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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

From The Frederick News Post
(Originally published March 31, 2009)

In July 1995, Jean Berube's father, a professor at Old Dominion University, was involved in a car accident. Soon after, he appeared completely recovered from relatively minor injuries.

"It was months later, in October, when he started slurring his words and showed symptoms that looked like he was having a stroke," Berube said. "My mother knew something was wrong."

Rushed to Virginia Beach General Hospital, Berube's father underwent emergency brain surgery. A subdural hematoma, as a result of brain injury, after weeks of slow, undetected bleeding, suddenly reached a critical mass.

"It took months, but my dad got better and eventually went back to work," she said. "In the end, he was fortunate."

The event changed her life.

A lawyer and legislative assistant working on health care issues, among others, on Capitol Hill for former Virginia congressman Owen Pickett, Berube returned home to Virginia briefly to take care of her family. She, of course, became very interested in what had happened to her dad, and in the nature of brain injury itself.

In 1997, she left Pickett's office to become director of public policy and government relations for the Brain Injury Association in Alexandria. Since, Berube, who now lives in Frederick , has been an independent consultant and lobbyist for a variety of brain injury organizations, including the International Brain Injury Association and the National Brain Injury Research, Treatment and Training Foundation.

Today she's recognized as a leading lobbyist specializing in work on behalf of nonprofits providing research and care in the traumatic brain injury field. She works with everyone from Dr. Rick Hunt, director for injury response at the Center for Disease Control, to Col. Michael Jaffe, M.D., the national director of the Defense and Veterans Brain Injury Center, to leaders of health care reform and the Wounded Warriors Project, to congressmen such as Rep. Bill Pascrell Jr., a leading advocate for brain injury research, and Frederick Rep. Roscoe Bartlett, who joined the Congressional Brain Injury Task Force last summer.

March is Brain Injury Awareness Month and the all-day fair March 25 featured presentations on mild traumatic brain injuries from the battlefield to the football field, a congressional briefing and reception. The next day an all-day seminar included panels on the costs of brain injury from the National Center for Injury Prevention and Control, health care reform and preventing disparity in civilian, military and veterans health care.

National Guard troops, for example, Berube said, once their tour of duty is done, often visit civilian doctors unfamiliar with diagnosing and treating issues such as mild traumatic brain injury.

Even before actress Natasha Richardson died earlier this month after initially rejecting medical attention following a seemingly minor fall while skiing, traumatic brain injury research and care has been receiving more attention in recent years because of the wars in Iraq and Afghanistan.

Continue reading the article.

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We've posted a lot about TBI injuries in the military over the past year or so, sadly because it's the sheer number of TBIs suffered in the Iraq War that has drawn so much needed attention to this once silent epidemic.

Well, it's silent no more. Congress and the military have gotten heavily involved. The Centers for Disease Control in Atlanta are sponsoring studies of TBI in prisons. Others are beefing up studies of TBI in homeless populations. In fact, Jack is meeting this month with a representative from Harvard to discuss studying TBI's impact on the homeless. The NFL has completed intensive studies on TBI in professional football. For a topic that rarely saw the light of day, it would now be hard to find someone who had NOT heard about TBI in the past year.

And speaking of the past year, the Surgeon General has just praised the improvements in the way Army medicine assists and transitions its wounded and ill. If you'll remember, it was not so long ago that the Army was on the receiving end of a lot of criticism in this very area.

Coupled with those improvements,
Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, spoke at the [same] media roundtable about improvements in mental health and brain injury research and treatment.

"There have been numerous advancements in the last few months with respect to mild traumatic brain injuries, Post Traumatic Stress Disorder, depression and anxiety," she said. Mental health professionals, both Army and civilian, will continue to cooperate and share information regarding mental health and brain injuries and the risks associated with them.

Sutton added that a scientific working group would convene later this month to review all areas and discuss ways to better serve affected Soldiers and their families.

"We are looking to take a holistic approach (when dealing with) injury and trauma," she said.
Read more about the roundtable here.

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The Buffalo News, by Lou Michel, Wednesday, December 19, 2007 --

You can see the cost of the wars in Iraq and Afghanistan in their empty shirt sleeves, the scars on their heads, in their eyes so weary from sleepless nights.

