Mild TBI is anything *but* mild

I’ve been reading a free book I downloaded from The National Academies Press. Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury

You can download it for free, after signing up with your email.

I found something interesting relating to discharges from the armed services.

Compared with the total discharge population, discharge due to alcohol or drug abuse was more frequent in those with moderate TBI (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.7–16.9) and those with mild TBI (OR, 2.6; 95% CI, 1.6–4.3) but not in those with severe TBI. Discharge due to behavior was no different in those with moderate or severe TBI and 1.8 times greater in those with mild TBI (95% CI, 1.4–2.2). Discharge due to criminal conviction was 2.7 times higher in those with mild TBI (95% CI, 1.9–3.9) and no different in those with moderate or severe TBI. Discharge due to medical disability was 7.5 times higher in those with mild TBI (95% CI, 6.0–9.3), 25.2 times higher in those with moderate TBI (95% CI, 16.2–39.2), and 40.4 times higher in those with severe TBI (95% CI, 30.0–54.4). The authors note, however, that because the risk of medical discharge is directly related to the severity of the injury, these individuals may be receiving medical discharges rather than other types of discharges (such as behavioral). A limitation of the study is that it did not take into account pre-existing factors, such as aggressive tendencies or preinjury alcohol abuse, which may have played a role in discharge outcome.

Seems that mild TBI was part of the picture in higher rates of discharge for alcohol/drug abuse, behavior, criminal conviction, as well as medical issues.

Initially, a traumatic brain injury may seem mild, but long-term, it’s much more than that.

 

Taking on our own issues

I’ve been reading a piece in USA Today about the care that people do/do not get after TBI. For brain injuries, a treatment gap is a pretty good read, though a bit depressing at times. It’s wonderful that Congresswoman Giffords is getting thorough care, but for the other millions of TBI survivors… that’s just a distant fantasy.

It is really easy to get depressed over this and become bitterly resentful towards the government for subjecting everyone else to insurance and healthcare uncertainties, whilst they have their own special plan that is little more than a pipe dream for the rest of the country. I, for one, cannot even conceive of having that level of care available to me. I don’t rank or rate highly enough for that. As far as the government and Blue Cross Blue Shield is concerned, if I’m in need of assistance, I’m just another liability and a drain that would take away from people with real problems.  “Blue Cross, Blue Shield doesn’t run a science fair. We run a business…” says the chief medical officer of the Blue Cross and Blue Shield Association, which makes recommendations that (BCBS) member companies typically follow. And my life is anything but a double-blind controlled laboratory test. I’m not sure if I’d call it a “science fair”, but I’m definitely on the cutting edge of self-therapy for TBI (and I’m actually winning – so there). For the purposes of formal insurance coverage and consideration by the established money-holders of who-gets-t0-live, my life is a statistically unjustifiable waste of funds.

But when I think about it, I have to say I’m not entirely sure I WANT the government — or the insurance companies or formal rehab — to rehabilitate me. The people and the (official) science and the money and the resources that these institutions have may be helpful and therapeutic for many who need their help, but I hesitate to place my total faith and confidence in them. They are, after all, institutions, and their approaches — while sophisticated and scientific and whatnot — are going to be informed from an institutional point of view. So, whatever personal attention and assistance you may hope to receive from them, is going to be tailored to a scientifically established standard, which may or may not work for you. It’s a real problem, because no two brains are alike, and no two people are alike, so you have this potentially damaging disconnect between what they are offering (and they tell you that you need or should need) and what is truly helpful to you. Plus, with their established standards of care, the folks working for them may be pretty much prohibited from exploring alternative therapies which may work wonders for TBI survivors.

