CRS: Can’t Remember —-.
Posted by Raven on April 25th, 2007
I write about Traumatic Brain Injuries here a lot. In my work, I see this dx with almost every patient I come into contact with. The wounds from accidents and falls are usually quite obvious: Parts of the scull are gone and until surgeries are done to replace the scull flaps, these gaping holes, covered with a thin layer of skin, have been the trademark of TBI’s. There are other kinds of brain injury though. Non traumatic. Closed head. Some people have brain injuries with no known cause. As is the case with so many of our soldiers and Marines, returning from Iraq.
RALEIGH, N.C. — Marine Gunnery Sgt. Bill Rosborough recalls with excruciating clarity when a water truck smashed into the building where he was preparing an Iraqi army payroll. Explosives hidden inside the truck vaporized the wall of his office in Kasik, vaulting him into the air. Shards of glass cut him, and building parts crushed him.
Back at Camp Lejeune three years later, many of Rosborough’s visible wounds have been patched. But his brain still isn’t right.
“I was able to do a million things before. Now I walk in the grocery store and I can’t remember why I went,” said Rosborough, 36, who works in the Wounded Warrior Barracks at Camp Lejeune, where injured Marines stay before returning to duty or leaving the military.
He knows his brain isn’t “right” and this is truly a sad thing. To have memory of events of the past is good; to not be able to recall why you’re doing something, right now, is not only bad, it’s scary and very disabling. I’ve said it here before too- it’s dangerous.
Diagnosing mild brain injuries is not simple. And the best treatments aren’t yet clear.
“We’re still trying to figure out exactly what this injury is, what exactly is the problem in the brain,” said Col. Jonathan Jaffin, acting commander of the Army Medical Research and Materiel Command at Fort Detrick, Md.
Symptoms include short-term memory loss, faulty concentration, irritability, changed vision and headaches, among others. And problems vary from person to person. On top of that, brain injuries can be mistaken for other disorders such as post-traumatic stress disorder or substance abuse.
Technology can’t yet clarify matters. Mild brain injuries rarely get detected on MRIs and other imaging tools.
One thing they should consider (and I know they do) is the memory factor. Short term memory loss, on a consistent basis, is probably the leading symptom of these kinds of brain injuries. It’s easy to identify drug abuse-induced memory loss; post traumatic stress disorder is not as simple to dx but there are certain factors that are present in almost every case.
In North Carolina, mental health researchers are trying to sharpen the picture. At the W.G. Hefner Medical Center in Salisbury, doctors will take MRI scans of veterans who were and were not exposed to explosions, including those with brain injury symptoms and those without. They hope patterns of differences will emerge.
If there are patterns, this is one method to seek them out. This, along with other symptom identification, will enable doctors to better dx and treat these life altering injuries.
They are collaborating with researchers at the Massachusetts Institute of Technology. Scientists there are using laboratory studies with brain tissue and computers to better predict how the force of an explosion affects various parts of the brain, particularly delicate axons. Those brain cell endings are needed for one cell to communicate with another.
What happens simply isn’t clear, Jaffin said. It is known that explosions damage air-filled portions of the body, especially the lungs and areas inside the ear. But the precise effects on the soft tissue of the brain is unknown.
Axons are the tail like part of a neuron - which are nerve cells. Neurons are cells that send and receive electro-chemical signals to and from the brain and nervous system. When one part of these cells isn’t working right or is damaged or altered, we see problems such as Parkinson’s Disease and other neural-muscular disorders. We don’t often see memory problems though. Until now. Damaged axons are apparent in brain tissue studies of soldiers who did not survive explosions in Iraq.
Scientists used to think the number of brain cells was finite. But that’s not true. So soldiers with mild traumatic brain injuries may require therapy that doesn’t merely adapt to a deficit but tries to heal it, stimulating new brain cell growth or strengthening other connections in the brain, Jaffin said.
“We now find that new brain cells grow and new connections are always being made. The question is can we influence that and if so, how?” he said.
We’ve seen evidence of brain cell growth for years. Why else would people, who have been dx with the dreaded PVS, suddenly wake up? And people with severe open brain trauma DO recover and ARE able to carry on with simple but productive lives- yes, they do have cognitive problems and often have short tempers and attention spans. But they were in comas for months if not years. Their brain was terribly wounded. In some cases, portions of it were torn away. So little is known about the brain and the cells that make it a whole organ. We know what these cells look like; we know what damaged cells look like; we can see these cells mutate and change and, we can track physical problems that occur with these mutations. The human brain has been mapped. Certain sections appear to “house” thought, sight, sound, taste…and memory and bodily functions. Brain cells are like a chain. If a link is weakened or breached in any way, physically and/or chemically, it has profound effects on any number of human processes.
