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The way home for war weary troops is a revolving door between the States, Iraq and Afghanistan.  MSNBC recently reported the tragedy of Major Jeff Hall's and Joe Callan's multiple deployments to war torn zones with brief breaks at home in the United States.  For many U.S. vets, life becomes a revolving door of war, home, then back to combat — where they again face the same dangers and stresses.

Nearly 300,000 troops have served, three, four or more tours of duty in Afghanistan or Iraq.  The signs, symptoms and consequences of multiple blast injuries to the brain and PTSD show up when soldiers come home and too often are misunderstood and neglected.

With two long wars — Afghanistan is in its ninth year and Iraq just entered its eighth — the U.S. military finds itself straining to maintain a steady flow of troops. More than 2 million men and women have been deployed to serve in both conflicts, and more than 40 percent of them have served at least two tours, according to military records.

For these men and women, life becomes a revolving door of war, home, then back to combat — sometimes within months — as they face the same dangers, the same stresses and the same agonizing separation from family. Some soldiers are gone so often, they're more comfortable being away.

The article looks deeper into the issues surrounding these military men and women.

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President Obama yesterday spoke with Veterans in Arizona.  He told them that traumatic brain injury and PTSD are the new wounds of war.  Those veterans in Vietnam and other wars who came home only to have depression, alcohol abuse, job loss, and the other "dominoes"  that fall for veterans can be substantially dealt with if treatment is received early enough for veterans of Afghanistan and Iraq.  The government, according to the President, is creating a culture of caring for veterans.

An excellent piece on PTSD in the military and what is being done to address it can be seen by clicking here.

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More attention has been paid to the mental health of American troops in Iraq and Afghanistan than in any previous war. Yet shame remains a significant barrier to military personnel and their families getting the psychiatric treatment they need, a report released Wednesday says.

Time Magazine reports today on the American Psychiatric Association's study that veterans are attaching a stigma to the psychiatric afftects of the war.  This is a function of educating the public and veterans about the reality of brain and mental injury.

The good news is nearly three-quarters of the 200 military men and women interviewed by the American Psychiatric Association (APA) said that it was very or somewhat easy for them to seek out mental health care. But 60% still feared that doing so could have negative consequences on their career. More than half reported they believe others would think less of them if they sought out counseling, and most surveyed said they have rarely or never spoken even to family and friends about mental health issues. These numbers show "there's still a long way to go towards reducing the stigma surrounding care," says APA board member Dr. Mary Helen Davis.

Click here to read the whole article.

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Why is it that when a group of soldiers share a horrific battle experience, some are able to work through it and get on with their lives while others suffer the persistent anxiety, emotional numbness and bomb-blasted nightmares of post-traumatic stress disorder (PTSD)?

The answer, researchers have long believed, is that an individual's response to trauma — whether in battle, or as result of a natural disaster, a violent crime or some other horror — depends not only on the intensity of that trauma but also on a complex interplay of past experiences and genetic factors. A new paper, published in the current issue of the Journal of the American Medical Association, provides remarkable support for this explanation and identifies a specific gene that influences susceptibility to PTSD.

Read the whole Time Article by clicking here http://www.time.com/time/health/article/0,8599,1723204,00.html?xid=rss-health

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I continue to follow the efforts made in diagnosing and treating brain injuries of war veterans.  The NY TImes reported a new study published in the New England Journal of Medicine.

About one in six combat troops returning from Iraq have suffered at least one concussion in the war, injuries that, while temporary, could heighten their risk of developing post-traumatic stress disorder, researchers are reporting.

The study, in The New England Journal of Medicine, is the military’s first large-scale effort to gauge the effect of mild head injuries — concussions, many of them from roadside blasts — that some experts worry may be causing a host of undiagnosed neurological deficiencies.

The new report found that soldiers who had concussions were more likely than those with other injuries to report a variety of physical and mental symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, or PTSD, and that accounted for most of the difference in complaints, the researchers concluded.

Read more click here.

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Rep. Baron Hill, D-Ind. (9th CD), has issued the following news release:

"Americans were shocked to learn one year ago of a crisis in care for soldiers returning from Iraq and Afghanistan," Hill added. "America can do better, and this historic funding increase, paired with our Wounded Warriors Act reforms, puts us on the right track for America's veterans."

With the release of these funds, the 110th Congress has provided an extra $6.7 billion over last year for the largest single funding increase in the 77-year history of the Department of Veterans Affairs. This funding is primarily aimed at:

* X Strengthening quality health care for 5.8 million patients, including about 263,000 Iraq and Afghanistan veterans, in the 5th year of the war in Iraq;

* X Investing in much-needed maintenance for VA health care facilities and treatment for Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury for returning veterans;

* X Reducing the backlog of veterans (400,000 claims) waiting for their earned benefits by adding 1,800 claims processors.

