one wants to be branded with the “violent vet” stereotype.  Again, not all veterans act out in violence, and spouses fear what increased scrutiny can do to their vet and their families. 

There is a reason, however, that domestic violence is part of the PTSD stereotype.  Just like in the “normal”, everyday world, it happens.

Veterans with PTSD can have a short fuse.   That is documented fact.  The difference is the treatment or coping skills used to help when anger begins to surface.

Without treatment, veterans can bring home the military mentality.  They can bark orders, treat their spouses and children as soldiers, and get frustrated when “orders” are not followed to the letter.  In combat, orders were to be followed immediately and without rebuttal or there could be accidents, injuries, or deaths.  This is why some vets can seem to “snap” over something that, in reality, is small and trivial.

In war, fear and intimidation are sometimes used to accomplish a mission.  Veterans can use intimidation and manipulation at home without realizing it.  That’s just what they were taught to do to get their point across or to get the desired result.  If there is resistance from the spouse, the veteran can then “lock on” and see them now as a threat.

Another way violence can spill into a marriage or family is through flashbacks.  Again, not all veterans experience flashbacks, and most aren’t the Hollywood-type flashbacks seen in films.  But yet, it can happen.

“There is no way under normal circumstances that my husband would ever intentionally hurt me,” says a veteran’s wife who wished to remain anonymous.  “But I have been thrown to the ground when he was having a flashback.  He threw me down to ‘protect me’ from sniper fire and twisted my arm behind me so I wouldn’t get up.  He thought he was saving my life by keeping me down.  It was terrifying.  I thought for sure he was going to dislocate my arm.”

DIVORCE RATE

Military couples have almost always faced divorce rates higher than their civilian counterparts.  Numbers are still coming in for the most recent wars, but a study by the VA on marital adjustment and divorce rates for Vietnam veterans shows that PTSD can be even more damaging to marriages.  Approximately 38% of Vietnam veteran marriages failed within six months of the veteran’s return from Southeast Asia.  The National Vietnam Veterans Readjustment Study sound that rates of divorce for veterans with PTSD were two times greater than for veterans without PTSD, and veterans with PTSD were three times more likely to divorce two or three times.

Many times following a divorce, the veteran can “fall through the cracks”.  With no one else there to see the symptoms and encourage the veteran to get help, he or she can lose hope or even stop trying.  From there, things can snowball quickly.

LEGAL PROBLEMS

Due to substance abuse, violence, or divorce, veterans can find themselves trapped in a never-ending legal battle.  In a 2002 Bureau of Justice report, 9.3% of the prison population is veterans.  That same report indicated that 70% of incarcerated veterans were in jail for non-violent offences.  In Travis County, Texas, the top non-violent offense was for DWI.

Veterans Courts are being set up around the country to deal with veterans having readjustment issues and find themselves in trouble with the law.  Veterans Courts combine drug courts with mental health treatment to encourage veterans to a better way of life.  They use innovative techniques to encourage veterans to a life free of addictions with stable, long lasting relationships.  Veterans Courts utilize resources from the VA Healthcare System, veteran volunteers, and veteran family support organizations. 

Currently, there are 40-50 Veterans Courts nationwide, and the prospects of one to service Randall, Potter, and Armstrong Counties are being discussed.  Veteran advocates feel the benefits of prescribing treatment and rehab for problems cause by PTSD far outweigh the convenience of throwing the veteran into the prison population where their symptoms could multiply and cause worse problems later on.

SUICIDE

Unfortunately, many veterans give up and choose to end their own lives.  The suicide rates for active duty and veterans have made headlines recently.  In a study this spring, it was announced that a veteran commits suicide every 80 minutes.  That is roughly 18 suicides a day.  The number of suicides by veterans back at home has surpassed the total number of service members killed in Iraq and Afghanistan, combined.  For those who came home with PTSD to unemployment in a bad economy, divorce, substance abuse, and legal problems, death starts to look like the only way and is sometimes fueled by survivors guilt for making it home when their battle buddies did not.

HOW TO HELP

The first way to help a veteran with PTSD is to get educated.  Just by knowing and understanding the symptoms and reactions of those with PTSD, you can make it that much easier for the veteran to reach out to and trust you.

