There are 18 veteran suicide attempts each day, according to the National Center for Veterans’ Studies.
That staggering number can be attributed to any number of problems service members face during life after the military. One of the major culprits has been traumatic brain injury (TBI) and its effect on those with post-traumatic stress disorder (PTSD). Veterans aren’t alone in their concerns. NFL officials are also trying to their part to research this growing medical issue.
We Aren’t Superheroes
Veterans are often overlooked when people think of brain injuries or emotional traumas. These stigmas are often due to the “tough guy” image we portray. I hate to let you in on the secret folks, but Captain America really is just a comic book character. The real heroes are out there in the desert, struggling to overcome family separations, unpaid bills and improvised explosive devices (IEDs).
Awareness is Key
TBI and CTE are growing concerns among military members, veterans and NFL players alike.
While scientists have increased their efforts to find the link between TBI and PTSD, correctly diagnosing the problem is still an inexact science. According to a study by the Army, the number of active duty service members on sedatives and anti-depressants has increased 800 percent since 2005.
This has led to more research and awareness, but we are a long way from unlocking all of the secrets a damaged brain holds.
But we may have found a new platform to address these issues –the NFL.
Unlikely Source Brings Help
Journalists and commentators have applied war metaphors to football for years, referring to coaches as generals or to the playing field as a battlefield. While that is as far as the parallels go, we may finally share a real commonality: traumatic brain injury and chronic traumatic encephalopathy (CTE). These injuries are incurred by veterans and NFL players alike, and as both are likely to sustain a head injury at some point during their careers, both will need similar treatment in the long run.
Dave Duerson was a former Chicago Bears defensive player who suffered multiple concussions while playing, a problem he believed led to his depression and feelings of despair. Duerson committed suicide last winter, shooting himself in the chest so his brain could be used for CTE research.
Future Hall of Fame linebacker Junior Seau took his own life recently, shooting himself in the chest in way that led some researchers to believe he was mimicking Duerson. Seau’s family holds the same belief, as they have since donated his brain to research for studies in CTE.
The relationship between TBI and CTE and how they relate to PTSD or similar psychological issues will continue to overlap as scientists study neuropsychiatric disorders and cumulative exposure to sub-concussive or concussive impacts suffered by people across different fields. And whether you’re a football player suffering from multiple concussions or a military member who has survived an IED explosion, the studies being done and the awareness that has been raised should ultimately lead to better care for all.
Traumatic Brain Injury (TBI) is the signature wound of conflicts in both Iraq and Afghanistan - with conservative estimates placing the number of US troops suffering from TBI at more than 200,000.
Currently, battlefield medical personnel rely on visual signs, along with the personal accounts of patients to alert them to the possibility of TBI.
However, DARPA's $45 blast gauge collects critical quantitative data for measuring blast related exposure, thus offering a mechanism for field medics to better identify those at risk for TBI.
"DARPA Blast Gauge provides doctors with information on what their patient actually experienced during an exposure," explained DARPA exec Jeff Rogers.
"After a blast, medics check a wristwatch-sized device displaying a green, yellow or red status light to indicate the relative risk of injury. This is an entirely new capability and has already helped medics and doctors in treating injured warfighters."
For example, a soldier recently suffered a shrapnel injury, yet did not report a blast exposure to the medic treating his visible wounds. The medic opted to check the test blast gauges, which told a totally different story. Indeed, the soldier's gauges displayed yellow lights, indicating a moderate exposure occurred during the engagement.
In response, the medics downloaded data from the gauges and followed standard protocol for evaluating someone at risk for TBI. It was determined that the soldier had suffered a mild TBI and treatment began immediately.
Essentially, the blast gauge can best be described as a small, self-contained system that measures the amount of blast exposure to which a warfighter has been exposed. The gauge is currently used by more than 6,400 troops in a variety of units across the military - a number which is expected to double over the next month.