* X Building on the first steps by this Congress at the beginning of 2007 - increasing veterans' health care and benefits by $5.2 billion for improved care and shorter waiting lines for veterans waiting 177 days to receive their earned benefits.

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Wayne State Univiersity is leading the research with a grant to study the effect of the "invisible fist" of blast injuries.  To see a short 2 minute video click here.

Dr. Pamela VandeVord, assistant professor at Wayne State University, is seen here using a blast tube to study how pressure from explosions might cause brain injuries.  The tube mimics explosions in Iraq to study what happens in the brain.

About 1.4 million people suffer a TBI every year in the United States, according to the Brain Injury Association of America.

Researcers now believe that what was once believed to by PTSD is actually TBI; organic versus non-organic injury.

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USA Today reports that blast injuries are producing more damage than previously realized.  The war in Iraq will be no different in producing a "signature wound" only this time the wound is in the brains of those affected. Medical experts are witnessing an emerging and significant increase in Traumatic Brain Injury (TBI).

The new findings are the result of blast experiments in recent years on animals, followed by microscopic examination of brain tissue. The findings could mean that the number of brain-injured soldiers and Marines — many of whom appear unhurt after exposure to a blast — may be far greater than reported, says Ibolja Cernak, a scientist with the Johns Hopkins University Applied Physics Laboratory.

Blast injuries are getting the attention of the war as a laboratory.  And now that attention is revealing what is already known from other familiar mechanisms of injury:  brain injury occurs at the cellular level.

The North American Brain Injury Society formed a committee to examine blast injuries.  Dr. Mariusz Ziejewski, biomechanical engineer, is heading that effort.  For more information go to http://www.nabis.org/public/message.shtml

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The National Guard is now being checked for signs and symptoms of brain injury with comparisons to base line data.

Beth Pearson, senior research associate at Dartmouth Medical School in New Hampshire and the principal investigator on the National Guard project, said Thursday that explosive devices used in the wars in Iraq and Afghanistan are causing traumatic brain injuries in many service members. But without a pre-deployment baseline, it's impossible to tell whether an individual's abnormal brain function predates deployment or is related to military service, she said.

"Now we'll have a baseline measure of the neurological functioning of each person, and they'll be retested on their return for any changes," she said. That will help doctors determine which areas of the brain have been injured and improve medical treatment. Veterans Affairs officials at Togus are supportive of the project, Pearson added.

Read the full article here.

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USA Today reports that military personnel are cheating on tests designed to detect brain injury to stay with their units.

By cheating troops risk being "exposed to a second concussion or mild traumatic brain injury. It could have more devastating effects not only on their health, but on the mission's success, or perhaps on the safety of the people on their patrol."

About one-third of war casualties brought to Walter Reed Army Medical Center in Washington, D.C., have some form of brain injury, Army records show.

The Pentagon lists 4,471 brain-injured casualties from Iraq and Afghanistan, but the actual number is likely higher because many cases go undetected.

Read the full article here.

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I am pleased to learn that the military has set up a process of detecting and treating soldiers with brain injury.  The Associated Press published an article today about testing military personnel before they are sent into service.  This mini-neuropsychological test is designed to measure memory and attention, among other cognitive domains, before an injury occurs. 

Before they leave for Iraq, thousands of troops with the 101st Airborne Division line up at laptop computers to take a test: basic math, matching numbers and symbols, and identifying patterns. They press a button quickly to measure response time.

It's all part of a fledgling Army program that records how soldiers' brains work when healthy, giving doctors baseline data to help diagnose and treat the soldiers if they suffer a traumatic brain injury — the signature injury of the Iraq war.

There are an extimated 30% of patients at Walter Reed Hospital receiving care for brain injury.  Of those suffering from what is misleadingly referred to as "mild traumatic brain injury," an estimated 20% go on to suffer permanent lingering problems.  According to research. Walter Reed found that irritability and memory, two classic symtoms of brain injury, are reported more on return home then in the battlefield.

Soldiers sometimes walk away from explosions with no obvious injuries. But the concussion from the blast can have a lingering effect that is not always immediately apparent.

"They look physically normal, but their neurocognitive performance is off," said Col. Mary Lopez, a physician specializing in occupational therapy.

Most brain injuries are mild, and soldiers can recover with rest and time away from the battlefield. But the military estimates that one-fifth of the troops with these mild injuries will have prolonged or lifelong symptoms requiring continuing care.

So little is known about traumatic brain injuries that these baseline readings could become an important cornerstone for future study.

To read the full article click here.

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