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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
We all know by now that Traumatic Brain Injury is the signature wound of the Iraq War. Explosions that would have killed soldiers in previous wars are now less often fatal, due to the improved protective qualities of military helmets. What happens, however, is that the brain is knocked around inside the skull, as the head forcibly hits the helmet during the explosion. The result is less fatalities, but more brain injuries. According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009. The military has planned clinical trials using pure oxygen in a pressurized chamber to determine if the technique can help brain-injury sufferers heal.

From The Associated Press:
The U.S. military plans clinical trials next year to see whether breathing pure oxygen in a pressurized chamber might help thousands of Iraq and Afghanistan war veterans suffering from traumatic brain injuries.

About 300 service members with mild to moderate damage will participate in the trials of hyperbaric oxygen therapy to help determine whether it can help them heal, or at least ease the headaches, mood swings or other symptoms linked to brain injury.

Some will spend a total of 40 hours over 10 weeks breathing pure oxygen in a hyperbaric chamber, where the atmospheric pressure is increased to a level similar to what they would experience about 20 feet under water.

According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009.

Read the story here.

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It's been a busy few weeks. We usually write about embryonic stem cells on the Beginning of Human Life blog, but since the research could benefit those suffering from traumatic brain injuries, I'm including those news items here as well. First, a recap on the embryonic stem cell issue:

The Moral Imperative to Relieve Suffering: Embryonic Stem Cell Research

There have been many moral objections raised to embryonic stem cell research. But as President Obama prepares to sign an executive order to repeal his predecessor's ban on federal funding for such scientific inquiry, we should also ask what the moral imperatives are to do this research. In addition, are there moral insights that can help us develop guidelines for the research?

Restrictions on federal funding of embryonic stem cell research have retarded scientific investigation that could well yield important medical advances. Devastating diseases such as Alzheimer's, Parkinson's, diabetes, heart disease, and spinal cord injury may see treatments emerge that can relieve enormous suffering and promote healing. There is a clear moral imperative, shared across many religions, to relieve suffering and promote healing. This is a strong ground on which to base religious arguments for the research.

The religious objections arise specifically in relationship to embryonic stem cell research. The religious controversy is rooted in the belief that the fertilized egg, even while not implanted in a woman's uterus, is still spiritually complete "life" and as such sacrosanct.

Read the article in The Washington Post.


President Obama Reverses Bush's Stem Cell Research Ban
WASHINGTON
– President Obama reversed a Bush administration order and vowed Monday to "vigorously support" stem cell research that scientists hope will lead to cures for deadly ailments like diabetes and Parkinson's disease.

"We will bring the change that so many scientists and researchers, doctors and innovators, patients and loved ones have hoped for and fought for these past eight years. We will lift the ban on federal funding for promising embryonic stem cell research," Obama said to cheers at the White House.

Fulfilling a campaign pledge, Obama signed an executive order ending President Bush’s ban on federal funding for embryonic stem cell research.

Read the article in U.S. News & World Report.


Some Catholics Disappointed in Obama

He garnered the majority of Catholic votes in the 2008 election, but a number of Catholic groups now say President Obama is showing a complete lack of regard for their beliefs.

They count his decisions to lift restrictions on abortion and stem cell research among the most offensive.

"As far as the Catholic church goes, there's no bigger priority for Catholics than human dignity and human life," said Cathy Ruse, senior fellow at the Family Research Council said. "And the Obama administration has just been an assault on those values again and again in just two months."

But some American Catholics support the president, saying his policies are consistent with their "mainstream" beliefs.

"President Obama has already reached out and won the Catholic vote," Jon O'Brien, president of Catholics for Choice, said.

"That's what happened in the last election in spite of the very loud voices of some extreme uber-Catholics who really want to paint this black and white picture -- to engage us in this endless culture war," he said.

O'Brien, whose group supports access to contraception and abortion, said Obama presented Catholic voters with a social justice agenda they can support.

Read the article at FoxNews.com.


Majority of Americans Likely Support Stem Cell Decision
Fifty-two percent support easing Bush-era restrictions or lifting restrictions entirely
WASHINGTON, D.C. -- A majority of Americans likely support President Barack Obama's executive order Monday doing away with the rules on federal funding of embryonic stem cell research that were in place under the Bush administration. In a Gallup Poll conducted last month, 38% of Americans said they support easing those restrictions and another 14% said they favor no restrictions at all. About 4 in 10 Americans favor keeping the Bush restrictions or eliminating federal funding altogether.

Read more about the poll and what the country's really thinking at Gallup.com.