Many spouses and family members feel helpless if their veteran is in denial or refuses to get help.  They can feel blocked by the very source who is there to help, the VA, when they are told that the veteran must first register himself and sign a release before they can speak to family members.  It can be confusing for the veteran to do it himself, but even more so when a civilian family member tries to get more information to help them get treatment.

The VA has recognized this problem and has created a program called “Coaching Into Care”.  Through the program, friends and family members can learn the procedures and requirements for enrolling their veteran for VA care, how to talk to their veteran about getting help, what to do if their veteran is enrolled in care but no longer attends appointments, and learn what to do if there is a crisis.  This is all about educating loved ones and giving them the tools to successfully encourage their veteran to seek help with their PTSD.  If they are ready and willing when the time comes that the veteran hits rock bottom and asks for help, they will be less likely to fall through the cracks.  And remember, the name is “Coaching Into Care,” not “Nagging Into Care.”

Coaching Into Care website: www.mirecc.va.gov/coaching

Hotline: 888-823-7458

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Mild Brain Injury in Combat May Lead to PTSD

 

Mild Brain Injury In Combat May Lead to PTSD

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on June 8, 2012 

 

The slightest brain injury — even one barely detectable by an ultra-sensitive imaging test — could put a soldier at greater risk for post-traumatic stress disorder (PTSD), according to a University of Rochester Medical Center (UMRC) study.

The findings are important for doctors who care for troops after deployment, as they try to decipher and treat the overlapping symptoms of PTSD and mild traumatic brain injury (mild TBI).

Previously, the complex interplay between TBI and PTSD was unclear. Researchers believe they are the first to discover a link that can be proven with advanced imaging techniques.

“Most people believe that, to a large extent, chronic stress from intense combat experiences triggers PTSD. Our study adds more information by suggesting that a physical force such as exposure to a bomb blast also may play a role in the genesis the syndrome,” said lead author Jeffrey J. Bazarian, M.D., M.P.H., associate professor of emergency medicine at URMC, and a member of the 2007 Institute of Medicine committee that investigated brain injuries among war veterans.

It has been estimated that 320,000 troops suffered concussions in Iraq and Afghanistan by 2008.
Bazarian’s research included 52 war veterans from western New York who served in combat areas between 2001 and 2008. Approximately four years after their final tour of duty, veterans were asked about PTSD symptoms, blast exposures, mild concussions, and combat experiences.

Study participants were given the standard Walter Reed Institute of Research Combat Experiences Survey to measure combat stress. The survey asks about the intensity of deployment duties (such as handling or uncovering remains), exposure to explosive devices, vehicle accidents, falls or assaults, and events such as being ambushed or knowing someone who was seriously injured or killed.

The veterans were also given standard MRI tests, as well as a more sensitive test called diffusion tensor imaging, or DTI, which has been used to detect axonal injury, a type of neuronal damage that occurs during a concussion.

Of the 52 veterans, 30 suffered at least one mild traumatic brain injury, and seven reported having more than one. Sixty percent of the veterans were exposed to one or more explosive blasts.

Every single veteran had one or more PTSD symptoms, and 15 met the formal criteria for PTSD, which is a devastating psychiatric illness. The severity of veterans’ PTSD symptoms correlated with the amount of axonal injury seen on the DTI scans.

Furthermore, five of the 52 veterans showed abnormalities on standard MRI scans, and their PTSD severity was much worse than the 46 veterans with normal MRIs.

Interestingly, PTSD severity did not correlate with the clinical diagnosis of mild TBI. This suggests that mild brain injury can be present without triggering the loss of consciousness or amnesia that is commonly associated with diagnosis of mild TBI, and that this injury may make a person more susceptible to mental illness when coupled with extreme chronic stress.

“Based on our results, it looks like the only way to detect this injury is with DTI/MRI,” Bazarian said.

“While it may not be feasible due to costs and limited availability of some neuroimaging tests to screen thousands of service members for brain injury, our study highlights the pressing need to develop simpler tests that are accurate and practical, that correlate with brain injury.”

