Archive for the 'The Wounded' Category

There is exciting hope for our warriors who may otherwise suffer from traumatic brain injury (TBI).

In a study of service members returning from Iraq and Afghanistan, researchers at the Rand Corporation found earlier this year that about 19 percent reported a possible traumatic brain injury while deployed, with 7 percent reporting a probable brain injury. An editorial last year in the medical journal the Lancet explained that due to increased use of explosive devices, the proportion of injured soldiers with TBI has increased to 60 percent, from 20 percent or less in previous wars. “With its mechanisms murky, diagnosis tricky, incidence under-reported, treatment uncertain, and personal, societal, and economic tolls enormous, TBI is a clear crisis for the U.S. military,” the editorial stated.

The results can be life-shattering. Even mild TBI, in which the victim never loses consciousness, can lead to erratic mood swings, impaired memory and confused thinking.

TBI used to be thought of as a single injury. But, over the past 10 or 15 years, a more complex picture has emerged.

“Now we know it’s a dynamic process,” said Dr. Ross Zafonte, professor and chair of the Department Physical Medicine and Rehabilitation at Harvard Medical School. “We like to separate it out into two parts.”

First is the immediate blow to the head. Neurons, the nerve cells that transmit and process information, might be stretched or torn apart entirely by the force. There might also be bleeding or swelling inside the skull, leading to more neuron damage.

But the process doesn’t end there. “There’s a whole chemical cascade,” said Lisa Kreber, senior neuroscientist and research coordinator for the Center for Neuroskills Clinical Research Education Foundation in Bakersfield, Calif.

“As neurons are damaged, chemicals and neurotransmitters get released in mass quantities. The blood-brain barrier might be compromised and calcium from your body could get into your brain. All that is toxic to brain cells, so you have further damage going on over the course of hours or days after the injury,” she said.

Trouble is, the damage isn’t always easy to spot. Axons, cable-like parts of neurons that form the fiber pathways information travels along, might not be completely broken, but could still be damaged from stretching and pulling. This kind of damage wouldn’t show up on an MRI or CT scan, Kreber said. So doctors might not realize anything is physically wrong.

But diffusion tensor imaging, a type of MRI, could change that by showing doctors the individual axon pathways. “You can see where the pathways have been stretched and where there are holes, so you have a better idea of how much damage has been done and to what parts of the brain,” she said.

Another possible diagnostic technique would sidestep imagery in favor of chemical analysis.

Serum biomarkers are substances, such as proteins or enzymes, which show up in higher-than-normal or lower-than-normal levels in the blood following specific types of damage. Hospitals already use a biomarker test to diagnose heart attack victims and researchers are looking for a way to make diagnosing TBI as simple.

“This is still in the research stage,” Bullock said. “But the idea is that you could take sample and know whether the person has had a brain injury, how severe it is, and whether there’s ongoing brain damage from hour to hour based on the biomarkers present in the blood.”

Once doctors know TBI has happened, treatment can begin. One of the most promising areas of research in treating TBI is in the field of neuroprotection, essentially finding substances that can protect neurons and give them an extra line of defense against secondary damage.

One example of neuroprotection comes from a study detailed June 27 in the Journal of Biological Engineering. Researchers Andrew Koob and Richard Borgens of Purdue University found that secondary damage might be lessened by giving victims an injection of polyethylene glycol.

Rats that got the injection within four hours of injury showed less behavioral impairment than those who didn’t get a shot at all or got one after that four-hour window. Because of the time constraint, this type of treatment would probably be most useful in situations where emergency personnel could reach victims quickly and give the injection before the patient ever reached a hospital.

Note this last warning.  The techniques under study necessarily deal with rapid response and amelioration of the conditions in order to avoid TBI rather than the treatment of it.  This is important.  This means that in addition to training doctors at military hospitals, there will be required training of rapid reaction personnel, including but not limited to the Corpsman and medic.

This will be difficult, time consuming, expensive and risky.  But it is worth it to protect the brain function of our warriors who have suffered battle space explosions.  It would be sinful and criminal not to invest in this technology.

