I have a friend who is fascinating to be around. Let's call him Garth. He's jovial, handsome, and a really nice guy. He's into fitness and nutrition. He's roughly 42, but he's still 20 in spirit. He absolutely loves riding his mountain bike through the woods.
He's in great shape and has spent years in small groups of guys for self-improvement. That's where I got to know him. He's the kind of guy that volunteers to help out on tough projects for both the challenge and comradery. That's what he loved about the Army.
Maybe you've seen Garth's look-alike making people a little uncomfortable with his loud voice and laughter - at a family get together, or in the Fellowship hall after the Sunday service. He's the guy that's a little weird, disconnected a bit, and has an unknown history.
From time-to-time, Garth would disappear for a few days, and show up with a great tale of tracking cougars through the snow and sleeping outside all night. He has a knack for both amusing and making people think twice.
I hired him a couple times to work on software projects. But, since he has periods of 'hiding out' it's tough for him to have a 'regular' job, especially in our smallish town, or when the weather is nice for riding through the woods.
He told me that one morning, marching to the chow hut in Riyadh, Afghanistan, he fell out of line to pet a mangy dog. He woke up in a hospital. His buddies were all killed in the blast. He was 'lucky' to be sent home in one piece.
His life is tough. His hearing is kind of bad. He battles with memories and escapes to the woods. He's not married anymore. His kids are now grown, but he hasn't seen them in over a decade.
He's a great guy with a series of traumatic brain injuries (TBIs). One day he crashed hard from a massive jump on an obstacle course, and 'forgot' to come back to work...
I haven't seen him for over a year now.
Maybe you know a guy in Minneapolis like this? Maybe that guy is you?
John Hamilton wrote an insightful article featured on NPR. He writes; "During the wars in Iraq and Afghanistan, the U.S. military did an about-face on detecting and treating brain injuries caused by explosions. After years of routinely sending blast-exposed troops back into combat, the military implemented a system that requires screening and treatment for traumatic brain injury."(1)
Since World War I and until recently, military doctors had been taught about blast exposure: "If you don't have blood coming out of your head, if you don't have a penetrating injury, you have not been injured," Christian Macedonia says. "Your job as a doctor at that point is to say, 'You're gonna be fine' and basically minimize any of the symptoms." Macedonia himself believed that when he was deployed to Iraq in 2004, to serve as chief of a combat support hospital near Fallujah. He was seeing horrendous injuries, so he didn't have much time for people who looked OK, even if they'd been dangerously close to a blast. Macedonia and other military doctors actually became suspicious of service members who suggested blast exposure was the cause of their headaches, fatigue or sleep problems. "The attitude was that these people were trying to get a Purple Heart or something like that," he says. "In retrospect, it was just awful. It was really a bad thing to do to people." Macedonia's conversion occurred one day in Iraq, when he got caught in a mortar attack. "I was out with a young Marine. We were in the middle of the attack. And the mortar was probably about 50 meters away," he says. The blast wave shook them violently. But they were alive. And they weren't bleeding. So Macedonia went back to the hospital. He did surgery until midnight. Then, he headed for bed. I had a shaving mirror hung up by my cot and I looked in that mirror and I didn't recognize the person looking back at me," he says. Macedonia realized that he couldn't remember anything from the operating room that night. And he recognized the vacant expression he saw in the mirror: "The same sort of strange look in the eye that I had seen in people who had been in IED blasts up and down the route near our base." Macedonia was pretty sure he wasn't having a purely psychological reaction to combat. The blast had injured his brain (1).
Since World War I and until recently, military doctors had been taught about blast exposure: "If you don't have blood coming out of your head, if you don't have a penetrating injury, you have not been injured," Christian Macedonia says. "Your job as a doctor at that point is to say, 'You're gonna be fine' and basically minimize any of the symptoms."
Macedonia himself believed that when he was deployed to Iraq in 2004, to serve as chief of a combat support hospital near Fallujah. He was seeing horrendous injuries, so he didn't have much time for people who looked OK, even if they'd been dangerously close to a blast.
Macedonia and other military doctors actually became suspicious of service members who suggested blast exposure was the cause of their headaches, fatigue or sleep problems. "The attitude was that these people were trying to get a Purple Heart or something like that," he says. "In retrospect, it was just awful. It was really a bad thing to do to people."
Macedonia's conversion occurred one day in Iraq, when he got caught in a mortar attack.
"I was out with a young Marine. We were in the middle of the attack. And the mortar was probably about 50 meters away," he says.
The blast wave shook them violently. But they were alive. And they weren't bleeding. So Macedonia went back to the hospital. He did surgery until midnight. Then, he headed for bed.
I had a shaving mirror hung up by my cot and I looked in that mirror and I didn't recognize the person looking back at me," he says. Macedonia realized that he couldn't remember anything from the operating room that night.
And he recognized the vacant expression he saw in the mirror: "The same sort of strange look in the eye that I had seen in people who had been in IED blasts up and down the route near our base."
Macedonia was pretty sure he wasn't having a purely psychological reaction to combat. The blast had injured his brain (1).
Dr. Daniel Amen is known across the country for his work and clinics that do SPECT imaging of the brain. He says; "you can't fix what you can't measure".
He consulted on 'Concussion' the documentary about the NFL's battle on retired football player suicides and mental illness from repeated small concussions on the field.
Dr. Amen has a fabulously 'sticky' example of how to make a brain 'mass' in your kitchen in order to understand just how soft our brains are. In addition to soft, they are housed inside our skull which is filled with sharp ridges - some are sharp as a knife!
You can make a brain mass model for yourself that is close in weight and consistency with 2 cups of sand, 1-1/2 cups potato flakes and 2-1/2 cups of water. (2)
Kevin Kit Parker was deployed as a scientist as well as a soldier, helping the Center for Army Lessons Learned figure out how to protect troops from IEDs. Parker's doctoral thesis had looked at a potentially lethal injury known as cardiac concussion.
The victim is typically a healthy young athlete struck by a baseball or some other projectile, just over the heart. "A hockey puck hits someone and they go down, sudden cardiac death," Parker says. "A single blow to the heart causes an electrical irregularity, and they can die."
Parker had investigated how this sort of blow — a brief mechanical force — could affect the behavior of heart cells. And his research had led him to proteins called integrins, which connect the outermost layers of a cell to the structures inside. The shock wave from a blast can cause the integrin to send unhealthy and sometimes fatal signals to the structures inside cells.
(3)Source: Harvard University Credit: Katherine Du/NPR
"A treatment that works on blast-induced TBI would be likely to help people with brain injuries caused by a car wreck, or a fall, or a collision on a football field. And, if given soon enough after the injury, it would treat the problem in a way that no currently available drug can. But the pharmaceutical industry has lost billions of dollars trying to develop drugs for other brain diseases, especially Alzheimer's. And the companies evidently weren't ready to take on the costly search for a drug that might help people with traumatic brain injury. "I was surprised," Parker says. "No one wanted to get in the fight." (6)
"A treatment that works on blast-induced TBI would be likely to help people with brain injuries caused by a car wreck, or a fall, or a collision on a football field. And, if given soon enough after the injury, it would treat the problem in a way that no currently available drug can.
But the pharmaceutical industry has lost billions of dollars trying to develop drugs for other brain diseases, especially Alzheimer's. And the companies evidently weren't ready to take on the costly search for a drug that might help people with traumatic brain injury. "I was surprised," Parker says. "No one wanted to get in the fight." (6)