Traumatic Brain Injury in Veterans

Max

Age at interview: 46
Outline: While deployed in Iraq and Afghanistan during his 16-year career in the Army National Guard and Reserves, Max, a combat medic and respiratory therapist, was exposed to routine blasts at the hospital where he was stationed. It wasn’t until he was home from his last deployment that Max began to notice issues including “headaches, massive migraines, intense sun light issues, blurry vision, and chronic neck and back pains.” Despite his challenges, Max returned to school and finished his doctorate in education and health care, a field in which he currently works and teaches.
Background: Military branch: Army

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Max spent 16 years in the Army National Guard and Reserves where he trained and served as a combat medic and was deployed twice, to Iraq and Afghanistan. While in Baghdad working as a medic and respiratory therapist, the hospital where he was stationed was “routinely bombed with RPGs, small arms fire and mortars daily, several times a day, for 24 hours in 2004/2005. So, the impact of those residual bomb explosions was very compounding.” In Afghanistan in 2005, Max was exposed to another blast when a truck pulled up beside his and detonated an IED, blowing up his vehicle. The impact of this explosion “caused the door to swing out and my head went back and jolted, and my knee got slammed with the door and I tore my ACL. I did not know I had a head injury until I got back home, because I was so worried about the knee.”

Back home from his deployment Max began to notice new issues with his memory. “I couldn’t remember small, short term memory things. I got angry. And I believe that’s one of the things that really presented to me, as a medical provider. I think, the impact of getting into these mood swings. Because you know, I had a hard time self-diagnosing, I tried self-diagnosing myself, it’s PTSD, it’s not TBI, but my neck was hurting.” Along with the memory loss Max began experiencing “headaches, massive migraines, intense sun light issues, blurry vision, and chronic neck and back pains.” At the VA, he was diagnosed with a traumatic brain injury.

Despite his challenges, Max returned to school and finished his doctorate in education and health care, a field in which he currently works and teaches. Of all the symptoms he struggles with, Max says the worst is “the short-term memory issues, that I can’t remember. That’s what irritates me, frustrates me.  The ability to not concentrate effectively.” Max works hard to keep moving forward by focusing on his work, connecting with others who struggle with similar issues, and keeping informed about brain injury research. But, he says it can be hard. “I used to have more patience. I don’t have it now. I used to be able to think more clearly, and I become scattered now. I still get lost. Routine is important for me. Having structure is important. Agendas are important.”

 

Max didn’t know he had a head injury until he got home and had constant migraines and issues with balance, mood, and memory.

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Max didn’t know he had a head injury until he got home and had constant migraines and issues with balance, mood, and memory.

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I do recall, the one that’s recorded in my medical records, is the stint in 2005 in Afghanistan. After I left Iraq I didn’t go home. I went to Afghanistan for [the] second war, and in 2005 I was in a vehicle, up-armor vehicle, and a jingle truck, or a traveling truck, they call it, we call it a jingle truck but it’s a truck next to us exploded, causing a concussion wave in our vehicle. I sat at the back right, back right, it was a four-person car with a person in the middle, you know, the turret, and I was at the back right and then it caused the door to swing out and my head went back and jolted, and my knee got slammed with the door and I tore my ACL.

I did not know I had a head injury until I got back home, because I was so worried about the knee. And I couldn’t count things. I couldn’t remember small, short term memory things. I got angry. And I believe that’s one of the things that really presented to me, as a medical provider. I think, the impact of getting into these mood swings. Because you know, I had a hard time self-diagnosing, I tried to self-diagnosing myself, it’s PTSD, PTS, it’s not TBI, but my neck was hurting. My head was, constantly, any sun, like [when] there’s so much snow, it hurts to see. And I know, I mean, I know like, a white out, but it’s at a point where it would give me migraines. Constant migraines every day. So even in, you know, it was when I got back, I just couldn’t think. I couldn’t see things straight. Hard time driving. Coordination and balance, it was all that. And I came to realize, you know, after the surgery, to say “Hey, there’s, there’s something else going on that we need to address.” So [they] tested me, and found out that I might have some TBI.

 

Max says that at the time he was diagnosed, the idea of TBI was someone who was neurologically incapable of doing anything.