The study is published online by the Journal of Head Trauma Rehabilitation.
Source: University of Rochester Medical Center

Original article can be found HERE: 

https://www.brainhealthconsulting.com/9-things-not-to-say-to-someone-with-a-brain-injury/

9 Things NOT to say to someone with a brain injury

July 26, 2012 By Marie Rowland PhD

Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.
And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.
Here are a few things you might find yourself saying that are probably not helpful:
9 things NOT to say to someone with a brain injury

1. You seem fine to me.

The invisible signs of a brain injury—memory and concentration problems, fatigue, insomnia, chronic pain, depression, or anxiety—these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood. Your loved one may look normal, but shrugging off the invisible signs of brain injury is belittling. Consider this: a memory problem can be much more disabling than a limp.

2. Maybe you’re just not trying hard enough (you’re lazy).

Lazy is not the same as apathy (lack of interest, motivation, or emotion). Apathy is a disorder and common after a brain injury. Apathy can often get in the way of rehabilitation and recovery, so it’s important to recognize and treat it. Certain prescription drugs have been shown to reduce apathy. Setting very specific goals might also help.
Do beware of problems that mimic apathy. Depression, fatigue, and chronic pain are common after a brain injury, and can look like (or be combined with) apathy. Side effects of some prescription drugs can also look like apathy. Try to discover the root of the problem, so that you can help advocate for proper treatment.

3. You’re such a grump!

Irritability is one of the most common signs of a brain injury. Irritability could be the direct result of the brain injury, or a side effect of depression, anxiety, chronic pain, sleep disorders, or fatigue. Think of it as a biological grumpiness—it’s not as if your loved one can get some air and come back in a better mood. It can come and go without reason.
It’s hard to live with someone who is grumpy, moody, or angry all the time. Certain prescription drugs, supplements, changes in diet, or therapy that focuses on adjustment and coping skills can all help to reduce irritability.

4. How many times do I have to tell you?

It’s frustrating to repeat yourself over and over, but almost everyone who has a brain injury will experience some memory problems. Instead of pointing out a deficit, try finding a solution. Make the task easier. Create a routine. Install a memo board in the kitchen. Also, remember that language isn’t always verbal. “I’ve already told you this” comes through loud and clear just by facial expression.

5. Do you have any idea how much I do for you?

Your loved one probably knows how much you do, and feels incredibly guilty about it. It’s also possible that your loved one has no clue, and may never understand. This can be due to problems with awareness, memory, or apathy—all of which can be a direct result of a brain injury. You do need to unload your burden on someone, just let that someone be a good friend or a counselor.

6. Your problem is all the medications you take.

Prescription drugs can cause all kinds of side effects such as sluggishness, insomnia, memory problems, mania, sexual dysfunction, or weight gain—just to name a few. Someone with a brain injury is especially sensitive to these effects. But, if you blame everything on the effects of drugs, two things could happen. One, you might be encouraging your loved one to stop taking an important drug prematurely. Two, you might be overlooking a genuine sign of brain injury.
It’s a good idea to regularly review prescription drugs with a doctor. Don’t be afraid to ask about alternatives that might reduce side effects. At some point in recovery, it might very well be the right time to taper off a drug. But, you won’t know this without regular follow-up.

7. Let me do that for you.

Independence and control are two of the most important things lost after a brain injury. Yes, it may be easier to do things for your loved one. Yes, it may be less frustrating. But, encouraging your loved one to do things on their own will help promote self-esteem, confidence, and quality of living. It can also help the brain recover faster.
Do make sure that the task isn’t one that might put your loved one at genuine risk—such as driving too soon or managing medication when there are significant memory problems.

8. Try to think positively.

That’s easier said than done for many people, and even harder for someone with a brain injury. Repetitive negative thinking is called rumination, and it can be common after a brain injury. Rumination is usually related to depression or anxiety, and so treating those problems may help break the negative thinking cycle.
Furthermore, if you tell someone to stop thinking about a certain negative thought, that thought will just be pushed further towards the front of the mind (literally, to the prefrontal cortex). Instead, find a task that is especially enjoyable for your loved one. It will help to distract from negative thinking, and release chemicals that promote more positive thoughts.

9. You’re lucky to be alive.

This sounds like positive thinking, looking on the bright side of things. But be careful. A person with a brain injury is six times more likely to have suicidal thoughts than someone without a brain injury. Some may not feel very lucky to be alive. Instead of calling it “luck,” talk about how strong, persistent, or heroic the person is for getting through their ordeal. Tell them that they’re awesome.