Then traumatic brain injury was all over the news this week for a sad story. The lovely, talented actress Natasha Richardson, married to actor Liam Neeson and the daughter of Oscar-winning actress Vanessa Redgrave, fell on a beginner's ski slope in Canada, felt and acted fine after the accident, began having headaches about an hour later, lapsed into a coma, her brain ceased to function, she was removed from life support and died within hours. Broadway, Hollywood, and the rest of the country were shocked. She was so talented. She was so beautiful. By all accounts, she was so funny, and loving, and giving. She was only 45. How could a simple fall in which she ran into nothing or no one cause her to die?
Richardson Died From Clot That Compressed Brain Natasha Richardson, the British actress who fell during a ski lesson on Monday and later in the day lapsed into a coma, died of a large blood clot compressing her brain, New York City's medical examiner said yesterday.The bleeding that led to the clot was caused by "blunt impact to the head," according to the official report, which also labeled the death an accident.

The formal name for the condition is "epidural hematoma." It is usually the result of bleeding from arteries torn when the skull is struck hard, often on the temple where the bone is thinnest.

Arterial hemorrhage inside the skull is a potential catastrophe. Each heartbeat pumps blood under high pressure into a confined space, compressing the brain tissue.

"It is the most feared, treatable problem in neurosurgery," said Gail Rosseau, chief of surgery at the Neurologic and Orthopedic Hospital of Chicago. "These are the patients who 'talk and die.'"

Read the article in The Washington Post.

Then the accident dissection and second-guessing starts. I know it's important to understand why she died, but it just feels like it would be a little more decent to wait until after her funeral. Anyhow:

Natasha Richardson Refused to Wear Helmet
Natasha Richardson chose not to wear an inexpensive ski helmet which could have saved her life.

According to "The Sun," the actress who died after falling during a ski lesson at a Canadian resort, turned down resort staff recommendations that she wear the head protection.

Read the article at ArkansasMatters.com


After Wake, Some Wonder If Helicopter Could Have Saved Richardson

A day before Natasha Richardson's scheduled funeral, some are wondering if a medical helicopter might have been able to save the actress, who passed away Wednesday at age 45 after falling on a Quebec ski slope. The province of Quebec lacks a medical helicopter system, often used in the US and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal's top head trauma doctor told The Associated Press that may have played a role in Richardson's death.

"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal's hospitals, told the AP.

Read the article at ABC News.
And then there's this final disgusting note:
Anti-gay church plans protest of Richardson funeral
MILLBROOK — Members of the Topeka, Kan.-based baptist church said they are coming to Millbrook Sunday to protest Natasha Richardson's funeral.

On it's Web site, Westboro Baptist Church said it plans to protest at St. Joseph's Church because Richardson supported research for a cure for AIDS. The small Kansas church has protested schools, colleges, churches, funerals and other venues.

The Westboro Baptist Church, founded in 1955 by the Rev. James Phelps, describes itself as an old-school Baptist church.

In April 2004, nine members of the church came to New Paltz to protest the same-sex marriages officials were conducting. They were met by hundreds of New Paltz-area residents who came out in support of the same-sex ceremonies and to oppose the Kansas group that held banners and shouted slogans with homosexual slurs.

Nearly 100 police officers from New Paltz, state police, Ulster County Sheriff's Department, Town of Lloyd and the Town of Ulster provided security at the event. No incidents were reported.

On Friday, local police said they are preparing for traffic and crowds Sunday, based on reports Richardson will be buried in a private ceremony near the family's Town of Washington home.

Read the article in the Poughkeepsie Journal.

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This morning I found an interesting site, Spot-On.com, which is, according to the site's About Us page, "a web-based syndication service offering a range of independent, intelligent and insightful looks at politics and current events." One post, by admitted liberal writer Christopher Brauchli, definitely merits sharing with our readers:
In his last State of the Union message, Mr. Bush received great applause when he said: "Our military families also sacrifice for America. . . . We have a responsibility to provide for them. So I ask you to join me in expanding their access to child care. . . and allowing our troops to transfer their unused education benefits to their spouses or children. Our military families serve our nation, they inspire our nation, and tonight our nation honors them." One week later he submitted his 2009 budget and dissed the veterans. No funds were included for transferring education benefits.

In submitting his $1.3 trillion budget he forgot to include the benefit that would cost between $1 billion and $2 billion dollars. That was not the end of ignoring the needs of veterans. According to a release from the Brain Injury Association of America, for the third year in a row, Mr. Bush has proposed the complete elimination of the Federal traumatic Brain Injury Program. The program "provides grants to state agencies and [other organizations] to improve access to health and other services for individuals with traumatic brain injury and their families." Susan Connors, president and CEO of the Brain Injury Association of America described the omission as "deeply disappointing" and went on to say that "President Bush just doesn't get it." Those two examples are not the only ones in which veterans who have withstood the onslaught from the enemy in Iraq have to defend themselves from the onslaught of the wolf in the White House parading in sheep's clothing.
Visit Spot-On.com to read the complete post.