Let’s get honest, people. Government isn’t going to solve our healthcare problems for us. The best that it can do is keep the greed and homicidal tendencies of fiscally driven insurance coverage decision-makers in check. Modern medicine isn’t going to improve our quality of life. It’s just going to keep us from dying from the crap that killed off our great-grandparents, and patch us up after catastrophes. The rest is up to us. If we want to live long and healthy lives, we need to act like we want to do just that — take care of ourselves, eat right, exercise, and stop doing the things that everybody knows will kill them. And we need to stop being so surprised when — after a lifetime of eating junk food, drinking to excess, subjecting our bodies to constant drama and stress, and smoking like chimneys — our bodies turn on us.

A Great Society is all very well and good, and having a government that gives a damn about whether you live or die is nice. But ultimately so much of our care (and rehab) issues come down to personal responsibility. Shared responsibility, too.

Now, I’m sure there are those reading this who protest that traumatic brain injury survivors are not in any position to take full responsibility for their lives — to at least some extent. And I would agree in principle. I myself was so impaired after I had my last fall, that it wasn’t till my life savings was almost gone and my life was in a shambles that I reached out for help. But I do think it’s important to accept your part in shaping your own life. I did, and it didn’t kill me. I would also suggest that when it comes to recovering from brain injury, it’s not just the survivor who needs to cowboy up, but the family and friends, as well.

I’ll spare you my rant about how I feel our society has become far too permissive and accommodating and personalized — to the point where nobody knows what we stand for and nobody seems to get the difference between right and wrong. The thing is, we need to re-learn what family is all about. We need to re-learn what community is all about. We need to stop being so isolated from each other, come together, and support one another in making the kinds of decisions and taking the kinds of actions that enable a person to live a productive and healthy life. We need to start sharing responsibility for each other’s health and well-being. We need to start TAKING responsibility for our own actions.

Even after TBI — especially after TBI — we need to strengthen our grasp on the concepts of cause and effect and get a clue about consequences — AND learn to choose the kinds of actions that will produce the results we want.

Which requires that we stop and think. Not just race from one distraction to the next. It requires that we overcome our impulsiveness — that’s both TBI-related and general socially encouraged — and learn to pause and examine what it is we are doing, and why, and what we hope to achieve. That deepened involvement in our own lives, the honest and courageous examination of what it is that we are doing and how it is affecting others — to my mind, it’s a sign of maturity. And we all need to grow up, at least a little (myself included).

I think there’s a real danger of falling for the false promises that the government will (or even can) help and preserve us in the face of danger. And persisting in the illusion that insurance companies are there to help you when you’re in need of assistance, is bound to disappoint, sooner or later. Insurance — and the government — exist for their own purposes: to survive. And the minute it stops being in their own best interests to allow you to live, you can expect to be cut out.

I’m not (entirely) bitter. This is just what I’ve seen – the cold, hard truth of what these institutions are all about.

And that leaves many, many of us out in the cold. Those of us who are lucky can get help. Those of us too busy (and not obsessed enough) or not living in the right place to find competent rehab help, fall by the wayside. We’re on our own. As are our friends and family members and coworkers. We end up trashing our families, destroying our finances, losing our businesses, living out of our cars (if we can even keep our cars), and eventually ending up on the street or in a nursing home somewhere. Not a pretty prospect, by any stretch. We DON’T end up like Rep. Giffords, surrounded by caring professionals who are at our beck and call. Those same professionals, if they passed us on the street, might very well avert their eyes and walk faster to avoid us, hoping to think of something more pleasant. We DO end up struggling. If we’re fortunate, our struggles pay off. If some weird trick of fate intervenes, they don’t.

I hate to say it, but that’s what it often boils down to — circumstance and fate.

Will broader government intervention help us? I’m not sure. I think it’s tempting to imagine that the VA is going to offer the same level of investment in injured soldiers that the armed forces offer to fully functional ones who are deployable, but I’m not sure that will ever happen. It’s nice to think that medicine is about healing and helping people live their lives, but it is after all a business, so good luck finding that level of care in the medical world. It’s tempting to imagine that one can find the same level of comaraderie and support in society at large, that you can find in fighting units… but in the personalized, customized, convenience-driven society we have built, it’s all about ME, and the rest of you can go pound sand, so I wouldn’t hold my breath on that one.