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Max says that at the time he was diagnosed, the idea of TBI was someone who was neurologically incapable of doing anything.

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I got diagnosed with traumatic brain injury at the VA, because of the concussion, the headaches, my low back pain. But I, you know I, they were, at that point in time, not necessarily ready for TBI. So, they were, their idea of TBI at that time was someone who was complete loss of limb, I believe, complete loss of limb, neurologically incapable of doing anything, I believe. So, for a walking wounded to come in and say I’ve got some issues with my, with coordination, stuff like that, I believe that’s, they declined me of service connection, even though it’s been recorded that I was in that explosion. So, I feel that, yes there’s a high impact of post-traumatic stress out there, but some of these incidences such as myself have TBI situations that could be underlying or masked from that, and we, you know, as a health care provider again, I believe that’s one of those things that I think this research would probably be good for them to overview and see. 

 

Although he isn’t sure if his TBI has gotten better, Max says that he has learned to mask it better and adapt.

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Although he isn’t sure if his TBI has gotten better, Max says that he has learned to mask it better and adapt.

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I have, I don’t believe it’s gotten better. The VA has decided to state it is not TBI so I have learned to deal with it. I believe I’ve learned to mask it better, and, I don’t know if it, maybe it has gotten better. It’s, you find ways to adapt. You find ways to, to get to know, to get to know the answer more. See this is a guy who wrote dissertations - and he can’t even talk - that’s one, so this is exactly it. I’ve written dissertations, hundreds of research papers, and putting the sentences together becomes difficult, and you know there’s no, it’s, that’s one of the things. And sometimes you, you know what you want to say but you can’t. So, and that’s one of the things that I’ve also seen. So, you sort of adapt to it. So, it’s gotten better, but I don’t, I don’t know if there’s ever going to be a - I don’t know if there’s ever going to be a treatment for it. I mean it’s been a decade for me. I’ve been sort of left on - 2004 left on your own kind of thing, you know. I got activated as an individual, and I was sent back home as an individual, so I had no support of a unit. No support of any bases here. They, you know they, all the picket parades, I didn’t have any of that. I was basically told to go. And I went and came back to this, and there was no support. I went to the VA and the VA wasn’t ready at 2004. So, there’s a lot of guys in 2004 that are affected, I believe, have these issues that might not, that might be masked. 

 

Max says that TBI impacts his neurological and cognitive functions, whereas the PTSD has more of an emotional impact.

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Max says that TBI impacts his neurological and cognitive functions, whereas the PTSD has more of an emotional impact.

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You know traumatic brain injury, you know, it’s going to impact the neurological, cognitive, the psyche, the, for me, it’s the mathematical equations. Before I left I was a respiratory therapist and was the lead RT. I was on flight teams. I went to codes, I ran to codes. I can, you give me a patient weight and I can give you the dosage that quick in my mind. I come back and I could barely remember - I know the dosage, one mg per kg, but I can’t calculate. It was so difficult for me to combine the calculation, and even as, even as a decade has passed, it’s still masking itself. It’s still difficult. People would say, you know, “That’s easy to know, you know, it’s eight times one” or whatever and to break it down I can see it, but the cognitive, the psychological, the remembering things, the basic remembering things, they were difficult, they were difficult for me. Driving, I know I had to drive to work, you know, the same route over, and I, you know, the cognitive process of just passing work and not even knowing that I, you’re supposed to stop here, you know.

So those were things that I saw, but the realm of PTSD was such a big thing in 2004. “Oh everyone’s getting PTSD,” that they were really trying to determine was it, and maybe it was, maybe it was PTSD because I, you know I, in 2004 in Iraq, I, 149 coalition members died in my hands. I literally tried to save 149 that I could not, they died. And that’s not even, that’s not even the ones that were, that were wounded. So there was PTS that I dealt with. But I just think that also, you know your head, your head is not trained to take jolts of RPGs and IEDs daily, nor is it trained to be in a concussion with a car explosion. And you’re wearing these helmets that causes an impact. Very similar to a football player, the high intensity impact that they’re seeing now. So yeah, that’s where I think the cognitive issue was a big issue with traumatic brain injury. I think the emotional psyche was the PTS. And I think that I‘m doing well with, but it’s the cognitive concepts, the remembering things. Just the basic stuff that people take for granted is, it was difficult. You know I, so my daughter is autistic - so I kind of come back to the point of that attention deficit issues with myself. I look at myself and I’m like, sort of, you know, I’m not getting that attention. I’m having a hard time concentrating - so it’s some of that right left brain balance is what I’m seeing with that traumatic brain injury. The fine motor skills sometimes. 