They return to their homes, trying to fit in again. Most will. Too many will not.

At least 25 local soldiers, four Marines and one sailor have been killed overseas since the war on terror began. Less known are the local veterans returning home with broken bodies or troubled souls.

Some 30,434 men and women in uniform have been wounded in Iraq and Afghanistan, but the Pentagon does not say where they are from, so it’s unclear exactly how many of the wounded hail from Western New York.

Almost 1,700 of those veterans have sought medical treatment at the Veteran Affairs Medical Center in Buffalo since 2003, with a majority seeking help for war-related injuries.

There are probably many more local veterans seeking medical treatment who are not counted in VA enrollment figures because of their status as citizen soldiers. Reservists and National Guard members often have access to private health insurance provided by from their civilian employers, according to VA officials in Washington, D.C.

But for the veterans who are trying to adjust while under the care of the local VA, the navigation of a sometimes unresponsive bureaucracy adds to the pain of life beyond the combat zone.

More than 600 of the 1,659 veterans treated here sought assistance for posttraumatic stress and other psychological readjustment troubles, according to the Department of Veterans Affairs.

“It is a full-time job working on getting whole, getting medical treatment and benefits,” said Bill Biondolillo, who served two combat tours in Iraq for a total of 14 months.

“We go and do the dirty work and we have to carry that, while the rest of the country goes on with life,” said Biondolillo, a major in the Reserves.

The list of injuries local veterans seek treatment for is frightening:

• Exposure to Russian-made bullets with depleted uranium in the shell casings. This can cause tumors, skin ailments and respiratory problems.

• Traumatic brain injuries and concussions from blasts, as well as shrapnel from explosive devices.

• Damage to the neck, back and hips from carrying as much as 100 extra pounds of body armor, ammo and other equipment.

• Irritable bowel syndrome and gastric illnesses caused by stress and living in unsanitary conditions.

Continue reading the article.

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WASHINGTON, Dec. 13 /PRNewswire-USNewswire/ -- "The American Veteran," a monthly half-hour news magazine from the Department of Veterans Affairs (VA), spends a full third of it's January edition on two of the most talked about health problems of combat veterans -- traumatic brain injury (TBI) and post traumatic stress disorder (PTSD).

"We are committed to informing veterans and military personnel about the VA programs and staff dedicated to helping these warriors recover from their physical and mental injuries," said Acting Secretary of Veterans Affairs Gordon H. Mansfield. "These stories put a spotlight on the determination, commitment, and discipline of these combat veterans and the support provided by earlier generations."

One feature looks at the state-of-the-art technologies used to assess and treat even the unseen damage done to the brain by the weapons and tactics of the current conflicts in Iraq and Afghanistan. A second feature looks at the services available to any combat veteran suffering from the often debilitating effects of PTSD, as well as the benefits of having veterans of previous wars available as a support network for veterans recently returned from combat. A third story examines the benefits of alternative therapies, including the use of horses in helping veterans to re-engage in managing their lives successfully.

The series is designed to inform active duty members, veterans, their families and their communities about the services and benefits they have earned and to recognize and honor them. VA's Office of Public Affairs and the VA Learning University/Employee Education System (VALU/EES) produce the program and broadcast it to VA facilities on the department's own internal network, around the world on The Pentagon Channel and to community cable outlets.

The VA Office of Public Affairs offers the program to local broadcasters and cable outlets and makes it available for viewing on the VA Web site, Just click on "Public Affairs" and then "Featured Items."

Continue reading the article.

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Kaiser Daily Health Policy Report Capitol Hill Watch --
Lawmakers Pass Measures To Improve Veterans' Health Care Services

Dec 12, 2007 -- House and Senate lawmakers recently passed measures addressing veterans' health. Summaries of news about the legislation appear below:

* Traumatic brain injury: The Senate on Tuesday by voice vote passed a bill (S 793) sponsored by Sen. Orrin Hatch (R-Utah) intended to improve treatment of traumatic brain injuries in veterans returning from Iraq and Afghanistan, CQ Today reports. The bill would require CDC and NIH to conduct research to improve treatment techniques for traumatic brain injuries and also would mandate that CDC monitor brain injury cases. In addition, the legislation would reauthorize and expand programs established by a 1996 law that permits CDC to grant states funds for brain injury patients to enter treatment and rehabilitation programs (Hunter, CQ Today, 12/11).