Ultimately, thinking about all this brings out my libertarian streak and makes me fall back on personal responsibility and personal empowerment type thinking. It also makes me pine for quality online resources where people can turn for reliable, non-commercially driven assistance to help TBI survivors rehabilitate themselves, educate family members about how best to help, and help people rally around each other in a supportive, common sense way. Any time you get money involved (and what is government, other than a way to collect and distribute money to the causes that further its existence?) and you put your hope and future in the hands of people far, far from you – geographically and ideologically – you’re gambling with your future.

That’s a gamble I’m not willing to take. I hate to say it — and many people might take offense at my point of view — but the government and formal medical establishment are about the LAST bunches of people I think should be answerable for our cognitive future. There’s just too much at stake, to lay it at the feet of any machine.

People are involved. People need to solve these issues. Not machines.

Traumatic Brain Injuries Linked to Long-Term Health Issues for Iraq Vets

Good news on the tbi news front – the Washington Post is running news of a new report on soldiers with tbi.

The 400-page printed report is forthcoming and will cost about $70 to purchase. You can read the full report online for free (tho’ you have to page through, one page at a time) at: http://www.nap.edu/catalog.php?record_id=12436#toc

While I am really, really happy that national attention is being drawn to this, what worries me is the thought that many tbi surviving vets may get dropped by the wayside and/or be underserved, because people keep repeating that old mantra about “every brain injury is different” and use that as an excuse not to fully engage in helping these wounded warriors heal.

It’s true — every brain is different, and hence every brain injury is different. But that can all too easily stop folks (especially bureaucratically bound professionals) from drawing conclusions and taking steps and reaching out to suggest new solutions to problems we tbi survivors face… just because (they insist) we’re all apparently so different from each other.

From the article at the Washington Post:

“The real bottom line significant finding is that there’s not a good human literature on the kinds of neurotrauma seen in Iraq and Afghanistan caused by blasts,” said Dr. George W. Rutherford, vice chair of the department of epidemiology and biostatistics at the University of California, San Francisco, School of Medicine. “The human literature is really about people who’ve had [brain injury] from car crashes or falling down stairs and, in the military, from shrapnel or gunshots. We’re all worried that blast neurotrauma hasn’t really made it into the human literature.”

This makes it difficult, if not impossible, to anticipate and hopefully mitigate the long-term consequences of such injuries, added Rutherford, who chaired the committee that wrote the report.

So, does this mean… because there’s not blast-related neurotrauma literature in abundance, there should be a bottleneck on looking for solutions and treatments and preventions for military personnel?

Because our Iraq/Afghanistan vets’ injuries are from a different source (and presumedly more severe or at least more severely unique) than your “standard issue” assaults, abuse, car crashes, falling down stairs, shrapnel, or gunshots, does this disqualify them from the benefits of the experiences of countless individuals who have experienced and survived tbi — albeit in a different form and from a different source?

Because there isn’t “good human literature” that’s germane to neuroblast specialization, must that prevent us from doing what we can to help these folks?

It’s a chilling thought, that people who are already disadvantaged by an injury that other people cannot see (and which may be in fact hidden from them because of cognitive issues), may continue to be under-served, because they are not your “run-of-the-mill” tbi survivors.

While blast trauma (and the ability to survive blasts) is a relatively recent phenomenon, in relation to the thousands of years people have gone to war, gotten hit on the head, fallen, been smashed and bashed around, and generally sustained brain traumas, the fact remains that head trauma and brain injury are NOT new to the overall human experience. Where human literature is missing, we DO have human experience. After all, the human race is still here.

Surely, there MUST be a way to employ what we DO know about tbi, surviving it, and recovering from it, to assist the folks who are coming back from one war, only to enter another, once they are back home and trying to find their feet again.