"The gauges work extremely well. [Yes], there is resistance [among soldiers] to doing anything that might take them 'out of the fight.' The paradigm of not seeking medical aid for the 'invisible injuries' of war, which include PTSD and TBI, is changing but there is still some reluctance to seeking aid," said US Army Major Theodore R. Stefani, MD.
"In the last 24 months, the rate of TBI diagnosis has increased. The blast gauge does not diagnose a TBI, but it does help ensure that a soldier seeks care. After a blast event, soldiers may downplay their symptoms, but if they have an amber or red indicator light on their blast gauge, that can't be downplayed."
U.S. troops in Iraq, Afghanistan and Kuwait have inhaled microscopic dust
particles laden with toxic metals, bacteria and fungi — a toxic stew that may
explain everything from the undiagnosed Gulf War Syndrome symptoms lingering
from the 1991 war against Iraq to high rates of respiratory, neurological and
heart ailments encountered in the current wars, scientists say.
"From my research and that of others, I really think this
may be the smoking gun," says Navy Capt. Mark Lyles, chair of medical sciences
and biotechnology at the Center for Naval Warfare Studies at the Naval War
College in Newport, R.I. "It fits everything — symptoms, timing,
everything."
Lyles and other researchers found that dust particles — up
to 1,000 of which can sit on the head of a pin — gathered in Iraq and Kuwait
contain 37 metals, including aluminum, lead, manganese, strontium and tin. The
metals have been linked to neurological disorders, cancer, respiratory ailments,
depression and heart disease, according to the Environmental
Protection Agency. Researchers believe the metals occur both naturally and
as a byproduct of pollution.
Researchers in and out of the military say the particles
are smaller and easier to inhale than most dust particles, and that recent
droughts in the region have killed desert shrubs that helped keep down that
dust. The military's heavy vehicles have pounded the desert's protective crust
into a layer of fine silt, Lyles says. Servicemembers breathe the dust — and all
it carries — deeply into their lungs.
The dust contains 147 different kinds of bacteria, as well
as fungi that could spread disease, Lyles found. Since the wars began in Iraq in
2003 and in Afghanistan in 2001, the military has seen a 251% increase in the
rate of neurological disorders per 10,000 active-duty servicemembers, a 47% rise
in the rate of respiratory issues and a 34% increase in the rate of
cardiovascular disease, according to a USA TODAY analysis of military morbidity
records from 2001 to 2010. Those increases have researchers seeking possible
causes.
Despite the research by Lyles and others, and the
documented spikes in respiratory illnesses, Defense
Department officials contend there are no health issues associated with the
dust.
"The (Defense Department) has examined the concerns raised by the studies
accomplished by Capt. Lyles," says Craig Postlewaite, who heads up the Secretary
of Defense's Force Readiness and Health Assurance Office. He said the military
found the dust is "not noticeably different from samples collected in the Sahara Desert
and desert regions in the U.S. and China."
Lyles initially analyzed dust samples from Iraq and Kuwait
in 2003 to help determine a way to keep the grit from rendering medical
equipment useless.
"When I saw the data, I said, 'Oh my God. This can't be
right,'" Lyles says.
Harry Fannin, a chemistry professor at Murray
State University, analyzed the dust for Lyles in late 2004.
"It was a little bit unusual," he says, citing high levels
of chromium, nickel and other metals.
"You wouldn't see metal like that in the U.S.," he says,
adding he was most concerned about the tiny size of the particles. "Any time you
have respirable particles, it's bad."
Scientists know fine particulate matter — that smaller than
10 micrometers, or about one-fourth the size of a single grain of table salt —
can cause lung and respiratory problems.
Catherine Cahill, associate professor at the Geophysical
Institute at the University of Alaska, began collecting airborne dust for
the military with the Army Research Lab in Baghdad in 2008.