About the author

Marie Rowland is a neuroscientist, writer, and patient advocate. She founded EmpowermentAlly to help promote patient empowerment in people who have mental illness or a brain injury.

PART 3: Traumatic Brain Injury

I first met Alma Hall at a Wounded Warrior Wives’ retreat in El Paso.  As fate would have it, she was my roommate for the weekend, and we quickly found we had many things in common.  Both of our husbands served as combat medics in the Army, both had similar struggles with PTSD, but then she began talking about his traumatic brain injuries and how it had affected him and their daily lives.  He had memory problems, and she had to be the one to remind him when to take his medications and sometimes even when to bathe.  Their latest battle had been with brushing his teeth.  She would ask him if he had brushed his teeth, and even after pausing for a moment to think long and hard, he could not remember.  Using a play out of the Parenting 101 book, she would check his toothbrush—dry. 

She confessed she was nervous to be away from him for the weekend because he relied on her memory to compensate for his own.  Even though he had good friends who were going to be checking in and spending time with him while she was away, she was as anxious as a new parent leaving a newborn with a babysitter for the first time.

Between sessions, Alma, like many other wives, could be found in the hallway, cell phone to her ear, calling to make sure nothing had fallen apart and to remind him to brush his teeth.  On the last day, breakfast moved straight into another class, and she wasn’t able to call as early as she had wanted.  She quickly slipped out, and when she returned, she was wiping tears from her eyes.  Concerned, many of us asked what was wrong.  She began to beam with tears of joy streaming down her cheeks.  “He remembered to brush his teeth,” she announced proudly.  And the room erupted with cheers.

TRAUMATIC BRAIN INJURY

PTSD isn’t the only “invisible injury” that our troops deal with when they return home from war.  Traumatic brain injury (TBI) has also become a signature wound of the war on terror, and like PTSD, sometimes symptoms do not arise, or are not noticed, right away.  PTSD and TBI share many common symptoms, so there can be confusion as to which one is causing the problems, and can sometimes cause a TBI diagnosis to be missed altogether.  What’s worse is when differing symptoms of both begin to compound and even clash, causing new and worsening problems.  Just like not every soldier has PTSD, not every soldier with PTSD has a TBI, but knowing can make a world of difference in the treatment of both.

WHAT IS TBI?

“Why do you look inside a carton of eggs before you buy it?  Because even though the outside of the carton may seem perfectly normal and intact, one of the eggs inside may be cracked.  The same holds true for TBI.  Your Veteran’s head may show no signs of being injured, but the inside, his or her brain, may in fact be damaged.” –Brannan Vines,

FamilyOfaVet.com

A traumatic brain injury occurs when an outside force (trauma) injures the brain.  This can happen with a blow to the head in sports, falls, and other physical contact with a hard object.  It can happen when nothing directly hits the skull, like sudden acceleration or deceleration in a car crash.  TBIs can also be the result of a blast, such as those experienced in Iraq and Afghanistan from improvised explosive devices.  In addition to the blast possibly causing the warrior to be thrown down or hit their head, the shock waves themselves can cause irreversible damage. 

Some may ask why there seem to be more cases of TBI in today’s military than in previous conflicts.  Why wasn’t brain injury more common in other conflicts?  The two easiest answers are advances in armor and the increased use of explosives by the enemy.  Technology has brought military armor a long way, and warriors are surviving many injuries that would have been fatal in the past.  IEDs and suicide bombers have been the weapons of choice for terrorists who seek to inflict major damage to a large number of people.  Veteran advocates estimate that 10-20% of Iraq veterans, or 150,000-300,000 service members have some level of TBI.

In the TBI tip card from Lash & Associates Publishing, Harvey E. Jacobs, Ph. D. and Flora M. Hammond, M.D. explain the types of brain injuries, causes, symptoms, and how to recognize traumatic brain injury.

“The causes and effects of a traumatic brain injury vary with each person.  The location and size of the blow or impact determine what parts of the brain are injured.  No two traumatic brain injuries are alike… Most commonly, the person does not lose consciousness when a brain injury occurs.  These are called mild brain injuries, but they can cause many difficulties that are not necessarily mild.  The person may feel dazed or just a little confused for a brief time and then return to work or usual activities.  Problems may develop later.  Sometimes people wrongly assume the effects of a brain injury are caused by something else such as combat fatigue, illness, stress, or nerves.”

