For Iraq Veterans, Headaches Continue After Traumatic Brain Injury

/PRNewswire-USNewswire/ -- Many soldiers who experienced mild head trauma or a blast exposure while serving in Iraq or Afghanistan are returning to the United States with headaches, according to a study released today that will be presented at the American Academy of Neurology's 61st Annual Meeting in Seattle, April 25 to May 2, 2009.

The study, conducted at Fort Lewis, WA, involved 978 U.S. Army soldiers returning from Iraq or Afghanistan in 2008. All had experienced a concussion, head injury or blast exposure while deployed.

Nearly 98 percent of the soldiers reported having headaches during the last three months of their deployment. The headaches started within one week of the traumatic brain injury for 37 percent of the soldiers, and within one to four weeks for 20 percent. Among the soldiers whose headaches started within a week of the injury, 60 percent had migraine-like headaches and 40 percent had headaches that interfered with their ability to do their daily activities. Thirty percent had headaches for 15 or more days each month.

"Mild traumatic brain injury is occurring in 15 to 25 percent of soldiers deployed to Iraq or Afghanistan," said study author Brett J. Theeler, MD, of Madigan Army Medical Center in Tacoma, WA, and a member of the American Academy of Neurology. "The associated headaches can be a source of impaired occupational functioning. These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, to the need to identify and properly treat headaches among soldiers."

The study was supported by the Uniformed Services University of the Health Sciences through a grant from the Congressionally Directed Medical Research Program.

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Soldiers Help Iraqis Revitalize Hospital

Photo: Army Staff Sgt. Matthew Jemison, of Headquarters Company, 1st Battalion, 15th Infantry Regiment, talks to two members of the Sons of Iraq security group Feb. 4, 2008, at a hospital in Salman Pak, Iraq, as regiment leaders and members of 489th Civil Affairs Battalion tour the facility. Photo by Sgt. Natalie Rostek, USA

With help from U.S. soldiers, work is under way in Salman Pak, about 15 miles south of the Iraqi capital, to revitalize a hospital that has not been fully operational for about five years.

Soldiers and leaders from 1st Battalion, 15th Infantry Regiment, and Team 915 of Company A, 489th Civil Affairs Battalion, from Knoxville, Tenn., attached to 1-15th Infantry Regiment, visited the hospital Feb. 4.

Army Maj. John Wolfe, from Scottsboro, Ala., a 489th Civil Affairs Battalion team leader, said the Iraqi National Police have been using the facility as a headquarters and barracks since 2005.

"The national police were forced by circumstance to work out of the hospital and other key facilities," explained Army Maj. Cliff Faulkner, from Silverton, Colo., commander of Company A, 489th CA. "Now that security has improved, they can give physical possession of key infrastructure back to local residents."

Wolfe said the first step in revitalizing the hospital was negotiating with the city council to relocate the police from the building. The next step is establishing community access to the hospital.

Several council leaders, a leader of the local Sons of Iraq security group, and maintenance representatives led the tour through the hospital's cold, dark halls.

Wolfe said he believes coalition forces and Iraqi leaders can restore the hospital to full operation. If the facility returns to its former capacity, jobs will be available for doctors, nurses, and other medical professionals.

"Past insecurity and sectarian violence kept many medical professionals away," Faulkner said. "We are optimistic that the improved security and stability will permit the return of these professionals and essential services."

Army Capt. Jason Carney, from Knoxville, Tenn., a 489th CA team leader, said changes have been made since the national police vacated the facility. The Sons of Iraq, members of a neighborhood watch-type program, took over security for the hospital, and three doctors see patients daily from morning to early afternoon.

"Doctors and patients are still leery to stay overnight," Carney acknowledged.

Wolfe said the Iraqi Health Ministry is helping fund improvements. The hospital in Salman Pak already has used Health Ministry funds to buy water pipes and porcelain sinks.

"Now we just need to get the people to understand that the hospital is open," Wolfe said.

Photo 2: Army Capt. William Clark, commander of Company A, 1st Battalion, 15th Infantry Regiment, looks through the operating room during a tour of a hospital in Salman Pak, Iraq, Feb. 4, 2008. Photo by Sgt. Natalie Rostek, USA

(Army Sgt. Natalie Rostek serves with the 3rd Infantry Division's 3rd Heavy Brigade Combat Team, in the Multinational Division Center Public Affairs Office.)