"I've done sampling since 1986, and I've never seen
anything that bad — not even in China," she says, referring to China's extreme
levels of pollution. The everyday fine particulate matter levels in Iraq were
about three times greater than what the EPA says is healthy within a 24-hour
period, she says — and those levels should not be exceeded more than once per
year. "We're blowing that standard out of the water."
She called the abundance of aluminum and lead she found
"our worst-case scenarios." Cahill says her research mirrors the work done by
Lyles.
"Most things are high is the bottom line," she says. "I
would expect chronic coughs, asthma, respiratory disease in the short term; and
(chronic obstructive pulmonary disease), heart problems and hypertension
long-term. Mark's theory, to me, makes perfect sense."
Lyles' team found almost 150 kinds of bacteria, 25% of
which may cause or worsen diseases such as meningitis, cystic fibrosis, septic
arthritis, gastroenteritis, staph infections, diarrhea and food poisoning.
Defense: Not so fast
The Defense Department says it hasn't linked any illnesses
among servicemembers to bacteria in the soil.
"All soil, no matter where it is found, has germs present,
so this finding is not unusual," Postlewaite says. "We have closely examined our
medical surveillance data for those personnel who have deployed — some multiple
times — and we have not been able to identify any increased disease that could
be associated with the germs that were identified in the soil."
Many had been exposed to a sulfur fire in Mosul, Iraq. They
also had been exposed to burn pits — the military disposes of trash at bases in
Iraq and Afghanistan by burning as much as 240 tons of it a day in open pits.
All of them came through chest X-rays and CT scans with clean bills of health.
The soldiers volunteered for a procedure to obtain lung cell samples, and when
Miller examined the biopsies, 50 of 54 showed constrictive bronchiolitis — a
rare lung disease that closes the tiniest airways.
Those biopsies also turned up dust.
"A polarizing lens shows sparkling — that's the dust,"
Miller says. "It is a concern."
He plans to analyze that dust, as well as a brown pigment
mixed with it.
"(Lyles) has pretty convincing evidence that the dust is a
carrier of toxins," Miller says. "But we need more information before we can
make any sweeping generalizations."
Veterans
Affairs researcher Anthony Szema found that about 7% of veterans who had
deployed to Iraq from 2004 to 2007 had asthma, compared with about 4% who did
not deploy. Then he heard about the burn pits, as well as Lyles' theories.
"Lyles gave a lecture in Denver," Szema says. "Everyone's
jaw was falling on the floor."
The range of respiratory disease he saw didn't appear to be
caused by one problem. And it seems to be getting worse: About 11% of soldiers
returning from Iraq have respiratory problems, he says.
Ronnie Horner, chairman of the Department of Public Health
Sciences at the University
of Cincinnati, saw clusters of servicemembers with ALS— or Lou Gehrig's
Disease — after the 1991 war in Iraq.
ALS affects about 1 to 2 people per 100,000 — usually men
older than 55. Half the Desert Storm veterans diagnosed with ALS were younger
than 25, and 98% were younger than 55.
"We know that aluminum has been associated with ALS, as
well as lead," Horner says. "We were definitely interested in Lyles' work."
And early heavy-metal poisoning symptoms also look the same
as post-traumatic stress disorder (PTSD), he says. "It's all speculation," he
says. "But it's very intriguing, especially when there are such high levels of
PTSD."
Former Army specialist Jeremy Bowman, 33, worked as a
mechanic in Baghdad in 2003. While he was still in theater, his hands began to
shake as if he were nervous. Now the shaking shimmies up his arms, into his legs
and sometimes into his face. He takes medication to prevent the shaking from
interfering with his daily life. His legs often feel numb or tingly, his back
hurts and his leg muscles feel weak.
"It all falls under 'neurological signs and symptoms,' but
nobody knows what it is," he says. "Everything new that comes out — burn pits,
dust, depleted uranium — I think, 'Maybe that's it.'"
Bowman also has troubles breathing since he deployed and
must use an inhaler.
