Attrition: Silent Maladies

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April 25, 2009: A growing debate in the military medical community is over how much influence brain injuries are having on PTSD (post-traumatic stress disorder). Brain injuries from roadside bombs, or other explosions encountered in combat, are believed to be a cause of combat fatigue (or PTSD, post-traumatic stress disorder). Neither problem is new, but better diagnostic tools, plus political and media attention, are making brain injuries, especially mild ones, a lot more visible. This has resulted in better methods for dealing with brain injury related PTSD. But this has uncovered two particularly vexing problems. First, it's been difficult to get troops to seek treatment for subtle brain injuries, which they usually don't know they have, or PTSD. Second, research, and practical experience, has shown that the best time to deal with both problems, is as soon as it shows up. This is not a problem with troops who have problems while they are still in the combat zone. For that reason, lots of mental health personnel are stationed as close to the fighting as possible. But many of the mild brain injuries, and PTSD cases, don't show up for months or years.

Brain scans, a technique not available during earlier wars, are able to detect brain injuries that, the past, could only be guessed at ( if there were noticeable side effects.) Often, the side effects were subtle, or did not become severe until years, or decades, after the injury was incurred. Worse, treating (usually with drugs) someone for brain injuries, when there are no such injuries, is expensive (up to $30,000, or more) and exposes the patient to harmful drug side effects.

As sports medicine doctors have already discovered, the impact, and long term impact, of mild brain injuries, is not yet known. But veterans have lots of lobbyists, pressuring the government to do something about a medical condition. This is not a new problem. PTSD has long been a serious problem, especially cases that manifested themselves long after the victim had been in combat. There have been similar problems with neuromuscular problems (usually back pain) resulting from physical trauma during combat (or even very physical combat support work). The painful, and sometimes crippling, aftereffects often do not show up for decades, much like some sports injuries suffered by high school or college football players.

On the plus side, there has been an enormous number of new diagnostic and treatment techniques developed in the last twenty years, that are making these previously undetectable conditions easier to find, and treat. But we are at the stage now, where a lot of the damage is just being accurately diagnosed for the first time. Finding the most effective treatments is going to take longer. It always does.

 


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