Faster, please.

When my son deployed to Iraq in 2007, there were many things I wanted to say but didn’t have time.  I used Motomail to accomplish much of this conversation over the next seven months (at times writing letters almost daily).  One such letter must have been puzzling to him and I have not yet discussed it to see if he recalls the contents.  I will do this soon.  Maybe.

I had known for some time that the bacteria to which he would be exposed if wounded were somewhat different than any to which he had previously been exposed, and my counsel in this particular letter went something like the following: “If you become wounded - especially on your extremities but also even on your whole body - and a doctor begins to discuss rapidly propagating infection, or amputation of limbs, you need immediately to request that he administer 50 Rads of gamma or x-ray radiation to the affected area.  If the infection doesn’t begin to retreat within 12 hours, request another 50 Rads.  If the doctor doesn’t understand or wants to talk about this, have him call me.  You know how to reach me at any hour, night or day.”

Strange?  Why would I have so advised my son in a war zone?  To begin with, a report on bacteria in Iraq (and elsewhere) was recently published that illuminates some of these issues.

“It’s why I lost my leg, so it sucks.”

The assessment, from a 22-year-old Marine toughing out physical therapy on two prosthetic limbs, is laconic, matter-of-fact. Sgt. David Emery lost one leg in February 2007 when a suicide bomber assaulted the checkpoint near Haditha, Iraq, where he and fellow Marines stood guard. Military surgeons were forced to remove his remaining leg when it became infected with acinetobacter baumannii-a strain of highly resistant bacteria that since U.S. forces began fighting in Iraq and Afghanistan has threatened the lives, limbs, and organs of hundreds wounded in combat.

“They could have saved it,” says Emery. “They had a rod in it, but then the bacteria was in too bad and my white blood cell count was up to 89,000-and they told my mom on a Friday that they had to take it.”

Emery’s mother recalls that the hazard was not confined to her son’s limbs.

“He ended up getting it in his stomach,” says Connie Emery, “and they tried to close his stomach back up, but when they did, the stitches ended up pulling away because the infection was taking over.”

An Army infectious disease physician says the germ has spread rapidly since the wars in Afghanistan and Iraq began. “Prior to the war, we were seeing one to two cases of acinetobacter infection per year,” remembers Lt. Col. Kimberly Moran, deputy director for tropical public health at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

“Now that’s much different. We’ve had hundreds of positive cultures over the last four years.”

Please, please read the entire article.  If you read nothing else today, study this.  This article will educate you and break your heart at the same time.  The doctors are doing all they know to do with the equipment and procedures they have, and the article goes on to describe the potential for kidney damage if they break out the “big gun” antibiotics too soon, but potential loss of life if they don’t.

Back to my Motomail to my son.  The answer for it is simple.  Radiation hormesis.  By definition, radiation hormesis is the “adaptive response of biological organisms to low levels of stress or damage, leading to a modest overcompensation to the disruption, and resulting in improved fitness.”  Basically, the radiation causes greatly increased activity of the body’s immune and reconstructive systems.  It has been tested on gas gangrene and other rapidly propagating infections, and there is no question as to its effectiveness.  Much more material to study on this can be found at Biological Effects of Low Level Exposures.

Are you still not convinced?  Then recall one of the final paragraphs of the report on Bacteria.

Researchers in military laboratories and elsewhere are exploring better means of fighting acinetobacter. Some are examining possible uses of radiation. At Harvard, Anderson is experimenting with a dye “painted” onto open wounds then activated with light. “Even the worst strains that are resistant to multiple antibiotics,” he says, “will succumb to the light-activated dye approach.”

Radiation is the answer.  This is true whether you accept or reject (and I do reject) the LNTH (linear no threshold hypothesis) for radiation.  The alleged risks are far outweighed by the advantages.  Thus my letter to my son made sense, if he read and remembered it and could discuss it under duress - that is.