Just the kind of duplicitous doublespeak we've come to associate with this administration, but it's especially troubling when those being hurt by it are our returning military, for heaven's sake, as well as some of our most vulnerable citizens. It's a disgraceful situation that should get tons of press, but I wonder how many of the Republican Party's faithful are even aware that the country's vets are being treated this way. My guess is not many. As I've said before, "Support our Troops" takes more than a magnet slapped on the rear of your SUV.

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St. Petersburg Times, By William R. Levesque, Times Staff Writer, February 12, 2008 --

TAMPA - The James A. Haley VA Medical Center and the University of South Florida Photo credit: U.S. Dept. of Veterans Affairsannounced on Monday that they are entering into a partnership to research traumatic brain injury.

Traumatic brain injury is considered the signature wound of soldiers serving in Iraq who are often exposed to explosions. Up to 20 percent of all returning troops exhibited symptoms of the injury.

Congress last year set aside $450-million for research on the condition, which is still poorly understood by the medical community. [This is something Jack has complained about for years. The extremely poor care he received immediately following his own injury inspired a lifelong crusade to have doctors better informed about brain injury. He believes even psychologists, although they are not medical doctors, would benefit from learning more about brain injury. And he's convinced their patients would. How can they expect therapy to be successful if part of the patient's problem is a brain injury that the therapist either doesn't recognize or knows little about?]

At a news conference outside Haley, Rep. Kathy Castor, D-Tampa, said she recently inserted language in the National Defense Authorization Act that gives the Haley-USF partnership "a leg up" in getting some of that $450-million.

How soon or how much of the money will come to Tampa is not immediately clear.

"We have unique assets here," Castor said. "So we're going to use all that leverage to draw down as much of those research dollars that we can."

She said it was unique set of circumstances having a major veterans hospital sitting side by side with a major research university like USF. And both are a short drive from MacDill Air Force Base.

Also, Haley is home to a polytrauma center, one of just four in the nation where physicians treat some of the most severely wounded veterans.

Haley doctors said the partnership contains an education component that allows researchers to "export" their knowledge on treating traumatic brain injury to hospitals around the nation.

Continue reading.

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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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Nurse.com, by Kurt Butzbach,RN, Monday December 17, 2007 -- I am a nurse on the brain injury unit at the Rehabilitation Institute of Chicago (RIC). This job means a lot to me because at one time I was the patient.

More than 22 years ago, I had an accident while working in a steel fabrication shop. I fell more than 15 feet from a ladder to the floor. While one coworker called 911, another coworker held my unresponsive body. I started to turn blue, so while he waited for help, he put me in a bear hug and squeezed me, "the way they do on TV," he said. I started breathing again, but to his surprise blood started gushing out through my left ear. He didn't know if he had saved me or helped kill me.

He had ruptured my ear drum, which allowed the blood and cerebral fluid that was building pressure in my head to escape, quite possibly saving my life. I had suffered a traumatic brain injury, caused by a basal skull fracture, in addition to a separated shoulder.

My short-term memory and speech were affected, and I suffered some left-sided paralysis. So, following my hospital stay, I started rehabilitation through outpatient therapy. I participated in cognitive therapy and physical and occupational therapies and admired the therapists and nurses who helped me find my way back.

After I was released from the hospital and went through ongoing rehabilitation, I was able to fine-tune some of the more creative skills I hadn't been using for a while, such as carving, woodworking, and music.

I started a small wood shop in my garage, and I started playing my guitar more, which was an escape from the daily challenges of recovering from a brain injury.

Continue reading the article.

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Ever since O.J. Simpson almost assuredly got away with murder, Jack has wondered if all of those years of football contributed to brain injury. We know that brain injury alone doesn't necessarily make one violent, but coupled with existing mental illness and/or child abuse, you end up fitting the model for one of Jonathan H. Pincus's violent killers.
Pincus and his colleague Dr. Dorothy Lewis, a child psychiatrist, developed the view that murderers, and especially the most notorious kind, such as serial killers, are the product of the combination of child abuse with neurological damage and psychiatric illness. The three factors interact, as childhood abuse creates enormous anger, while neurologic and psychiatric diseases of the brain damage the capacity to stop urges to violence. A supplementary disinhibiting factor is the abuse of alcohol and drugs, involved in an estimated 70 percent of violent crimes.
You can read more here.

So, with all of that in mind, here's an article from "Slate" that explores the same question -- could football have contributed to O.J.'s behavior?

Slate by Chadwick Matlin, Sept. 21, 2007 -- With the murder trial, the "hypothetical" outline of how he would have killed his ex-wife, and now his "sting operation" in a Las Vegas hotel room, it's hard to remember that O.J. Simpson used to play football. He was actually pretty good at it, running away with the Heisman Trophy in 1968 and making the Pro Bowl five times in his NFL career. As a pro, Simpson carried the ball more than 2,400 times. As the evidence mounts that football can cause massive head trauma, it's worth wondering: Could O.J.'s erratic behavior have something to do with taking too many gridiron collisions?