Another strike against warriors who received a TBI in a warzone is the lack of rest that is crucial to recovery after a brain injury.  When an athlete sustains a concussion, the doctor will typically order rest so the brain has time to heal and recover.  This is not an option for warriors who are still in an extremely stressful environment with a mission to accomplish.  Repeated blasts and injuries, often before the previous injury has healed with very little rest in between, can compound to make very serious changes to the way the brain functions. 

“Injury on the football field can be devastating, but after the concussion, people aren’t trying to kill you,” says Dr. Shane McNamee from the Richmond VA.  “People aren’t shooting at you.  You’re not seeing your loved ones, your brothers, maimed and killed in front of you.  You’re not then pressed out the next day, to go back out and do it again, and again, and again.”

In recent years, the military has also begun to notice the increased risks for concussions and multiple TBIs.  In 2011, PBS ran a series called “Where Soldiers Come From”.  In the episode on TBI, they talked about changes the military has made to stop warriors from suffering multiple concussions.

“The Pentagon recently released a new policy for the treatment of TBI, which includes a mandatory 24-hour rest period after a blast and a complete neurological assessment for anyone who’s had three or more concussions.  The United States Congress has mandated that military and veterans’ hospitals screen all service members returning from combat assignments.  Yet even when TBI is properly diagnosed, it is difficult to treat properly.  Often a soldier does not realize he or she has suffered a concussion—symptoms may first surface months or years later.”

SIMILARITIES TO PTSD

Some warriors who return home with PTSD often don’t realize they could have a TBI because some of the symptoms overlap.  Difficulty with short-term memory could be written off as cognitive problems from PTSD and lack of sleep.  Substance abuse can be suggested as the warrior trying to avoid, but instead could mean that the area of the brain regulating impulse control and judgment have been compromised.  Some studies also suggest that having a TBI increases the risk for PTSD in service members.

Marilyn Lash has over 35 years’ experience working with persons with disabilities and is a respected key-note speaker on the topic of brain injuries.  She has spoken at many wounded warrior wives retreats, including the El Paso retreat mentioned earlier.  She says the five areas that she most often hears about being common in both PTSD and TBI are cognition, depression, anxiety, insomnia, and fatigue.  When asked if there was one area that seemed more common in veterans with PTSD and TBI, she said it would probably be those in terms of thinking, such as memory changes, organizing, problem-solving, and other executive skills.

SYMPTOMS

TBI symptoms can be broken down into four categories: Physical, Cognitive, Communication, and Emotions and Behaviors.  Again, every TBI is different, and symptoms are usually a result of what part of the brain was injured. Some people may have several different symptoms while others only have a few.  These are just general lists of possible symptoms.

Physical: headaches; seizures; nausea; weakness/paralysis; balance; clumsiness; changes to vision, hearing, smell, taste, or appetite; sensory sensitivity (sensitive to light, sound, smells, etc.); fatigue; sleep disorders.

Cognitive: amnesia; memory problems; slowed processing; organization and planning; poor judgment; inability to multitask; poor initiation; confusion; easily distracted; repetitive thoughts and comments; impulsive.

Communication: slurred speech; word finding (trouble finding the right word- “it’s right on the tip of my tongue!”); not on topic; trouble listening; dominates conversation; problems with reading and writing; change in rate of speech (usually slower); repetitive storytelling; literal; comprehension problems.

Emotions & Behaviors: anxiety; depression; self-centered; short temper; frustrated; inappropriate crying or laughing; mood swings; rigid or stubborn; dependent; personality change; disinhibited.

If you or a veteran you know has been exposed to blasts, has had a head injury, or has had repeated concussions while serving overseas and you have noticed any of the above changes, then it’s time to be checked for a TBI.

LIVING WITH TBI

It was after the El Paso retreat that I began to reassess my husband’s behaviors and symptoms.  I knew he had been in multiple blasts and had lots of hard landings that made him “see stars” when he jumped out of planes with the 82^nd Airborne.  He had a lot of the symptoms that were common to TBI but not PTSD.  We were both more than shocked to find when he asked to be tested at the VA for TBI that it was actually already in his medical record.  They knew very early on what we did not know: that TBI had caused significant changes to the way he functioned each day.

