Traumatic Brain Injury in Veterans

Peter

Age at interview: 46
Outline: Peter was exposed to an IED blast while on foot patrol during his deployment in Iraq. When he returned home his family noticed differences in his speech and demeanor, such as trouble finding words and stuttering. Peter also noticed issues with his memory and organization skills. To cope with these symptoms, Peter relies on his phone, online calendars, and a password manager tool. He has also uses programs like Luminosity and Mindspark to keep his brain sharp and focused.
Background: Military branch: Marine Corps

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Peter served three years in the Marines and two more as a reservist. When he first returned home from Iraq, issues stemming from his brain injury were not immediately apparent to him. There were other things to deal with at that time. While in Iraq, he was in an IED blast during a foot patrol. The blast took off his right arm below the elbow and left shrapnel in his side where he was exposed between his armor plates. Back in the states he underwent several surgeries to repair the damage done by the blast.

Peter first realized something was amiss when his father mentioned that he seemed different, that he didn’t talk the same way he used to. His father noticed that he had trouble recalling words and that he stuttered, which he hadn’t before. These issues prompted him to reach out to the local VA Polytrauma Clinic. His diagnosis was mild TBI possibly stemming from the blast he experienced in Iraq.

While Peter is wary to blame any and all issues he encounters on the TBI diagnosis, he has experienced deficiencies with his memory, speech, organization, and notes that multi-step tasks are more overwhelming to deal with than before. To keep track of appointments and keep his life organized, Peter relies on his phone, online calendars, and a password manager tool. He has also used programs like Luminosity and Mindspark to keep his brain sharp and focused.

Peter acknowledges that there isn’t a lot known about the effects of concussion and TBI, but that those struggling with the symptoms should just try to pay attention, take it as it comes, and do the best they can.

 

Peter talks about sustaining a blast injury from after an IED exploded less than 10 feet away.

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Peter talks about sustaining a blast injury from after an IED exploded less than 10 feet away.

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So - I was in a - I had a blast injury in 2005, IED. I was on a foot patrol. I was probably about ten feet or less from a bomb that killed another Marine, although it was a homemade deal and not - I mean if it was, if it was made out of an artillery shell or something, we’d all be dead for sure. But it was like an olive oil can and so probably had an inconsistent blast pattern. The – I mean the Marine that was killed - did not have a scratch on him and was entirely killed by overpressure and I wasn’t all that much further than he was. And there, there were two others of us who were thrown probably more than six feet by the, by the blast. And you know I had a bunch of injuries and the other Marine didn’t have any, any injuries and was also apparently fine.

 

A family member noticed changes in Peter’s speech, such as stuttering and hesitating when searching for words.

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A family member noticed changes in Peter’s speech, such as stuttering and hesitating when searching for words.

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It was the first time he had spent much time with me really since I got hurt - and you know he brought up, he said that, he said you know, you know, you – I didn’t really notice until I spent a lot of time with you that you don’t really talk the same way that you used to. He pointed out that he had noticed some differences in my speech and particular hesitations for words and stuttering and that kind of thing - which if I think about I would probably do more right now when I’m talking to you, listening to myself talk. And you know he just pointed out that he thought that those things were different, were all, you know, different, different enough from the way he was used to listen to me talk that it was enough for him to remark on. So I went actually to the speech people at the VA after I got back and they started doing some stuff with me and they referred me to the poly-trauma people, the OIF/OEF poly-trauma people, and they gave me this whole battery of tests. I mean you know for me it, it was really the discovery - it was that trip that I took with my father and his commenting on my speech pattern and that kind of thing. And then end up, then I ended up sort of, you know, with that information – thinking, thinking more about that and then also looking at other stuff.

And then in retrospect - and then you have sort of like this you know, confirmation bias or whatever - like once you, once you say, “Oh now I’m thinking about this,” and so, then everything is evidence that, you know. And frankly a potential excuse - I mean if you’ve, you know if you’ve been told that you have a traumatic brain injury – and you know my wife and I had a discussion about this. It’s like – and you know she was doing it, too. It’s like, “Okay, so he forgets something.” You know, we, we’re going to notice it more than we notice it with everybody else and it’s going to be like, oh like if we have an argument about whether or not you know who remembers what’s true about what we’re trying to – “Well it can’t, you can’t possibly be right because of the TBI,” you know? And so, you know, where do you go from there? So, we try not to do that and I try not to use it as an excuse.

 

Peter was referred for testing by a speech therapist, and was eventually diagnosed with mild TBI.

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Peter was referred for testing by a speech therapist, and was eventually diagnosed with mild TBI.

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So, I went actually to the speech people at the VA after I got back and they started doing some stuff with me and they referred me to the polytrauma people, the OIF/OEF polytrauma people and they gave me this whole battery of tests. And then I talked to the woman who does that stuff at the VA and she talked to me a little bit about it all. I mean I guess it’s, she said it was mild. I guess it’s mostly focused, it’s mostly, I test according to her in the low end of normal for short-term memory and some executive function and a couple of other things - and you know very high in other areas and you know that sort of don’t match up. So even though it’s still normal, it’s maybe not normal for me and that was kind of my guess.

