Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

 Can someone have post traumatic stress disorder and mild traumatic brain injury at the same time from the same event?  Some experts say no while others say yes.

Approximately 7.7 million Americans suffer from PTSD, according to recent population-based survey research. The most common causes of PTSD in the civilian sector are motor vehicle crashes and assaults (including domestic violence and rape), with women approximately
twice as likely as men to suffer from PTSD.

Surveys of military personnel returning from deployments to Iraq and Afghanistan find prevalence rates of PTSD ranging from 8% to 16%; it is likely that these rates are underestimates, given the many barriers to reporting mental health problems in the military . Approximately 15% of
these veterans seeking care at Veterans Administration hospitals in the United States have been given a diagnosis of PTSD.

One train of thought says that in order to have post traumatic stress disorder you must remember the traumatic event.  Indeed it is the very memory of the event that causes the post traumatic stress.  Yet others opine that mild traumatic brain injury must involve some loss of consciousness and therefore memory of the event is missing.  Hence you can not have mild traumatic brain injury and post traumatic stress disorder.  However the fact of realizing what happened when revived leaves the post traumatic stress question wide open for discussion.

An estimated 1.5 million brain injuries occur every year in the United States, and over 5 million Americans (2% of the population) live with disabilities resulting from TBI. In the civilian sector, the leading causes of TBI are falls, motor vehicle crashes, struck-by-or-against events, and assaults . Interestingly, motor vehicle crashes and assaults are also two of the most common causes of PTSD in the U.S. civilian population, highlighting the overlap in exposures to TBI- and PTSD-causative events.

In the U.S. military, TBI is the most common type of physical injury sustained by combatants in Afghanistan and Iraq, and explosion or blast injury is the most common cause. In a 2006 survey of more than 2,500 recently returned army infantry soldiers, 5% reported injuries with loss of consciousness during a yearlong deployment to Iraq, and 10% reported injuries with altered mental status. A recent RAND report suggested even higher rates of probable TBI in a 2007 telephone survey of almost 2,000 previously deployed service personnel. A similarly high rate (23%) of clinician-confirmed TBI history in a U.S. Army brigade combat team with at least one deployment corroborates these findings.

 It is important clinically to recognize that both disorders are associated with higher rates of other psychological health problems, including depression, substance abuse, and suicidal behavior in both civilian and military populations . Furthermore, the presence of these comorbid conditions may have an impact on conventional treatments, lending additional impetus to the need to understand these interactions more completely.

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 We are almost through August and more than half way through Summer 2010. Parents, children and kids are preparing for the return to school in the next couple of weeks. In Nevada, public schools start August 30.

Meanwhile Nevada, and particularly Las Vegas, continues to muddle through the recession which for Southern Nevada has been a novel experience. The unemployment rate is close to 15% as I write.  The city many thought was immune from economic storms has seen itself hardest hit. Hopefully things will improve.

We face a heated election where the Tea Party candidate, Sharon Angle, accuses Democrat incumbent, Harry Reid, for the current state of plummeted home values while Reid criticizes Angle for not making job creation a part of her job!

The Station Casino’s recent resurface from Bankruptcy with owners, Frank and Lorenzo Fertitta, manning the helm, may be a boost. Of course some creditors had to write off $4,000,000,000 – four billion dollars! But maybe the massive adjustment will re establish the local casino group and have a positive impact on Las Vegas. 

Today’s report of the M Resort, opening just over a year ago, being put up for sale may result in an interesting bid; especially if Boyd gets back into the picture. Boyd’s recent failed effort to take over Station properties may be a prelude to an M resort bid.  Although my sources tell me that Station may make a bid to buy M resort now that they have shaken off 4 billion in debt.

I am reporting on 2 separate topics relating to Brain and Spine Injury issues. First is a look at the Cleveland Clinic’s Las Vegas Lou Ruvo Center. Second is the recent revelation concerning veterans. 

Lou Ruvo Brain Center

Nevada, and specifically Las Vegas, may be on its way to becoming the "go-to" place in the country for Brain Health.  The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them.

 For persons with mild cognitive impairment such as early stage dementia and Alzheimer’s disease, the center offers the most up-to-date and technologically advanced diagnostic imaging services, including 3-Tesla MR, performed by one of the leading neuroimaging academic centers in the world. The CCLRCBH also offers a multimodal treatment program for persons with mild cognitive disorders, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Recently named to head up the Center, leading researcher and neurologist Jeffery L. Cummings, MD, will be the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

Prior to joining Cleveland Clinic, Dr. Cummings was the director of the Mary S. Easton Center for Alzheimer’s Disease Research and a professor of Neurology and Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA.

