National Nurses United

TBI:2 5/27/08 12:35 PM Page 13 opposite: Lance Cpl. Sam Reyes, 22, looks over a book of his homework assignments. Reyes survived three attacks in Iraq, including when a suicide bomber blew apart a lightly armored 18-wheeler Reyes was riding in. The explosion sent a powerful shock wave through his brain tissue, bursting blood vessels and smacking his brain against the inside of his skull, causing an undetected traumatic brain injury. this page above from left to right: Dr. Alisa Gean prepares an ICU patient at Landsthul Regional Medical Center for transport back to the continental United States. Note the extensive equipment, in effect a self-contained "miniature ICU," needed to monitor and care for the wounded soldier during the 10-hour transport. Military personnel load a critically injured soldier on the flight from Ramstein Air Force Base back to the United States. The C-17 aircraft used for transporting the troops is a virtual "flying ICU." and problems like addiction and homelessness. "Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure," said Wayne A. Gordon, director of the Brain Injury Research Center at Mt. Sinai School of Medicine, in a January 2008 Wall Street Journal article. One Mt. Sinai study of 100 homeless men in New York found that 80 of them had suffered brain trauma, much of it from child abuse. A similar study of 5,000 homeless people in New Haven, Conn., discovered that those who had suffered a blow that knocked them unconscious or into an altered state were twice as likely to have alcohol and drug problems and to be depressed. It also found higher rates of suicide attempts, panic attacks, and obsessive-compulsive disorder. One of the major effects of TBI is what Landau of Linking Human Systems calls the development of "identity ambiguity: people who were decisive become indecisive. People who were charming become withdrawn. They may have trouble reading. They may fly into rages." Landau said this can be devastating for those around TBI sufferers. "The family is excited that this young person is coming home [from the war] with no major injuries. They left as a good son, a good father, and a good husband. Suddenly they start hitting their children, can't have sex, start drinking too much, talking too loud." Mary Watson, a psychiatric RN at a Cleveland VA hospital, said TBI sufferers can "seem to be perfectly normal and then spontaneously become confused and irritated, suddenly set off by something in their surroundings and start yelling and cussing." M AY 2 0 0 8 Pennsylvania Psychologist Barry Jacobs, author of Emotional Guide for Caregivers, said TBI victims may lose their ability to empathize with others. "It is like a stranger has suddenly shown up." Even lesser degrees of TBI can disrupt lives. A recent Army study downplayed the seriousness of mild TBI (MTBI), suggesting that the health problems associated with MTBI were largely a result of PTSD and depression. But a careful reading of the study reveals that researchers failed to directly link PTSD to MTBI and that "these data should not be construed as suggesting that mild traumatic brain injury is not a serious medical concern." Soldiers who suffer MTBI, especially those knocked unconscious or who experience it multiple times, "were at a very high risk for physical and mental health problems." UCLA's Hovda even questions the term "mild." He said, "I don't know what makes it 'mild,' because it can evolve into anxiety disorders, personality changes, and depression." Victims can suffer a tapestry of psychological syndromes. "Even mild brain trauma shakes up the entire body," said Landau. "Many doctors and therapists just don't see this." One problem, she noted, is that MTBI can produce such a wide variety of systems, from disrupting the female hormone system to irritable bowels. Jacobs said he is particularly concerned about MTBI. "Mild injuries are most at risk," he said, because the symptoms are subtle and may not be recognized as neurological. But while the symptoms may be subtle, the consequences for family, friends and coworkers may be severe. According to Landau, "There is a 70 percent chance that relationships will break down after TBI." F or all tbi's dramatic effects, scant attention has been paid to it until recently. Dr. Alisa Gean, the chief of neuroradiology at San Francisco General Hospital, has been "carrying a torch" on civilian TBI for more than 20 years—she is the author of what is considered the standard textbook on imaging TBI—but the subject has not been a popular funding category. People worry about whether they are going to get breast cancer or AIDS, but "people don't think they are going to get TBI," said Gean. Afghanistan and Iraq have changed all that. "The wars have W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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