Alma Hall picked up on signs that something was not right immediately, even from another continent.  Her husband, Russ, called her after his vehicle took a direct hit from an IED and flipped over.  He wanted to let her know that he was okay, but she could tell something was off.

“He kept repeating himself over and over again, and he was speaking very slowly,” she said.  “It just didn’t sound right.”

His fellow combat medics showed concern, but as senior medic, he waved them off saying he was fine.  He completed his tour and returned home in December 2007.  It was then that Alma really began seeing the red flags that he was not “fine”.

“It was pretty obvious,” said Alma.  “He had developed a stutter, he would repeat things within a few minutes of each other, he had horrible migraines, and he would constantly lose his train of thought.”

Russ has since had two years of occupational therapy to help with the cognitive issues as well as two and a half years of speech therapy.  While it’s not a permanent fix, they did teach him tools and coping skills to make living with a TBI easier.  She still has to remind him to take his meds, guide him through the steps for everyday tasks, and yes, sometimes still remind him to brush his teeth, so it’s easy to see why something so small would be such a big celebration when he remembered without prompting.

Still, just as with PTSD, there are good days, and there are bad days.

“If he is extremely tired, has had very little sleep, or has migraines, the first thing I notice is his speech is wonky,” said Alma.  “He’ll start throwing out words that don’t pertain to anything about what he is saying.  His short-term memory loss is also ten times worse.”

Sometimes it’s hard to explain these symptoms to others, especially civilian wives.  I’ve spoken to many wounded warrior wives who are frustrated when they try to describe what it’s like, only to have someone say, “Oh, that’s just a man for you.  They don’t listen, and they never remember.”

I’m sure everyone has had those moments when you walk into a room and forget what you went in there for in the first place.  That’s common, but much, MUCH more frequent, and sometimes on a much larger scale.  There have been times my own husband has gone to Amarillo, only to hit I-40 and think, “What was I coming to town for?”  He confessed to me that there had been times that he simply drove around town for hours, hoping to see something that would spark his memory.

We also have the same conversations over and over, sometimes in the same 10-minute time frame because they don’t remember having it the first time.  The times when there is disagreement over who said what and when are daily.  Getting flustered and giving him a hard time about not remembering something I said or asked  him to do doesn’t help, so we chalk it up as a “TBI moment” and move forward.  Just as I have learned not to take it personally when he forgets, he has learned not to take it personally when I remind him ten times a day about an upcoming appointment or something he needs to do.

“The best advice I can give is to be patient,” said Alma, a sentiment that echoed from every PTSD/TBI group I posed the question to.

LONG-TERM EFFECTS

Multiple studies have found an increased risk for Alzheimer’s in people with TBI.  Moderate and severe TBIs (respectively) are associated with a 2.3 and 4.5 times increased risk for Alzheimer’s.  If you were to look at some of the early warning signs of Alzheimer’s, you would see that most of those symptoms listed are also symptoms of TBI.  Knowing you have a TBI, learning ways to cope, and always being aware of any changes or worsening symptoms are the best way to detect problems later on.

There have also been studies that suggest people with TBIs have a higher rate of suicide.  Add that to the higher rate because of PTSD, and it can be a scary situation for the veteran who has both.  It has also gotten attention from outside the military.  Athletes, particularly football players who take hard hits for a living, are showing their vulnerability as well.  The NFL has been in the spotlight as some of its former players have committed suicide the past few years with some experts theorizing a link between suicide and brain injuries.  Junior Seau, NFL linebacker, took his own life this year, and preceded by Dave Duerson who left a note asking for his brain to be sent to the “NFL brain bank” for study.  This fall, the U.S. Army and NFL publicly announced that they would be teaming up to spread awareness and pioneer research on TBI.

There seems to be new research coming out every day about TBI and its effect on the military and athletes.  Technology is beginning to catch up, bringing new imaging machines and therapies, but they are still out of reach for many veterans, especially in rural areas.  Many of the first troops who returned home from Iraq and Afghanistan did not have the information on TBI that has become more common and readily available.  Many who separated before 2008 were not tested for TBI or may have had symptoms that began to manifest years later.  And just like PTSD, it’s created another group of disabled veterans with invisible wounds who struggle every day with a public that doesn’t understand.

YOU ARE

NOT ALONE.