Capt. J.A. "Cappy" Surrette, spokesman for the Navy Bureau
of Medicine and Surgery, said Navy researchers investigated to see whether the
dust in Iraq and Afghanistan is toxic. The Navy has no record of troops
complaining of cognitive difficulties unrelated to traumatic brain injuries, he
says.
However, he says the Naval Health Research laboratory found
that trace metals in the dust showed levels of toxicity.
"There is no definitive basis to say the sand is harmful to
people or animals," he says.
However, one Navy study is examining the toxicity of sand
from Afghanistan to see how it affects cell death, he says. A second is looking
at whether Afghanistan dust contributes to brain trauma pathology in animals.
Navy Petty Officer 2nd Class Rob Erckenbrack, 40, of West Fargo, N.D.,
deployed at Taqaddum, Iraq, in 2006, and guarded the perimeter at Taji, Iraq, in
2008. He began losing weight, and having respiratory problems and migraines. He
also dealt with short-term memory loss but says he was not in an incident that
would have caused a traumatic brain injury. In June 2010, he had a stroke.
"My doctors were surprised because I'm a healthy, active,
adult," he says. "Then another guy from my unit went through the same
thing."
Dale Griffin, an environmental public health microbiologist
with the U.S. Geological Survey, also found metals and bacteria in the dust.
"We know that certain metals are toxic," he says. "I
believe there is a risk there."
'It's a very complex problem'
Early in the 2003 Iraq War, a rare flu — eosinophilic
pneumonia — infected 18 and killed two servicemembers in Iraq, according to a
military study. Researchers theorized that the bacteria entered troops' lungs
through the dust or through bacteria picked up from the ground from tobacco in
foreign cigarettes.
In 2003, Richard Stumbo worked as a civilian contractor for
the Department of the Army when he became sick with a flu so bad he had to be
airlifted out of Iraq.
"My doctor said he thought it was some kind of bacteria in
the dust that I picked up," Stumbo says. "My boss called me after I got home and
told me a couple of the guys had died."
It took Stumbo two months to recover.
Geoff Plumlee, a research geochemist with the U.S.
Geological Survey, sifted through dust samples in the aftermath of the World
Trade Center attacks in 2001 to determine what in that particulate matter
might affect first responders. His work led to legislation meant to take care of
people with respiratory problems and cancers who had breathed in the dust.
After looking at Lyles' work, as well as military-sponsored
and EPA research, Plumlee said he wants to see more.
"It's a very complex problem," he says. "I think all of the
different studies are pointing to a need for a very detailed look."
Richard Meehan, chief of rheumatology at National Jewish
Health in Denver, assisted the Army's Public Health Command with a particulate
matter study.
National Jewish had received several cases similar to those
of Miller's at Vanderbilt, and Meehan began to think it might be more than
simply the burn pits. "We wanted to know why we were seeing these rare injuries
that Bob Miller was finding," Meehan says.
He is part of a team working on a study to determine how to
address the problem. "We need to see this in peer-reviewed journals," Meehan
says. "I'd like to have this done correctly upfront so we don't end up with
another Agent Orange."
Meehan emphasized that the dust isn't the only problem:
Stress causes post-traumatic stress disorder. Explosions cause traumatic brain
injuries. And burn pits shape yet another piece of the puzzle.
"I don't want a false cause," he says. "You miss really
discovering what else is out there."
Meanwhile, Lyles says he wants samples taken in several
places to determine hot spots in Iraq, Kuwait and Afghanistan. He wants to
follow people in units to see how they fare after exposures. He wants toxicology
studies and more animal studies. And he wants the military to take notice.
Hero N.J. cop turned NBA ref helps vets with post-traumatic stress
Wednesday May 23, 2012, 12:34 AM
BY JEFF ROBERTS
STAFF WRITER
The Record
The shotgun never was out of reach, stashed near the bed on those anxious nights Bob Delaney actually dared to sleep.