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Savannah Morning News, Sunday, December 2, 2007 -- Laboran Pickens sits inside the busy Savannah coffeehouse.

He flinches every time the grinders whine so strangers can walk away with frothy, caffeinated beverages.

He looks nervous. He assures his company he's fine.

He's on medication from Georgia Regional Medical Center.

It helps, but not always.

The Iraq nightmares still come, medicine or not.

Sometimes the spell is prompted by a loud noise or errant thought. It makes him space out. He moves like he's in a dream. He often disappears from his Hinesville home, sometimes for hours.

His wife spends those hours frantic, wondering where he is. She worries each time will be his last. That he won't come back to her and their three children.

He returns, but remembers nothing.

At 30, he is a shell of the man he once was.

'Signature wounds'

It is estimated that up to 20 percent of the 1.5 million men and women who have served in Afghanistan and Iraq since America's War on Terror began may suffer from post-traumatic stress disorder or traumatic brain injuries, according to the Defense and Veteran Brain Injury Center, which is part of the Walter Reed Medical Center.

And a 22-month study by Veterans for America of all soldiers returning to Fort Carson, Colo., found more than 17 percent of all servicemen and women who had deployed from the installation had some form of traumatic brain injury.

Veterans organizations fear that thousands of soldiers are living undiagnosed.

Many have left the military. Or, like Pickens, were asked to leave.

They carry invisible scars.

These wounds take the form of honorable discharges, public disturbances, police reports, missing memories, sleepless nights.

And their numbers are only increasing.

Continue reading the article.

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USA TODAY, Gregg Zoroya, November 22, 2007 --Marine Lance Cpl. Gene Landrus was hurt in a roadside bomb attack outside Abu Ghraib, Iraq, on May 15, 2006, and faces medical separation from the Corps. He's also up for a Purple Heart.

Along with 20,000 other veterans, he's not included in the Pentagon's official count of U.S. troops wounded in Iraq and Afghanistan.

That's because Landrus' wound was to his brain and hidden from view. Landrus, 24, of Clarkston, Wash., says he did not realize the nausea, dizziness, memory loss and headaches he suffered after the blast were signs of a lasting brain injury.

Army medics who examined him in the field didn't find the wound either. "They wanted to know if we had any holes in us, or if we were bleeding. We were in and out of there (the aid station) in 10 to 15 minutes," Landrus remembers.

For the balance of his combat tour, he tried to shake off the blast's effects and keep going. Now, "my goal is to get back to a normal life," he says.

A USA TODAY survey of four military installations and the Department of Veterans Affairs, where combat veterans are routinely screened for brain injury, has found that about 20,000 people show signs of damage. They are not counted in the Pentagon's official tally of 30,000 war wounded.

The military lacks "a standardized definition of traumatic injury or a uniform process to report all TBI (traumatic brain injury) cases," Assistant Secretary of Defense Ellen Embrey wrote in a memo last month. As a result, it is hard to determine the scope of the problem, she wrote.

Continue reading article.

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Earlier this week, Gregg Zoroya in USA TODAY wrote:
Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.

They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.

The new findings are the result of blast experiments in recent years on animals, followed by microscopic examination of brain tissue. The findings could mean that the number of brain-injured soldiers and Marines — many of whom appear unhurt after exposure to a blast — may be far greater than reported, says Ibolja Cernak, a scientist with the Johns Hopkins University Applied Physics Laboratory.

This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.

Physicians and scientists are calling TBI the "signature wound" of the Iraq war because of its increasing prevalence among troops.
Continue reading the article.

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FORT CARSON, Colo. — The Army, faced with thousands of cases of brain injury from the Iraq war, will soon begin testing brain-scanning equipment in hopes of finding a more accurate way to identify hard-to-diagnose wounds...

To date, the Army has not extensively used neuroimaging equipment to detect brain injuries in returning soldiers because not enough testing has been done to judge the

Read the rest of the article.