Time has named Vladimir Putin person of the year.  George W. Bush looked the man in the eye and found him to be “very straightforward and trustworthy.”  On the other hand, I look Putin in the eye and see Lucifer.  Obviously, since he is fond of assassinating people by administering lethal doses of Polonium-210, he is not the choice of The Captain’s Journal for man of the year (we have jettisoned the gender-neutral “person” of the year moniker as stupid).

There are powerful arguments for General David Petraeus for man of the year.  But even Petraeus doesn’t make it to the top of the list.  Who then do we advocate for man of the year?  He is Corporal Raymond D. Hennagir.

Corporal Hennagir is a brave warrior who lost both legs and four fingers to an IED, and his story is one of An Unforgettable Reunion.

CAMP LEJEUNE, N.C. - For 10 weeks, ever since Cpl. Raymond D. Hennagir was blown up, he had longed for this moment, this homecoming, when the rest of his platoon would return from Iraq.
He missed them, his brothers. Hennagir, a 21-year-old Marine from Deptford, N.J., felt he had let them down by stepping on an improvised explosive device (IED), blowing off both legs and four fingers on his left hand - now, he said, in his darkest Marine humor, just “a pink mist and a memory.”

Hennagir desperately wanted to mend enough so that the Marine Corps would let him travel to Camp Lejeune for this day, Aug 26.

That wish motivated him, maybe even kept him alive, through the summer’s 16 surgeries and three skin grafts. The pain was so intense that he was sure his screams were heard all through the National Naval Medical Center in Bethesda, Md.

“There were times when I wondered if the kid was ever going to get a break,” said his uncle Jim English, a 20-year Navy veteran, who would stare helplessly out the hospital window.

And now here Hennagir was. The late-August sun was blazing. He sat in his wheelchair, his baggy new jeans from American Eagle tucked up under his lost legs.

Read all of the story - it will make you weep for the brave men who have suffered TBI, lost limbs, and lost lives, and weep for their loved ones.  And it will make you proud of their bravery.

But Corporal Hennagir is also a surrogate, and our nominating him man of the year is a vote for all of the wounded and all those warriors who have given it all for the cause.  Men like Lance Corporal Dale G. Peterson, Lance Corporal Walter K. O’Haire, and Lance Corporal Jonathan E. Kirk of 2/6 who lost their lives in Fallujah during the summer of 2007 are also men of the year.  It is men like these for whom I am truly thankful.

Not too long ago, sending anonymous Christmas letters and cards to the wounded was impossible.

The U.S. Postal Service will not deliver any letter, post card, or package that is not addressed to a specific individual. Anything sent to “A Recovering Soldier,” “Any Wounded Soldier,” or “Any Service Member” is unacceptable.

“We cannot accept any mail that is not specifically addressed to an individual or an organization at the medical center,” says Terry Goodman of Walter Reed.

Sometimes one of these letters will make it through to the medical center. If that happens, it is returned to sender. Goodman says officials are just following Department of Defense policy designed to ensure the safety of patients and staff at all military hospitals.

And don’t try to contact Walter Reed or any other military medical facility to get the name of a wounded service member to write. Because of medical privacy regulations, hospital officials  can’t give out that information.

But Soldiers’ Angels and American Red Cross have stepped up to the plate, trustworthy servants of the armed forces that they are.

A holiday greeting or a “Get Well” wish can brighten the day of a servicemember recovering at Walter Reed Army Medical Center.

However, hundreds of thousands of cards addressed to “Any Servicemember,” or a variant thereof, were returned to senders last year due to security concerns. A Defense Department policy in effect since 2001 specifically forbids the delivery of generically addressed mail to servicemembers.

This year two organizations have stepped in to ensure this type of mail makes it to servicemembers and does what it’s intended to do … boost morale.

Soldier’s Angels and the Red Cross serving the metropolitan Washington, D.C.-area will collect, screen, and deliver the well-wishes of those who want to brighten the day of a wounded servicemember recovering away from home this holiday season.