Army Aims to Better Identify Soldiers with Brain Injuries

By C. Todd Lopez
Special to American Forces Press Service

An Army report released yesterday outlines how the service can better identify and help soldiers who have suffered traumatic brain injuries.

The report contains some 47 recommendations to help the Army better prevent, screen, diagnose, treat and research traumatic brain injury, said Brig. Gen. Donald Bradshaw, who led the task force charged with investigating TBI. Bradshaw is commander of Southeast Regional Medical Command and Eisenhower Regional Medical Center, at Fort Gordon, Ga.

"Our report indicates that, like our civilian counterparts, the Army has done well in the identifying and treatment of severe or penetrating traumatic brain injury, but is challenged to understand, diagnose and treat personnel who have suffered short-term or persistent symptoms of mild TBI," he said. "The task force identified opportunities for improvement as well as best-practice guidelines."

The general said 80 percent of those who suffer from mild TBI, commonly known as a concussion, recover completely. Some 10 to 20 percent of soldiers and Marines returning from Iraq and Afghanistan with experience in combat may have suffered symptoms consistent with mild TBI.

Today, eight of the recommendations made by the task force have already been implemented, said Col. Judith Ruiz, deputy director for rehabilitation and reintegration with the Office of the Surgeon General.

"We have made significant progress to take care of soldiers and to standardize practices across the Army medical department," she said.

Some of the recommendations that have already been implemented include:

-- Working with interagency and civilian groups to better define TBI;

-- Implementing in-theater TBI screening and documentation for all soldiers exposed to brain injury-inducing trauma;

-- Adding TBI-specific questions to deployment-related health assessments;

-- Developing a proposal on the appropriate functions of a "TBI center of excellence";

-- Proposing the Defense and Veterans Brain Injury Center as the core of the new center of excellence;

-- Optimizing the positioning of clinical, educational and research activities;

-- Centralizing the evaluation of the scientific merit, clinical utility, and priority of new treatment strategies, devices or interventions; and

-- Adapting the Military Acute Concussion Evaluation overprint as an approved Department of the Army form to document mild TBI closest to the point of injury.

Ruiz said 31 additional recommendations are in progress, four are planned, and four are in the process of being transferred to other agencies.

For soldiers in theater, the most common cause of brain injury is a blast, such as from an improvised explosive device. But sometimes such blasts do not cause visible external injuries.

"Brain injury does not have to have outside symptoms, such as bleeding," Bradshaw said. "It may, but doesn't have to. That is one of the compounding things; folks may look totally normal, but be dazed."

Because some victims of IEDs or other blasts do not have external injures, they may feel they have not been injured at all -- even if they did sustain a mild TBI.

"It's hard to identify TBI when soldiers don't come forward and don't identify," Bradshaw said. "Some of the actions that have been taken (include) a very big ongoing education process for leaders, soldiers and family members."

The Army launched the post-traumatic stress disorder/mild traumatic brain injury chain teaching program in 2007 to help soldiers better identify signs and symptoms of these conditions and to reinforce the collective responsibility to take care of each other.

The Army is also working to educate the civilian medical community about mild TBI so that soldiers in the reserve components, who may not have full-time access to military medical care, also can be identified, said Col. (Dr.) Jonathan Jaffin, deputy commander of the U.S. Army Medical Research and Material Command.

"One of the things we are concerned with and ... one of the points behind the whole chain teaching was trying to get the message out to the country, not just the active-duty force, Guard and reserve," he said. "(We wanted) the country, including providers throughout the country, to be aware of mild TBI and concussions and the long-term symptoms that some people may be having."

Bradshaw said Army leaders at all levels are committed to the good health and well-being of all soldiers and are proactively addressing the issue of TBI. "Continued research in this area can only help us more clearly understand the medical impacts of the war and the best ways to prevent, recognize and treat soldiers with TBI," he said.

(C. Todd Lopez works for the Army News Service.)