After former Eagles defensive back Andre Waters committed suicide last year, the Waters family sent pieces of his brain to a forensic pathologist. The doctor reported that damage sustained while playing football had made Waters' brain similar to that of "an octogenarian Alzheimer's patient." According to his doctors, Hall of Fame center Mike Webster suffered frontal lobe damage due to repeated head injuries; he was suffering from dementia when he died at age 50. A post-mortem analysis of Chris Benoit, the professional wrestler who killed his wife and son and then committed suicide, revealed massive brain damage. Diaries were also found with cryptic, disturbing passages that suggested Benoit's behavior wasn't a result of steroid-induced rage, but rather a gradual decline into violence and dementia.

All of these athletes sustained traumatic brain injuries that killed brain cells and left them permanently impaired. Dr. David Hovda, a neurosurgeon at UCLA told me that any altered consciousness—seeing stars, dizziness, or feeling dazed after a hit—is considered a mild TBI. Even a mild concussion causes damage. With football's macho culture, players often pick themselves up and stay in the game, leaving themselves open to more serious harm. But repeated TBIs can lead to an altered frontal and temporal lobe, which can cause heightened anxiety and a loss of emotional control. Football players tend to damage their temporal lobe, which controls feeding, fighting, fleeing, and the person's sex drive.
Keep reading.

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U.S. Army Sgt. Frank Sandoval
It's hard to believe that, at this late date, certain people still accuse those of us opposed to the Iraq War of not supporting our troops. How in the world can they construe supporting our troops to mean sending them back into that escalating quagmire for repeated (and extended) tours of duty where over 3,700 have died and approximately 1,800 have suffered traumatic brain injuries (TBIs)?

According to the Washington Post, "...neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch." A study by researchers at Harvard and Columbia predict that brain injuries from the Iraq war will cost the government at least $14 billion over the next 20 years.

Here's one more recent story:
CAMP WILLIAMS, Utah (ABC 4News)- A voluntary assignment to help the people of Afghanistan develop new agriculture skills turned into a life long sentence for a Utah man, who joins an increasing list of returning soldiers who suffer from traumatic brain injuries caused by roadside bombs.

"I remember leading up to it, the event, most of the explosion, no," said Highland resident Doyle Peterson.

A roadside bomb destroyed Peterson's vehicle in rural Afghanistan two years ago on August 21, 2006. He is recovering physically, but like many roadside bomb survivors Peterson sustained permanent damage to his brain.

"It's a blank spot. I do remember some of the things that happened when we were being evacuated to the field hospital," he said.

Brain injures are now the signature injury of the Iraq war according to former Secretary of Army, Martin R. Hoffman. Hoffman came to Utah to meet with members of the Community Based Health Organization (OBHCO) located at Camp Williams.
Continue reading.

The photo accompanying this post was honored in The Best of PhotoJournalism 2007. Go here to see this picture and other winners.

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Courtesy movieprop.com
The Murfreesboro Post By Dr. MARK KESTNER
A savant is a rare individual that possesses an extraordinary ability to perform mental tasks that seem superhuman. Savants are typically autistic people that are limited in some aspects of intellectual capacity, but perform like a genius in others. The most widely known example of a savant is the real person that inspired the movie, “Rainman.”

The movie was based upon a real man named Kim Peek...Now in his fifties, Kim is the most famous savant in the world. He can read a page of text in about 10 seconds.
( Click here to watch a short documentary on Kim Peek. If the link doesn't work, just go to www.youtube.com and type Kim Peek in the Search bar.)
Darold A. Treffert, a leading medical expert on autism, states that savants tend to have exceptional abilities in one of five areas: music, art, lightning calculations, calendar calculating and mechanical or spatial skills. Savants may be able to play a complete symphony after hearing it only once or draw an exact rendering of a city skyline with only a brief glance to record the vision.

It is even more astounding to realize that there is another type of savant … those known as acquired savants. These individuals were born and developed normally. They acquired astonishing skills usually after a traumatic brain injury. [emphasis added] Often they are left with a mental impairment, but are able to do calculations and exhibit near perfect recall of certain types of memory.

A most unusual case involved Orlando Serrell. Orlando was a normal 10-yeaold boy until he was hit in the head with a baseball. Within a few months of that injury Orlando began recalling such things as every license plate of the cars that had passed. Or, if you mention a date since his accident, he can effortlessly recall the weather and his whereabouts for that day. Unlike many autistic savants, however, Orlando still retains normal brain function.

Keep reading.

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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 sossisson.com:
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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