A threat had been discovered on a wiretap recording, part of a conversation among mob figures. And the message was all too clear.
SPECIAL TO THE RECORD
Former NBA referee Bob Delaney sharing a moment with Kobe Bryant of the Lakers.
Delaney had to die.
“All I was thinking was, ‘They’re coming to get me,’ ” the former New Jersey State Trooper said.
The mob never caught up with the Paterson native, despite his work in the landmark undercover operation Project Alpha, in which he infiltrated the Genovese and Bruno crime families from 1975 to 1977.
But the stress of being so deeply immersed — often with a wire attached to his body — exacted a toll on Delaney.
However, the hero cop turned decorated NBA referee has harnessed that experience in his third career, helping the soldiers and veterans of the Iraq and Afghanistan wars cope with the debilitating effects of post-traumatic stress disorder.
SPECIAL TO THE RECORD
Bob Delaney having a word with Maj. Gen. Sherko Zerva during a trip to Kurdistan in Northern Iraq.
As a state police officer, Delaney also was part of a landmark undercover investigation that infiltrated organized crime on the New Jersey waterfront from 1975-77.
Delaney, 60, will be honored today by Army Chief of Staff Ray Odierno for that work as a recipient of the Outstanding Civilian Service Award. Giants coach Tom Coughlin will be among the others also honored just outside Washington.
“Bob is our hero,” Karen Lopez wrote in an email. She and her husband, Luis — a retired Marine sniper sergeant who suffers from PTSD after a series of IED blasts in Iraq – formed a bond with Delaney.
“Bob has been Luis’ mentor and motivator,” she wrote. “Luis has been able to get out of his shell and gain his confidence again slowly.”
Delaney’s story is one of legend, the basis for two books he’s co-written: “Covert: My Years Infiltrating the Mob” and “Surviving the Shadows.”
He grew up the son of a state police captain and became an All-State basketball player at Neumann Prep in Wayne before joining the state police in 1973.
Two years later, he formed the center of the historic undercover investigation of mob operations on Jersey’s waterfront.
Delaney then began a 24-year career as an NBA referee in 1987, officiating nine Finals and two All-Star Games before retiring after last season.
But he knows what it’s like to feel alone, helpless, as if no one else understands. That’s one of the curses of PTSD, an anxiety disorder that develops in response to experiencing a traumatic event.
The west Florida resident was just 23 when he slid into the shadowy world of organized crime. He left meetings with wiseguys so rattled by nerves he would vomit. Violent night sweats soaked his sheets. Nightmares haunted his sleep.
The stress compounded after he resurfaced despite the dozens of indictments his investigation produced. He even felt guilty for betraying the mobsters’ trust.
And he struggled to escape the shadow of his assumed wiseguy persona — Bobby Covert — which largely had overtaken his real personality.
“I wasn’t acting. That’s who I was,” Delaney said. “I became Bobby Covert.”
The affable Delaney uses those war stories – adding in tales from the hardwood – to reach the troops.
The man who kept order among stars such as Michael Jordan and Kobe Bryant didn’t serve in the military. But some horrors translate.
Like knowing the odor of burning flesh.
Delaney often recounts to soldiers a horrific scene he responded to as a trooper, finding an elderly couple trapped inside their engulfed car, burning alive.
“You hear the screaming and the yelling,” he said, his voice trailing off. “The smell of burning flesh is something that’s very distinctive. You never forget it.
“I share that story because those images are seared in their brain. The IED blast. Their buddies who were blown up.”
Luis Lopez, 32, knows that suffering all too well.
The Florida resident suffers from traumatic brain injury and has endured a series of surgeries. But he credited Delaney with helping him through his recovery.
“Not being able to remember things, not being able to be who I used to be and do what I love the most, being a Marine [is the hardest part],” Lopez wrote.