He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published more than 600 peer-reviewed papers.
 

Misdiagnosis Hurt U.S. Soldiers

We now know that during the height of the Iraq war, the Army routinely misdiagnosed hundreds of soldiers with “personality disorder.” In doing this, the Army was categorizing veterans being dismissed from duty, with a pre-existing condition. Pre existing conditions are not covered by the military health care for veterans.

Leaving wounded veterans ineligible for military health care and with a stigma attached to mental weakness, advocates for veterans, congress and the public actively pushed for re-evaluation of veterans conditions. The Nation, published an article exposing the practice and caused the Defense Department to change its policy. 

All soldiers diagnosed with Personality disorder prior to 2008 are being re-evaluated. Before 2008, over 1000 soldiers were dismissed based on personality disorder. In 2009 only 260 were dismissed for personality disorder.   By 2008, 14,000 soldiers were diagnosed with brain injury or post traumatic stress disorder.   The number of personality disorder cases dropped 75%. Watch this You Tube video.

The significance for those men and women that serve the country in the military is staggering. Could you imagine sacrificing life and limb only to have the U.S. government tell you that you suffered a pre-existing personality disorder? Why, you might ask, did the Army, for example, not make that determination until after my sacrifice of life and limb? How convenient for the Army to take advantage of the sacrifice and not pay the veteran when they can no longer make the sacrifice.

We now know about PTSD as it relates to war, something the Vietnam veterans did not benefit from. We also know, unlike Vietnam, that more soldiers stay alive after blast and concussion trauma due to the enhanced protective gear.

I really hope that the U.S. will be proactive in caring for its military. I think we should all support brain injury groups like the Brain Injury Association of America who are on the front lines, so to speak, in getting legislation for brain injured survivors.

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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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University of Missouri research indicates there may be new hope in dealing with Post traumatic stress disorder commonly referred to as PTSD.

The brain is a complex system made of billions of neurons and thousands of connections that relate to every human feeling, including one of the strongest emotions, fear. Most neurological fear studies have been rooted in fear-conditioning experiments. Now, University of Missouri researchers have started using computational models of the brain, making it easier to study the brain's connections. Guoshi Li, an electrical and computer engineering doctoral student, has discovered new evidence on how the brain reacts to fear, including important findings that could help victims of post-traumatic stress disorder (PTSD).
 

Read more here.

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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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Many victims of traumatic brain injury develop Post Traumatic Stress Disorder.  I recently came across a great article on the symtoms, causes and other information of PTSD.

PTSD (Post-Traumatic Stress Disorder) is triggered by a traumatic event - it is a kind of anxiety. The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness. Most of us experience a brief period of difficulty adjusting and coping with traumatic events. However, we gradually get better with time and healthy coping methods. On the other hand, there are times when symptoms get worse and may last for several months, or years. This study explains how PTSD can surface two years after a traumatic event. Another study found that one in eight Lower Manhattan residents likely had PTSD two to three years after the 9/11 attacks.
 

Read the full article here.

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A tremendously important story has gone virtually untold by the media, ignored by our political leaders and unknown to the American public. Despite the extraordinarily high price they have paid, America's severely wounded veterans are enduring humiliating financial hardships of epic proportions. Home evictions, utility shutoffs, car repossessions and foreclosures are commonplace.

Spouses have to give up their jobs to become caregivers, cutting family incomes by up to 50 percent or more. Most disabled vets receive much less in compensation and benefits than they did while on active duty, reducing incomes even further. Many are too dysfunctional to hold a meaningful job, if any, because of the devastating effects of post-traumatic stress syndrome (PTSD) and traumatic brain injury (TBI). 
 

Rick Amato of the Washington Press.  Rick Amato is a radio talk-show host in San Diego and with Washington Times Radio News. Amato Strategic Communications provides consulting services to nonprofit organizations, including veterans causes.
 

There is a great deal of information out there on PTSD and the military, and this may largely be due to the origins of the PTSD diagnosis.

Post traumatic stress disorder (PTSD) can be considered a "young" diagnosis. It was not until 1980 that the diagnosis of PTSD as we know it today came to be. However, throughout history, people have recognized that exposure to combat situations can have a profound negative impact on the minds and bodies of those involved in these situations.

In fact, the diagnosis of PTSD originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has previously been described in the past as "combat fatigue," "shell shock," or "war neurosis."

It is not surprising that high rates of PTSD have been found among soldiers from World War II, the Vietnam War, the Persian Gulf War, and the war in Iraq.

