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VFW Ladies Auxiliary offers help TBI/PTSD & HBOT

 Traumatic Brain Injury: The new Scurge of Returning Veterans

Sharon Miller, Ladies Auxiliary Chaplain, VFW Post #12046 with Dr. Carol Henricks

... written October 2006, the numbers of wounded have changed but the general information remains the same....

 

We are fighting a war that is producing a new population of injured veterans. The term “polytrauma” is the descriptor used by the VA Hospital system to describe soldiers that have received a combination of orthopedic injuries, damage to internal organs and / or brain trauma.  An estimated 16,000 troops have been injured with up to 2/3 of that population suffering some degree of traumatic brain injury (TBI).  While the improved body armor has increased survivability from high power explosive blast injuries, the serious nature of the multiple injuries and their prolonged and complex recovery period has overwhelmed the system.  Recovery from brain injury is the most critical aspect of a soldier’s ability to recover.

 

TBI is a complex injury to the brain which may cause concussive or shear injury (which results in generalized disconnection of one area of the brain to another; like a computer with a lot of wires cut ), intracranial bleed and / or stroke.  Sometimes the manifestations of TBI are immediate and devastating; sometimes they are more subtle.  Brain injuries can be the most disabling and life changing type of injuries because they can affect a soldier’s personality, interpersonal relationships and ability to work.  Patients with TBI may have persistent psychiatric symptoms, emotional instability, cognitive deficits as well as paralysis.  These patients often develop seizure disorders, which interfere with their ability to drive and to be employed.  They often become outcasts.

 

With such a large population of these returning injured troops, it is timely to talk about supporting neurorehabilitation.  In sharp contrast to the projected need for services, Congress has just cut funding for neurorehabilitation from 14 million dollars a year to 7 million dollars a year.  This is a crisis.  Doing the math, if there are even 10,000 patients who need ongoing neurorehabilitation, dividing that into 14 million dollars equals $1,400 and then with the budget cut that becomes $700.   This also suggests that new treatment options will not be made available.  Typically within the system recovery goals are walking, talking and eating.  If patients do not improve within a 3 month period, they are often relinquished to the equivalent of a nursing care facility.  This should not be what we offer to our injured troops.  Just as injured soldiers should not be left on a battlefield, they should not be left at a care facility.  Neurorehabilitation needs to be maximized despite the cost of treatment.   Financial entities have financial goals, goals that should not be a limiting factor to the soldiers that risked the loss of their lives to protect our country.

Providing assistance and restoring better living conditions would best be applied by helping a veteran who has experienced head trauma and its effects reach their full potential in their health, their family and in society.  It is critical that these veterans receive ongoing treatment and rehabilitation in order to maximize their functional recovery. 

A revolutionary therapy that is being used world-wide for neurorehabilitation is Hyperbaric Oxygen Therapy (HBOT).  A recent International meeting was hosted by Dr. Richard Neubauer in Ft. Lauderdale.  Hundreds of physicians from all over the world who use HBOT for neurorehabilitation met to discuss their protocols and successes in treating brain injury.  In fact, there is a hyperbaric chamber in China that is able to treat 42 patients at one time!  If you google the terms Hyperbaric Oxygen together with brain injury, 220,000 matches are found.   Knowledge of the benefit of HBOT is spreading like a grassroots movement.  As patients avail themselves of the treatment and recover, they share their experiences with others.  The VFW can develop a similar network to advise veterans and their caretakers of the help that is available.  

HBOT delivers high-dose oxygen to injured areas of the brain to rejuvenate injured brain tissue.  When a patient sits in a hyperbaric chamber breathing 100 % medical oxygen (at an increased pressure, for example at 1.5 atmospheres of pressure) an increased amount of oxygen is dissolved into the plasma ( fluid )  part of blood. There is no harm associated with this treatment.  Blood is made up of fluid and cells such as red blood cells and white blood cells.  Under pressure, more oxygen dissolves into the fluid part of blood, and therefore more Oxygen can be delivered to the injured areas of brain.  With increased Oxygen, the brain can do some of it’s own repair work.  As the brain begins to recover, evidence of increased healthy brain activity can be demonstrated on a SPECT  ( single photon emission tomography ) scan.   As the brain heals, the patient is able to recover function.  Patients are treated in the chamber for one hour a day, and continue with other therapeutic modalities.  Physicians who use HBOT for neurorehabilitation throughout the United States have noticed dramatic recoveries.  However treatment is not yet standard of care and many physicians do not have any knowledge of HBOT in TBI.  The VA has considered doing studies, but that would put the projected use of therapy in the distant future and it is optimal to treat patients as close as possible to the time of their injury.  HBOT has been used to treat stroke-like symptoms and spinal cord injuries in divers with the bends for many years.  It is important to transfer our knowledge and understanding of the effectiveness of HBOT in those circumstances to our treatment of similar injuries caused by different mechanisms. 