Delaney — now an ambassador for the NBA Cares program — has traveled the world to reach veterans like Lopez, an extension of the PTSD work he’s been doing for decades with first responders.
He twice has trekked to Iraq and once to Afghanistan as PTSD has reached epidemic proportions in the military.
Suicides among Army, National Guard and Reserve troops hit a record high last year of 164 — a near-record 278 if non-mobilized units are included.
PTSD is thought to be a major factor, with about 20 percent of Middle East veterans diagnosed.
Delaney offers help because he needed it following his undercover stint.
Colleagues recognized something was wrong. And they talked him through it, including FBI agent Joe Pistone, the agent who posed under the alias “Donnie Brasco” — yes, that Donnie Brasco — to infiltrate the mob.
“One mistake undercover, and as they say in the movies, there’s no more takes than one,” Paterson native Pistone said. “But most cops, they don’t want to have any problems. It’s that macho thing. But Bobby faced it head on.”
There’s a continuing tension over
whether mental disorders are “organic” or “psychological”. The first is easier
to define — a brain injury caused by an insult, such as a bullet wound, blow to
the head or bomb blast. “Psychological” is usually chalked up to bad
parenting.
Two new debates raise this issue again. One is
whether “post-traumatic stress disorder” should be called “post-traumatic brain
injury”. The other is the emerging findings on “CTE” — chronic traumatic
encephalopathy — which shows long-acting brain changes after concussions.
I am reminded of the
controversy about “shell shock” in World War I. Soldiers developed symptoms of
anxiety and confusion, after being in the trenches, showered by artillery
shells. Initially in WWI doctors believed this to be an organic insult by
artillery shells. Later the belief changed and doctors concluded that it was a
psychological reaction to the daily threat of death and destruction. In the
current discussion about mild TBI, or concussion, it is worth reviewing the
discussion about shell shock being only a “psychological” reaction to
warfare.
The term “shell shock” was later re-named “not yet diagnosed, nervous”,
“battle fatigue”, “PTSD” and “combat stress reaction”. Now the term
“post-traumatic stress injury” is being considered.
Dr. Remington Nevin has proposed that some of these reactions are actually
the result of neurotoxic injuries from certain anti-malarial medications given
to soldiers over the years, most recently mefloquine, or Lariam®. He believes
that these drugs can induce a “limbic encephalopathy” — a firing-up of the emotional portion
of our brains. The powerful emotional side effects of mefloquine, which can
include intense feelings of horror, paranoia, and anxiety, have been well known
for years.
Today, the Centers for Disease Control and Prevention (CDC) even concedes that these side effects may “confound the diagnosis
and management of posttraumatic stress disorder.” An interesting hypothesis is
that some PTSD from Vietnam and earlier wars may have been precipitated by
chloroquine and similar anti-malarial drugs, which mefloquine later
replaced.
But the overall point is that the distinctions between organic and
psychological disorders are artificial. Schizophrenia used to be thought of as
due to bad parenting. Now we know that the disease has a biological basis; we
just don’t know the source of the bad biology.
Likewise, patients with PTSD, in research studies, have a smaller amygdala.
In a small but very interesting study, relatively young Soldiers showed CTE on autopsy. Thus, the already blurry distinctions
between “organic ” and “psychological” causes of brain dysfunctions may
eventually disappear completely.
Higher Ground is a nationally recognized rehabilitation program. They help out both veterans who have been wounded in Iraq or Afghanistan and their families by combining sports, family, and coping therapies.
Want to learn more about them?
Then joins us tomorrow May 22, 2012 on FOV's Life After Combat Radio "Caregiver Edition" as we talk with Higher Ground's Veteran Outreach Coordinator, Bert Gillette. Mr. Gillette will tell us all about the program and how they can help you as well as hear testimonials from others who have been through the program.
Have a question about Higher Ground that you wish to ask then please call in during the live show at (323) 657-1470.
But we may have found a new platform to address these issues –the NFL.