For now though, we use the time tested methods to assist those with brain injuries.
In the Wounded Warrior Barracks at Camp Lejeune, where Rosborough works, mild brain injuries are common. Marines there joke how they all suffer from CRS: Can’t Remember —-.
No one really thinks that’s funny. Many of the Marines carry palm-sized electronic calendars to help them remember appointments. But compensation tools may not be all that brain-injured people need. Rosborough knows firsthand that aids can’t solve all the trouble his memory problems cause. He carries a palm calendar to remind him of meetings and commitments.
…and similar tools to help these people manage their day to day lives. But, it doesn’t cure their injury. It doesn’t take away the very degrading and often embarrassing symptoms they must live with. Relationships and job opportunities are effected by these symptoms. The ability to be aware of personal safety is altered; problems with nutrition and weight are often seen. These people look normal and they usually have high ambitions AND they are aware of their injury limits…but they forget these limits and must be constantly reminded. What an existence. Put yourself in their shoes.
There is a push to do more research in brain injuries, and it’s very relevant with this war. But the research and studying HAS been going on for years. It’s a slow process, because of many reasons. Money, funding, is not one of them. The human brain holds it’s secrets really tight and close. It’s a battle to loosen things up and explore and learn.
April 27th, 2007 at 11:49 pm
Huh…and all those years I just thought I had that PTSD thingie and that drinking and chasing women would cure it. Of course the VA said I had to sit around with other Vets and talk all my problems away.
Nobody told us that having your brain rattled around caused problems. Guess they were too busy trying to prove there was nothing really wrong with us.
Papa Ray
West Texas
USA
April 29th, 2007 at 1:59 am
The main thing about the recovery process from brain injury of any sort, is that it cannot be “fought” or conquered through an act of will. The most terrible word in the world is “acceptance”; but the dreaded word should never be the end of the sentence. The end of the sentance must be “–for right now”. The body doesn’t have a perfect map of where all of the connections are supposed to be, it does the repairs using a “trial and error” process. All one can do is try to be calm, and try to keep the frustration and anger at bay. The resources are limited, and the same resources the body uses to move stuff around and establish new connections are used up when the person pushes things too hard and gets frustrated and angry. The idea is to strive for improvement gently–for lack of a better way of saying it–to ask the body to try to do the repairs and attempt to maintain a focus on the tiniest of positive results. When there is any positive change, the person who is attempting to recover must celebrate it. Being grateful, and happy over improvement is the only way of providing positive feedback to his body for going in the right direction. This may sound trite, but it works. Unfortunately, it can not be done by anyone but the patient himself.
I struggled with some pretty bad damage for years, and had little positive result as long as I had the rage over the damage in the first place. I was filled with frustration and rage–and stark raving sober at the time.
When I finally was able to lower my expectations “–for right now”, and accept that I had limitations “–for right now” and concentrated upon making each day worth living as I was experiencing it at the time, there was rapid change.
Some of that could be explained away by saying that many times in clinical studies there have been cases with no significant change for long periods, followed by dramatic improvements. But, after having gone through the experience, I was in an auto accident and had to learn how to remember and read for a second time in Adulthood. Taking the above approach from the beginning of the process, I was able to regain the ability to read for pleasure and utilize my intellect fairly well.
Unfortunately, short-term memory is pretty well shot. I bought improvement with Cylert for a while, but over time it lost efficacy. Other stimulants did not improve clarity and performance nearly as well, nor has Strattera had the same effect on performance. (I find that when my hand writing gets too bad, or my hands begin to shake, or my eyes lose sharp focus, that a short break–and a short walk is sufficient to restore everything if I haven’t pushed it too hard.) It was determined that I had ADD/ADHD before the brain damage, and the damage and subsequent strokes (from the auto accident) intensified it. Pace is important, there is a tendancy to become too intense; to start thinking more rapidly when getting frustrated and spin-up out of control into anger and rage. It is very difficult to maintain an awareness of pace, and as I have found, it is much easier to lose that habit of pacing oneself than to build it up. (I have been a bear lately.)
I can honestly say that there is nothing more intimate than having a brain that doesn’t work. It becomes a matter of life or death to teach the skill of looking for moments of beauty and joy in each day; to make each day something that trancends endurance into something worth living.
I needed to write this. I needed to be reminded of the things that I have to do in order to maintain a healthy attitude and pay proper attention to the pace at which I think and live–all of it was hard won, and I have back-slided quite a bit.
Eric