 

HBOT is most effective when combined with other therapies. Although it is optimal if a patient is treated at the time of injury, dramatic improvements occur even when treatment occurs at a much later date.  A patient we are currently treating is continuing to heal even though she is 13 years post-injury.  An initial window of recovery is a 3 year-period.  The number of HBOT treatments necessary depends on the severity of the TBI.  40-100 treatments may suffice for most soldiers, but a soldier with more serious injury may require more treatments over a several year period. HBOT can be used as long as patients continue to experience recovery.  Other assistance to recovery, including Physical Therapy / Occupational Therapy /Speech Therapy, should be supplemented with cognitive retraining.

 

Cognitive retraining is a real – life experience.  While areas of deficit need to be addressed, it does not need to be within the setting of a rehabilitation unit.  Concussive injuries typically cause frontal lobe injury.  Frontal lobe function is important for decision-making and social graces.  A patient advocate can help a soldier with TBI to review information in detail before making a major decision.  The temporal lobes of the brain are also typically injured with TBI.  Our temporal lobes process information from the present moment into short-term memory so that it can be transferred into our long term memory.  Temporal lobes also help us to manage our orientation in space and time.  Helping someone to improve functional memory may be as easy as reading a paragraph or magazine article together and discussing it, or, alternatively watching a brief program or movie and discussing it.  Orientation can be reinforced with calendars, clocks and chalkboards providing that information throughout the home. Soldiers who have concussive injuries often experience emotional instability and difficulty with anger management.  Counseling, anger management classes and good family /community support are often necessary.

 

What can we do?  It is specifically to meet this kind of need that the VFW and Ladies Auxiliary have their purpose.  It is an appropriate time for the VFW and Ladies Auxiliary posts to step up to a new level of awareness and assistance to veterans and their families outside the hospital.  We have easily embraced giving moral support by many of the suggested means including get-well and sympathy cards, plants and funeral sprays, meals, visits, transportation and even financial assistance, as well as many other activities we put under the heading of rehabilitation.  All of these are good, but it is a new generation of soldiers who need a new generation of assistance from the VFW and Ladies Auxiliary Posts.  The legacy that we need to leave to the next generation of VFW and Ladies Auxiliary members should be an example to follow that as our young men and women continue to serve this great country we will also do our best to make sure that they are able to live the American dream that they so valiantly protected.        

 

The definition of Americanism as stated by the Commanders in Chief of the Grand Army of the Republic, United Spanish War Veterans, Veterans of Foreign Wars of the United States, the National Commanders of the American Legion and the Disabled American Veterans of the World War at a conference held in Washington, in February 1927, reads,  “Americanism is an unfailing love of country; loyalty to its institutions and ideals; eagerness to defend it against all enemies; undivided allegiance to the flag; and a desire to secure the blessings of liberty to ourselves and posterity.” I propose that we add to that definition: “And a commitment by the people to honor those who have, are and will defend America by securing the best that our country has to offer for those who give their best for it.”  Let’s Move this organization into a cutting edge organization that will be a role model for the present and future generations.

 

We need to be heroes to our Heroes.  There are HBOT facilities around the United States that can be utilized by local VFW posts in order to obtain treatment for soldiers.   The local VFW and Ladies Auxiliary at each post can be involved with taking patients to their daily treatments, as well as participating in their ongoing rehabilitation. 

 

Contact Dr. Carol Henricks with medical questions at clhmaxwell@aol.com.  Contact Chaplain Sharon Miller with requests for an instructional video / DVD at sharon@heritageink.com .  One per VFW please.

Dr Paul Harch and staff would like to thank Dr Carol Henricks, Chaplain Sharon Miller, & the VFW Ladies Auxiliary for all that they do to help us help our wounded warriors, our heroes, our US Veterans.  For more information about TBI/PTSD pilot trial, call (504)309-4949

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