Cancer-Survivor Soldier Joins Unit in Iraq

By Pfc. Monika K. Smith, USA
Special to American Forces Press Service

CAMP STRIKER, Iraq, Jan. 10, 2008 - They call him "Tiny," and as with many nicknames, the moniker inaccurately describes Sgt. Jared Squires' stature. At 6 feet, 5 inches tall, the crew chief with Company A, 2nd Battalion, 3rd Aviation Regiment, more than snugly fits into the space allocated for crew chiefs in the Black Hawk helicopters he flies in.

Army Sgt. Jared Squires reviews his pre-flight checklist Jan. 4, 2008. After conquering cancer, Squires joined his unit deployed to Iraq.

Squires, from Los Lunas, N.M., doesn't mind his nickname. He's just happy to be flying again.

In July 2006, Squires learned he had skin cancer. An Army surgeon estimated he had just six years to live.

"When I first found out, I went to the doctor's office and my wife went with me," Squires said. "The doctor came and said, 'I'm sorry to let you know you have malignant melanoma.' I thought, 'I've got two kids. I've got my wife.' ... I wanted to do everything I could right away, because in six years, I might not be there for my boys."

Squires began a series of surgeries and positron emission tomography, or PET, scans, used to detect cancer and the effects of cancer therapy. The cancer spread to the lymph nodes in his left arm. Surgeons removed the lymph nodes, but his body couldn't produce the skin needed to heal his wounds. The fourth surgery was a skin graft to help close the wound, which Squires said was "by far the most painful thing I've ever been through in my life."

Squires said his inability to fly was one of the worst facets of his illness. "I was grounded and couldn't fly after my first surgery," Squires said.

Once Squires completely healed from his surgeries, he began taking interferon to stimulate his body's immune system to fight off cancer. He began 30 days of daily four-hour intravenous treatments.

"The first day of treatment, I could barely walk out on my own strength," Squires said. "I almost had to be carried out."

For 11 months, Squires self-injected interferon three times a week. Though he didn't lose his hair, it did begin to thin out. His days consisted of treatments and sleeping, because his treatments left him exhausted. But he got great support from his unit.

"My company's (family readiness group) stepped up big-time," Squires said. "For two weeks they came to my house and dropped off meals, because my wife was busy taking care of me. It was a lifesaver. It really helped."

Army Sgt. Thomas Lacroix was one of those who stepped up to help the Squires family. A member of Company A, 2-3rd Aviation Regiment, Lacroix has known Squires for seven years. The two met in advanced individual training, served a tour in Korea and then again with the combat aviation brigade.

"(I) felt pretty bad for him," Lacroix said. "I knew his family, his wife, two kids. I tried to do everything I could to help his family out; there wasn't much anyone could really do for him."

As the brigade prepared to deploy to Iraq, Squires was sent to the rear detachment because his illness made him ineligible to deploy. He worked with incoming soldiers who were deploying while continuing with his treatments. He finished his treatments at the end of October and was cleared to fly. But he wasn't content with that. He wanted to deploy.

"I had the opportunity to stay in rear detachment, and I chose not to," Squires said. "I told them 'No, I want to go.' It took a lot of me, from my side, to get them to say, 'Hey, yeah, you're good to go.' They tried to med-board me, and I had to get my oncologist to say, 'He's fine.' They thought I was crazy. My wife knew I wanted to go and that I missed the guys. I missed my friends. We've been together so long, they're my family."

After Squires obtained all the letters he needed from dermatologists and from his oncologist stating he was rid of cancer and capable of deploying, he was on the first plane to Iraq.

"I know it was a big morale boost to have him come out and join the team again," Lacroix said. "It was pretty rough deploying without him. There was a big void in the company."

For the rest of his life, Squires must have routine PET scans and visit a dermatologist every six to nine months, and he must take active measures to prevent cancer from reoccurring.

"I have a 75 percent chance of it coming back," Squires said. "But skin cancer is preventable. It's not like breast cancer. It's not passed down for generations. There's a chance it will come back, but if I take the preventive steps, it shouldn't be a problem."

Lacroix said the company is glad to have Squires back and that his returning was expected.

"That's what he wanted, and he showed he could do it," Lacroix said. "He got better and beat it. He's a true leader. He had the option of staying home and dodging a deployment, but he chose to come out here. The younger guys look up to that."

(Army Pfc. Monika K. Smith serves with 3rd Combat Aviation Brigade.)