No-Brainer
The 4th of July is upon us, and flags are unfurled to annual demonstrations of jingoism, victory, and God Bless America. Forgotten in the mix, however, are the indelible reminders of what freedom or national foolhardiness costs. Car bombs and improvised explosive devices (IEDs) go off in Iraq, Afghanistan, and other faraway places, and body bags find their way back to the Patria, to the sounds of marching bands blaring the Star Spangled Banner. And that might just be the more merciful side of the coin for countless victims of conflict and their families, as something far more sinister, sad, and long-lasting clouds the horizons of young adults whose outlooks would most certainly have been rosier had financial circumstances, oil, terrorism, and political innuendo not won the day. What am I alluding to here? What could possibly be worse than lives cut short before their prime? As Old Glory is raised to the hustle and bustle of backyard barbecues and the hoisting of beers, give a thought to traumatic brain injury and its devastating effects on modern-day patriots, their loved ones, and our pocketbooks.
Do the math, which may not be intended for the faint of heart or mind. Since the start of hostilities back in 2001, more than 1.5 million U.S. servicemen and women have been deployed to Iraq or Afghanistan. They have been better equipped than ever, and protective body armor has resulted in the survival of hundreds, if not thousands, of wounded who would have perished in previous wars. Nonetheless, the situation is double-edged, as hand-in-hand with increased survival struts a concomitant increase in head and neck injuries, including severe brain trauma. According to some estimates, the proportion of U.S. military personnel with mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), may be as high as 18%, and, even if that figure were found to be exaggerated, there is no denying that postconcussive symptoms such as irritability, memory problems, headache, and difficulty concentrating are on the rise in returning “keepers of the peace.” The growing frequency of episodes of domestic violence in military families may also be tied into the rising incidence of mild traumatic brain injury and post-traumatic stress disorder (PTSD).
Mild traumatic brain injury (synonymous with the term “concussion”) has been significantly associated with psychiatric symptoms, most notably PTSD and depression. In fact, more than 40% of soldiers whose injuries involved a loss of consciousness met the criteria for PTSD. No direct link between PTSD and injury to brain tissue from the concussion or trauma itself has been found, and current theories implicate a wide variety of factors operating prior to PTSD onset, such as exposure to extreme stress, traumatic changes in the pituitary gland, altered immune system responses, disturbed sleep physiology, and distorted perception of symptoms.
Perhaps “mild” traumatic brain injury is a misnomer, as the myriad of physical and mental health symptoms resulting from it are anything but mild. While postconcussive symptoms usually resolve rapidly, usually in a matter of days or weeks, multiple concussions lengthen the recovery period, with no answers forthcoming to explain persistent postconcussive symptoms after injury. The neurologic effects of primary blast explosion on the brain are also hard to explain, which does nothing to alleviate the anxieties and concerns of U.S. military personnel about the nature of their symptoms.
Treatment methods for persistent postconcussive symptoms are unproven and have as yet to reach a medical consensus, at a time when medical disability and compensation processes have reached an all-time high, and the expectation and belief systems of patients regarding their injuries are being sorely tried. With neuroimaging and neuropsychological testing procedures often inconclusive and medical management simply symptomatologic at best, patient education has become exceedingly important in the recovery and rehabilitative phases of brain injury.
Mild traumatic brain injury is extremely difficult to diagnose and treat, and, yet, the persistent PTSD, depression, and physical health symptoms resulting from inadequate management warrant further investigation into the timeliness and cost-effectiveness of improved interventions. Digest that, along with your barbecued ribs, on the 4th of July, as U.S. troops remain on the ground in Iraq and Afghanistan!
© 2008, Albert M. Balesh, M.D. All rights reserved.
Do the math, which may not be intended for the faint of heart or mind. Since the start of hostilities back in 2001, more than 1.5 million U.S. servicemen and women have been deployed to Iraq or Afghanistan. They have been better equipped than ever, and protective body armor has resulted in the survival of hundreds, if not thousands, of wounded who would have perished in previous wars. Nonetheless, the situation is double-edged, as hand-in-hand with increased survival struts a concomitant increase in head and neck injuries, including severe brain trauma. According to some estimates, the proportion of U.S. military personnel with mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), may be as high as 18%, and, even if that figure were found to be exaggerated, there is no denying that postconcussive symptoms such as irritability, memory problems, headache, and difficulty concentrating are on the rise in returning “keepers of the peace.” The growing frequency of episodes of domestic violence in military families may also be tied into the rising incidence of mild traumatic brain injury and post-traumatic stress disorder (PTSD).
Mild traumatic brain injury (synonymous with the term “concussion”) has been significantly associated with psychiatric symptoms, most notably PTSD and depression. In fact, more than 40% of soldiers whose injuries involved a loss of consciousness met the criteria for PTSD. No direct link between PTSD and injury to brain tissue from the concussion or trauma itself has been found, and current theories implicate a wide variety of factors operating prior to PTSD onset, such as exposure to extreme stress, traumatic changes in the pituitary gland, altered immune system responses, disturbed sleep physiology, and distorted perception of symptoms.
Perhaps “mild” traumatic brain injury is a misnomer, as the myriad of physical and mental health symptoms resulting from it are anything but mild. While postconcussive symptoms usually resolve rapidly, usually in a matter of days or weeks, multiple concussions lengthen the recovery period, with no answers forthcoming to explain persistent postconcussive symptoms after injury. The neurologic effects of primary blast explosion on the brain are also hard to explain, which does nothing to alleviate the anxieties and concerns of U.S. military personnel about the nature of their symptoms.
Treatment methods for persistent postconcussive symptoms are unproven and have as yet to reach a medical consensus, at a time when medical disability and compensation processes have reached an all-time high, and the expectation and belief systems of patients regarding their injuries are being sorely tried. With neuroimaging and neuropsychological testing procedures often inconclusive and medical management simply symptomatologic at best, patient education has become exceedingly important in the recovery and rehabilitative phases of brain injury.
Mild traumatic brain injury is extremely difficult to diagnose and treat, and, yet, the persistent PTSD, depression, and physical health symptoms resulting from inadequate management warrant further investigation into the timeliness and cost-effectiveness of improved interventions. Digest that, along with your barbecued ribs, on the 4th of July, as U.S. troops remain on the ground in Iraq and Afghanistan!
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
6/29/2008 05:08:00 PM
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