Combat Traumatic Brain Injuries Part of Veteran Suicide Trigger

22-Veterans-a-Day-memorial
Memorial to 22 veterans a day committing suicide to be seen in Tucson September 18 at event in Armory Park and in many cities throughout the U. S.

by Carol L Henricks, MD

 It is Suicide Awareness Month and it is time to connect the dots and understand why the suicide rate is so high among our active duty military and military veterans. It is a consequence of the brain – blast injury (a form of TBI) they have sustained! Dr. Duncan, COO of Patriot Clinics, Inc. states that “Not since World War I have service members in a war theater been exposed to the level of blast injury that US service members have experienced in recent wars. “

A blast – brain injury has 2 mechanisms of injury to the brain: the concussive force of the blast and the decompression injury. You don’t need to hit your head or lose consciousness to be injured. Even one concussion brain injury is associated with an increased risk of depression and suicide – but military members are typically exposed to blast after blast after blast. Most of the military veterans I have seen in my office don’t even “count” the more distant blasts they experienced or view repeated blasts experienced in a single day as separate events. Every blast creates injury and the sooner after one injury you are exposed to more injury the worse the cumulative injury.

Blast – brain injury injures the whole brain. On a pathological level, the decompression injury causes ischemic lesions (like tiny strokes) all throughout the brain. When this occurs in an elderly person they are clinically diagnosed with Alzheimer’s dementia. The axonal shear component of injury is also a diffuse injury and disconnects the networks in the brain. The networks that perform basic processes such as the cycling between wakefulness and sleep are destroyed. Attention, concentration, short-term memory and executive function (planning) are lost. Emotional control is unstable and unpredictable. Life with a brain injury is a life that feels out of control. It is disorienting and confusing. This cognitive – emotional state triggers suicide. When a psychiatric diagnoses is made medication is prescribed resulting in clinical worsening.   Substance abuse also causes clinical worsening.

If you don’t diagnose and correctly treat brain injury, there will never be a successful treatment program. Medications do not heal the brain. This is a call – out to all military veterans: if you have been exposed to IED’s, RPG’s and other blasts and concussive forces, be evaluated with a SPECT brain scan, brain MRI – DTI (diffusion tensor imaging) or some other high level technology. Routine brain MRI scans (even with contrast) or head CT scans (even with contrast) are not able to “see” the injury. It is a limitation of technology, not proof that the TBI is not there.

There is treatment for this type of brain injury: Hyperbaric Oxygen Therapy (HBOT). The Patriot Clinics, Inc. of Oklahoma and the International Hyperbaric Medical Foundation have championed the cause to set up HBOT treatment facilities in every state. In Oklahoma, the Oklahoma State House, the Oklahoma State Senate and the Governor all signed a bill into law that would create a funding mechanism so that money would be available for their hyperbaric facility to treat all the military veterans in their state. The state of Oklahoma recognizes the connection between brain injury, PTS and suicide and the effective treatment. The goal is to have every state set–up a program for its military veterans so they can be treated at no charge.

Military traumatic brain injury and its consequences are at a crisis level. There are HBOT facilities, non – profit organizations and concerned citizens around the country that are prepared to come together and help insure that those who need it are treated. This is a grassroots movement and we the people must rise to the occasion. We must be heroes to our Heroes.

 

Carol L Henricks, MD

Behavioral Neurology, Epilepsy,Sleep Disorders, Traumatic Brain Injury  & Hyperbaric Medicine.                     .

NorthStar Neurology PC…7596 N La Cholla Blvd…Tucson AZ 85741

Office Phone: 520-229-1238

Office FAX: 520-229-1242

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Insights Into Military Traumatic Brain Injury (TBI)

 Carol L Henricks, MD

 I just returned from the 2014 International Hyperbaric Medical Conference with new and powerful insights. My thanks to Dr. Paul Harch and to physiologist Tom Fox for helping to bring to light the mechanism of injury of a TBI  as well as the proper treatment.

As a neurologist – specialist I have seen many active duty military veterans returning from deployment in my office to assess them for a diagnosis of Traumatic Brain Injury (TBI) or Post Traumatic Stress (PTS). As I go through the interview, many insist that they have not had a TBI because they have never been struck on the head or lost consciousness from a blast explosion. Unfortunately that does not mean that they have not had a TBI, and when I study them with brain MRI – DTI imaging the evidence of injury is present.

When you use a high-powered gun / weapon or are exposed to a blast (even from a distance of 150 yards or more) and you feel the impact of that blast you have a potential for injury from that event. The high power pressure wave that is created correlates to the pressure that you would feel if you were deep – sea diving. Quickly following the pressure wave there is a period of time of decreased or hypobaric pressure. This is physiologically like coming to the surface too quickly after a deep dive. So a blast exposure may create symptoms of decompression sickness. Many military veterans have been exposed to explosion after explosion after explosion, and the brain injury is cumulative. We know the treatment for decompression injury: Hyperbaric Oxygen Therapy (HBOT). This treatment was not offered on the battlefield (despite the possibility of using deployed chambers) and has not been offered as a choice for healing the chronic effects of the TBI.

Protective body armor worn by troops may multiply the brain – blast injury. Helmets protect against bullet wounds and flying debris, but they reflect the energy from the pressure wave back from inside the helmet.

Even sending injured military by life – flight may compound their injury. If you have decompression injury, one of the most harmful things you can do is to be transported in an airplane at a high altitude. Many severely injured military were transported by air to hospitals in Europe.

The more exposure you have to blasts, the closer in time those injuries are, the more injury. Many military warfighters were exposed to blast after blast after blast during the time they were deployed. IED’s. RPG’s. Repeated injury produces more disability. The injury to military veterans is similar to the injury that NFL football players suffer from repeated concussion. In fact, football players suffer repeated TBI injury from repeated impact even if they don’t clash helmets. There is more than one league of denial.

Symptoms of TBI have an extensive overlap with symptoms of PTS. If military veterans are not aware of the connection between blast injury and their symptoms, they may be falsely diagnosed with PTS or some other psychiatric condition that does not apply. It is important that all health care providers are aware of the injury associated with blast injury and ask interview questions that will bring that history to light. If we do not know the nature of the injury, we cannot treat.

Even one concussion / TBI blast injury increases the risk of suicide. The majority of warfighters have had many assaults. We cannot continue to allow our military veterans to suffer and to take their own life because we do not provide them with effective therapy. The number of military veterans that take their own life, on average, daily is 22 – 35 or more. That is 8030 – 12,775 a year and is many times more than the number of military members that were lost in combat during the recent conflicts.

The use of HBOT for TBI has been extensively documented by Dr. Paul Harch. A treatment protocol of an initial 40 treatments x 1 hour @ 1.5 ata will treat most military veterans with TBI from blast injury. As with all medical therapies, there are no absolute guarantees, more treatments may be needed, nutrition is key and adjunctive therapies may be appropriate for ultimate symptom resolution. It is a national crisis that we need to combat with urgency and effective solutions. Stop Soldier Suicide.

 

Carol L Henricks, MD

Behavioral Neurology, Epilepsy,Sleep Disorders, Traumatic Brain Injury  & Hyperbaric Medicine.                     .

NorthStar Neurology PC…7596 N La Cholla Blvd…Tucson AZ 85741

Office Phone: 520-229-1238

Office FAX: 520-229-1242