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Thesaurus / image via Wikipedia
I love the CBS television show Without a Trace. There's the dramatic tension you might expect from a one-hour program about a search for a different missing person every week. But the writing is superb, the acting exceptional, and, as my wife could tell you, I often end up sniffling by the time the hour is up. Alas, this season, since they moved the show to Sunday nights -- where its airtime is frequently, unpredictably bumped by sports events -- I don't see it much anymore.

But I did for some reason catch the episode ("Crash and Burn") originally aired last Sunday, April 15. (Trailer here, on the ever-valuable YouTube.)

I won't detail the plot here, spoiling it for any of you who'd like to see it. But I can tell you that the plot hinged on a brain injury suffered by a veteran of the US Marines -- not in combat, but in a trail-bike accident.

Two items of interest about this episode:
  • First, the storyline depended not just on the facts of the veteran's brain injury, but on what life was like for him afterwards. For instance, he recounted one particularly excruciating incident: He'd left his house to walk a couple of blocks to a store one night. When he came out of the store, he looked down the street to his house... and he didn't recognize it.
  • Second, nowhere in the episode -- that I caught, anyway -- did the phrase "traumatic brain injury" appear (nor, of course, the abbreviation "TBI"). As Jack Sisson says in chapter 1 of his book here at
I believe one reason traumatic brain injury is not more widely recognized is that it has no name, or rather, too many names. Think about it – concussion, closed head injury, coma, shaken baby syndrome, diffuse axonal injury, second impact syndrome, coup countrecoup injury, contusion -- all refer to brain injury and are often used interchangeably with TBI...

Acquired brain injuries (ABIs) further complicate matters... many experts and organizations refer to all brain injuries as ABIs, with TBI being just one type of ABI. Confused? You should be.

It can be surprising to find TBI referenced in popular culture. More, it can be astonishing to find it referenced as TBI; I kind of wish one of my favorite show's writers had latched onto the term.

If you're interested in the episode, again, the episode title is "Crash and Burn." It will no doubt be re-broadcast sometime between now and the start of next season; you might also watch for it on the TNT cable channel, which shows Without a Trace reruns.

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Former GOP Sen. Bob Dole
The government is finally beginning to address the myriad problems faced by our returning wounded troops, including those with TBI. Found this at
WASHINGTON - Injured soldiers returning home for medical treatment face an unacceptable maze of paperwork and bureaucracy, leaders of a presidential commission on veterans' health care said Saturday.

At its first public meeting, the nine-member panel heard from veterans, spouses and advocacy groups who decried what they said was a failed system. The commission pledged to work quickly to find solutions rather than assign blame.

"This is not going to be a witch hunt," said former GOP Sen. Bob Dole of Kansas, one of the heads of the Commission on Care for America's Returning Wounded Warriors.

Dole said the commission planned to build upon the work of at least nine congressional committees and other government panels that are investigating veterans' health care problems. Those inquiries followed disclosures in February of squalid conditions and poor outpatient treatment at Walter Reed Army Medical Center in Washington.

Their reviews in recent weeks have pointed to inadequacies with the treatment of brain injury and post-traumatic stress disorder, as well as outpatient care.
Read the entire article.

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Reuters, March 21, 2007.
More Americans are being hospitalized with very serious head injuries, and government statisticians say they don't know why. Statisticians on Wednesday reported a 38 percent increase in hospital admissions for the most serious kind of head injury, type 1 traumatic brain injury, between 2001 and 2004. The biggest single cause was falls.

The researchers found that in 2004, nearly 204,000 people were treated in hospitals for traumatic brain injury at a cost of $3.2 billion...The figures do not include military personnel or people treated at Veterans Affairs hospitals. Nor did they include people who died before they made it to the hospital.

Read the entire article.

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Here's a link to a Fox News transcript of Greta Van Susteren interviewing Bob Woodruff. The interview took place last night.

Good article in the Detroit News about Woodruff's growing influence on good medical care for TBI injuries.

Yesterday ABC News reported receiving over 1000 emails from wounded veterans and their families. The emails resulted from ABC's documentary about Woodruff, "To Iraq and Back," "with many claiming they have had problems dealing with the Veteran's Benefits Administration as they seek rehabilitation from injuries sustained in Iraq and Afghanistan." Read the article (and talk to the Woodruff family) here.

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