 Rick's perspectives include getting congress to put soldier and veterans disability right to top of the stimulus packages being authorized of late.  He quotes President Reagan "Until our politicians feel the heat, they won't see the light."

Read the whole article  in the Washington Press including a specific case of a military couple struggling to endure.

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Indiana National Guard Sgt. Gerald "G.J." Cassidy, who served his country in Bosnia and Iraq, died alone and ignored in a barracks at Fort Knox from an accidental drug overdose. His fate left a legacy that has changed the lives of thousands of wounded soldiers, Army officials say.

Cassidy began experiencing migraine headaches after a roadside bomb exploded about 11 feet from his Humvee in Iraq in August 2006. With diagnoses of post traumatic stress disorder and mild traumatic brain injury.

One Fort Knox soldier told investigators, "The staff at the WTU did not keep accountability of soldiers and were not making any checks on the welfare of soldiers" with PTSD and brain injury.

On the day Cassidy died, his platoon sergeant reported him at formation when he actually hadn't seen him for two days.

After repeated calls from Melissa Cassidy after she had not heard from him in a couple of days, Sgt. Cassidy was found dead in his chair. A toxicology report from the Armed Forces Institute of Pathology ruled his death accidental, caused by "multi-drug toxicity," compounded by coronary artery disease.

Excerpted from Soldier's hospital death leads to changes as published in Associated Press.  Information from: The Courier-Journal, http://www.courier-journal.com

 

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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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After legislation to reauthorize the Traumatic Brain Injury (TBI) Act successfully passed by Congress last week, the bill still needs to be considered by the President for his signature into law. The Brain Injury Association of America (BIAA) anticipates this consideration will occur in the very near future.

This week saw major activity occur on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. On Wednesday, the bill was unanimously approved by the full House Energy and Commerce Committee, setting up a potential veto showdown with the White House. BIAA has strongly endorsed this legislation and submitted an official letter of endorsement to the bill’s sponsors, Rep. Dingell (D-MI) and Rep. Murphy (R-PA), last week.

Also this week, The Rand Corporation published an important comprehensive study of the mental health and cognitive needs of U.S. servicemembers returning from Afghanistan and Iraq. This groundbreaking study - which focuses specifically on the post-deployment health-related needs and economic costs associated with post traumatic stress disorder (PTSD), major depression and TBI - estimates that 320,000 servicemembers may have experienced TBI as a result of recent combat operations.

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A new 5 year study is underway to determine how to recognize and treat post traumatic brain stress disorder.

Military and civilian researchers from across Texas will be involved in a five-year study of the best way to detect and treat post-traumatic stress disorder.

The $33 million project will be led by the University of Texas Health Science Center and open to soldiers serving or being treated at Texas military installations, the San Antonio Express-News reported.

Few studies have been conducted that look for the best way to treat veterans and active duty personnel, said Alan Peterson, a retired U.S. Air Force psychologist and health science center professor.

The study will evaluate current forms of the standard treatment and medications. In addition, it will include neuro-imaging to observe changes in brain and genetic studies to search for genes that may place some people at greater risk for the disorder.

Read more from the United Press International.

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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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 Time magazine reports that Post Traumatic Stress Disorder risk is elevated in situations where a concussion occurs.  But not all concussions result in PTSD and not all PTSD requires concussion.

The article, along with the many others since the Afghanistan and Iraq wars, have brought the focus on brain injury and related issues into the public forum.  I hope this "awakening" will help educate lawyers, insurance companyies, Judges and juries about the very real "unseen" injury.

To read the article click here.

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The ongoing efforts in the news to prevent and treat veterans brain injuries continue. 

Researchers from the Uniformed Services University of the Health Sciences (USU) are pursuing efforts to find new ways to prevent and treat the increasing numbers of combat troops who are suffering from injuries due to traumatic brain injury (TBI). University research teams are also leading efforts to better diagnose and manage post traumatic stress disorder (PTSD).

Of the more than 20,000 service members who have sustained injury in the war in Iraq, TBI from improvised explosive devices (IED) is the most common injury. In addition to efforts to better treat those with such injuries, the university is increasing the focus on diagnosing and treating PTSD. Currently, there is no single test to diagnose either TBI or PTSD. However, researchers at USU are studying the physical and behavioral consequences of moderate and severe TBI to characterize each injury and examine methods of identification and management. The TBI research focuses on injury caused by blasts of air following an explosion and attempts to promote recovery by using anti inflammatory medication and sensory stimulation to regenerate brain cells and growth of brain tissue.

To read the full article click here.

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