Those wishing to send a letter or a card to a recovering servicemember should send those cards to either:

Soldiers’ Angels
1792 E. Washington Blvd.
Pasadena, Calif. 91104

or 
 
We Support You During Your Recovery!
c/o American Red Cross
P.O. Box 419
Savage, MD 20763-0419

But time is short.  Your letter or card needs to be in the mail very soon.  If you feel inclined to contribute more this Christmas season, there are many good charities associated with our service.  Ralph Peters has a very moving commentary in the New York Post, Semper Fi, Semper Fi: Injured Marines Fighting On.  He ends a very personal account of his visit with wounded Marines by saying:

You can donate to the Warrior and Family Support Center project via credit card by phone at 1-888-343-HERO or on the Web at ReturningHeroesHome.org.

To give by mail, send donations to:

Returning Heroes Home
P.O. Box 202194
Dallas, TX 75320-2194

Checks should be made out to Returning Heroes Home, Inc. This is a nonprofit 501c3 endeavor; all donations are tax-deductible.

All contributions, in any amount, will help our wounded warriors. Please give to those who gave so much.

Here is a short presentation of their mission and plan for the future.

Whatever you are inclined to do, please do so soon.  I thank you, and our wounded warriors thank you.

At my request, Jack Holt kindly made a transcript available from the bloggers interview with Colonel Rice who leads the Army Wounded Warrior Program.  I was unavailable to participate in the interview, but here is a sample.

CHARLES “JACK” HOLT (chief, New Media Operations, OASD PA): All right, sir. Thank you very much.

COL. RICE: All right, well thank you for inviting me to talk to you about the U.S. Army Wounded Warrior Program. I’m honored to lead the U.S. Army Wounded Warrior Program and to serve the nation’s severely wounded, injured and ill soldiers and their families. This progress is here to serve those who have given so much to this country through their service.  The U.S. Army Wounded Warrior Program follows the war ethos, “I will never leave a fallen comrade.” We assist and advocate for severely wounded soldiers and their families for as long as they need us, wherever they are located. The primary way the U.S. Army Wounded Warrior Program makes a difference in their lives — in the lives of the severely wounded soldiers and their families, is by taking the time to really listen to their needs.  Every soldier in this Program is assigned a specialist who gives them  personalized recovery assistance in navigating government and non-profit  organizations on their behalf to ensure they get the help and support their families need. Our soldiers gave us their best, and we now remain committed to  giving them ours.  The U.S. Army Wounded Warrior Program is part of a larger Army initiative that is focusing on providing more comprehensive services to our soldiers and their families. We are in the forefront of an important transformation that is building the health care model for the future for the military’s wounded warriors.  For more information on this program, or to obtain support services, any soldier or his loved one can call: 1-800-237-1336. They can also visit our website at: www.aw2.army.mil, where I recently posted the first entry in our new Army Wounded Warrior blog. Please take the time to learn more about the Program, our dedicated staff, and the severely wounded soldiers we serve. As director of the Army Wounded Warrior Program, my duty is also my honor, and I will continue to work every single day to make sure that no soldier is left behind.

Read the whole interview.  Those who have followed this humble blog for a while know that this is a pet issue of mine, this issues of wounded warriors, caring for our fallen and injured, and properly managing our health care for these brave men.  Regarding the so-called Walter Reed scandal, I have weighed in that General Weightman was probably not the right man to sack when the scandal broke.  The problems were an ineffective and inefficient Department of Defense bureaucracy that didn’t support the wounded warrior when he left Walter Reed and went home, not when he was there.  But be that as it may, the message today was that we are under management that cares and understands that the DoD must treat this holistically.

The advancements in battlefield medical care (e.g., Navy Corpsmen, Marines qualified as combat lifesaver, etc.) have ensured a drop in battlefield deaths, and yet a commensurate increase in battlefield wounded and “disabled.”  The goal, then, is to ensure that the term “disabled” doesn’t really apply - to rehabilitate, to retrain, and to enable.  May God grant them success.

As one final followup item, my regular readers also know that TBI (traumatic brain injury, the signature wound of the war due to IEDs) is a pet concern of mine.  Here are two very interesting links for your study.

Dog Helps TBI Victim
Battlefield Brain Injury: The Lessons from Iraq (highly technical article written by an M.D.)