 

With the exception of medication, Peter feels like most of the VA services are for those with more serious issues

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With the exception of medication, Peter feels like most of the VA services are for those with more serious issues

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I do think that I fall into a space that, you know, where what’s available may be more focused and rightly so on people that have a lot more serious issues than I do. So, for somebody with issues like mine - you know I’m paying myself for this online brain training stuff - I wish that the VA could figure out a way to pay for that instead of offering to buy me a phone that I do not need. Because that seems dumb. But apparently the VA doesn’t do software subscription or anything. I mean you can buy a lifetime subscription to these things for the same price that they would buy me an iPhone for - and I think that would be a good use of VA funds because they can’t offer me apparently anything similar.

And then, you know, I’m trying the medication stuff, I suppose I, you know I appreciate that my doctor took the time to keep following up with me. Because honestly, like, you know, I wouldn’t be here and trying this next kind of medication unless she had called me. So that’s pretty good, although it – you know, although it’s slow. So basically, as far as I know there’s not a whole lot available to me except for some medications. And you know – and a weaker version of some of the brain games that I’ve found on my own.

 

Peter can get overwhelmed when faced with complex tasks, and has trouble completing simple things like cleaning up the house.

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Peter can get overwhelmed when faced with complex tasks, and has trouble completing simple things like cleaning up the house.

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So, okay here’s another thing that I didn’t really mention related to the executive function kind of stuff. There are times in, you know, even something as simple as like cleaning up the house where I’ll find myself like, you know, picking a bunch of stuff up and not really knowing where to put it and putting it back down again and being really inefficient about doing stuff like that. And I will say that like my, you know, my office became a much worse mess than it ever was. I seem to have a lot of trouble you know – I mean so, you know, following through on all kinds of things. Like a specific task like that, but then any sort of complicated task sometimes I, I get like I feel myself getting kind of overwhelmed sometimes, I think. And I have to sort of – and actually this is something that I had a conversation with my wife about and this is actually a specific piece of advice that she offered to try to fix some of it - she said that it seems like it’s more easy for me to be distracted and that I have difficulty multitasking. So you know, she always tries to get me to just focus on, you know, a specific task and get it done instead of trying to do everything at once.

 

 

After an unsuccessful trial of Wellbutrin, which exacerbated his feelings of anger, Peter’s doctor suggested he try Provigil

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After an unsuccessful trial of Wellbutrin, which exacerbated his feelings of anger, Peter’s doctor suggested he try Provigil

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When my son was much younger, you know I would get, I would get angry and frustrated at him and yell at him. And you know I never, I never hit him. Although I did, I did kick a hole in a kitchen cabinet one time, you know when he wouldn’t eat his breakfast, which was clearly an overreaction. And so I guess, I guess you know I try to pay attention to that too and not do it. And so my doctor had prescribed the VA’s TBI medication protocol for this sort of thing, I guess starts with, I guess they, they have some of the SSRIs and some other things that they make you try. And so I tried, recently I tried Wellbutrin and we noticed that that, that seemed to have a negative effect. Like it, it made my, you know and I was on it for, like long enough for – you know that’s, that’s one of those ones with a really long half-life, so it takes a while to get to the low that they want you to have - and when I got there, I was having some, I, my temper got worse for sure. And so I just quit taking it and I figured whatever else it was doing for me, it certainly wasn’t worth aggravating that. And so the next thing that my doctor wanted to try was Provigil. And so she wrote a prescription for that, but then I guess it required some multi-step approval because it’s non-formulary. And so, so I’m waiting for that.

I think I mentioned earlier on the, some of the symptoms that I think I have seem to be potentially on the same spectrum as, you know, like undiagnosed ADHD or sleep apnea. And so I mean I don’t know a whole lot about it, honestly. But I do know that, you know, the way my doctor explained it to me, there are a few medications that the VA, the VA has some sort of protocol which I actually have not ever seen written out anywhere or note. And it seems like the front line of these things are to try some of the ADHD-type medications. The other reason why they weren’t totally excited about trying me on those, like Adderall for example, is that I’m a heart patient. I had a heart attack, so giving me stimulants is maybe not necessarily the best idea. So that’s sort of another reason – the Provigil’s a little bit different apparently than some of those.

 

Peter wishes the VA would do more research on the effectiveness of electronic resources like Mindspark or Luminosity.

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Peter wishes the VA would do more research on the effectiveness of electronic resources like Mindspark or Luminosity.

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And the same thing could be true with – and I’m finally getting to the TBI stuff - is like with the Mindspark or Luminosity or something like that. They could collect, you know, daily – you know, you could even do a study on everybody you know with daily use and probably collect far more data. You could even throw in during the study questions about like the kinds of things you’ve been asking me about. Like, you know, open-ended questions. How do you feel today? What did you have trouble with today? What are you improving at? And all of that could be, you know, could be available for therapy and for study. And you know if they’re willing to do something like this, I don’t see why they couldn’t, why the IRB couldn’t approve something like that, too. So I guess I just wish that you know – and the other thing is you have, you know you have this patient population is enormous and is generally pretty compliant. I mean if, you know, like if you let people do it, people probably would. You know, people would probably do more of that kind of therapy stuff that would be helpful to them - and so not only would they be doing it, but you could collect data on it as well.

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