 

Max thinks there should be a better way to evaluate for TBI and recognition that TBI isn’t caused just by explosions.

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Max thinks there should be a better way to evaluate for TBI and recognition that TBI isn’t caused just by explosions.

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So, I think people who are activated individually needs a better way for evaluation, post evaluation, for neurological and traumatic brain. If they, you know, if they had been into a site where there is not only a - and I don’t believe it’s just an explosion - the flights that we went down into Iraq, they were literally going left and right, and your helmet is basically bouncing left and right, left and right in the, because you can’t land straight - you’re gonna get hit - so they would literally swing left, right, 360, we’re going upside down, whatever it might be to land, that’s where we’re going to land. Helicopters that we went through, same exact thing. There was no explosion, but we had to go left to right. You’re always wearing your helmet. Everywhere you went. Everywhere you went, you’re wearing your helmet. They made you run, where if you’re not in a firefight, they wanted you do to physical training, you’re wearing your helmet. And you’re getting constantly banged on that. So, and because I had the biggest rifle, it was always swung over my head and it was always smacking me, so I really don’t believe that just because it’s an explosion that creates traumatic brain injury. It’s the constant impact of that helmet that created a lot of these issues for me. I mean I, yes, I was in firefights, yes I was in explosions, and I believe that Afghanistan one was a big issue, but it was the constant banging. If you don’t have the right size helmet, even those helmets, I had the older helmet too, the big heavy one, because in 2007 they had the better ones with the better chin masks and everything, I didn’t, I had like the Vietnam War helmet. It was the heavy, metal one that they, you know, and then they had the metal armor plates that they had on me, constantly wearing, it was, it tore, it tore you and that, and you can’t go anywhere without it. So, it was, it was hard.

 

Max describes returning home as very difficult, he had headaches, couldn’t remember things, and felt alone and angry.

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Max describes returning home as very difficult, he had headaches, couldn’t remember things, and felt alone and angry.

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Wow that’s, that’s a very tough question. Because, a lot of people want the picket parades. They want, they want to be recognized. They want people to, I think, I think a lot of them really like that. You know, they want that, they won’t say it but they really do. I didn’t want that, you know. I was having headaches. I was having so many headaches. I felt alone. I felt, I felt like I was activated, left in theater by my unit that I was supposed to be at, I was very upset that my unit never tried to find me in Iraq. I had a lot of animosity. I don’t care what’s going to happen, you need to go back to your unit, and you need to go ahead. I could have gone home after Iraq. There was no reason. I could have just did it. Because I did, I spent my six months there, I was good. I could have found a - I’m sure I could have found a way of saying - you know what, I’m in Iraq, I don’t, you know, but no I went back and I was - my wife stated that I had emotional instability, but a lot of that had to do with the anger that I had for the unit. I just couldn’t remember things. It was difficult.

 

Max wants to know more about the link between where the head injury occurred and how the brain is affected.

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Max wants to know more about the link between where the head injury occurred and how the brain is affected.

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Yeah, so, I think the research. And I think, one of the things is I believe that there is concussion association with TBI. The, so the brain has central, different parts. You have the frontal, parietal, the different lobes, as I remember, and having certain impacts within the brain at certain ways can affect the individual. What I like to know is, you know, if you can, if you can diagnose these patients having, or these patients coming in with all these symptoms, we should be able to see or pinpoint what impact of the brain was hit. If you hit your head, you can’t see. If you hit your front, you can’t remember. I think those are things that should, that I would like to know more about. So where’s my cognitive issue? How did this occur? Because for me, it’s remembering. Short term memory. Did I get hit at the back, or how did this occur? The explosion was on the left, so, and then I hit my head this way, so, that would be kind of interesting to know.

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