How could going to Walmart ever feel "normal" after combat-induced stress? Dr. Shane McNamee of the VA talks about the physical and psychological effects of blast injuries.
The history of the blast-induced TBI is a long, long one. You go back to WWI and WWII, and we're all familiar with the term shell-shock and things along those lines, but since human beings have been blowing each other up, which is about 100 some-odd years now, there has been some recognition that the blast wave potentially may affect the brain. It's interesting coming up into this conflict, there still was no research done in that area whatsoever, and there were a tremendous number of questions early on regarding the primary blast waves, the actual over-pressure and under-pressure, that comes through, could that actually affect the brain. Did it have enough ability to actually produce a trauma to produce an injury to the brain to a concussion? Fortunately, over the last 10 years or more so, there's been a large number of studies out there. Animal models and also looking at human beings that have been through it. It does seem that a blast wave is capable of causing a traumatic brain injury, a concussion. Really not much more than that, though. When you start to look at the other complexities of a blast wave, it's not just a blast wave that goes through, but you may also be hit by a radiator or an air conditioner or you may be thrown 50 feet against a wall, and those can cause some more severe types of traumatic brain injury with intracranial bleeding and the other things that we're accustomed to, but the blast wave itself definitely appears able to cause a concussion. Fortunately, it looks like the recovery courses from blast-induced mild traumatic brain injury are really very similar to sports-related or civilian-based mild traumatic brain injury as well. There isn't a lot of research in this area, but it's gaining relatively quickly. It does appear that a blast TBI is very similar, as an isolated event, to an individual who suffers a sports-related concussion or motor-vehicle related concussion, whereas the majority of people get better, and there's a smaller percentage of those who don't. There's a huge difference though in terms of the context of the injury. If you're injured on a football field, which could be devastating, a concussion can be devastating, as we know, in that area, but after the concussion people aren't trying to kill you. People aren't shooting at you. You're not seeing your loved ones, your brothers, being maimed and killed in front of you. You're not then pressed out the next day to go back out and do it again and again and again. So when you look at the combat stress syndromes, I think people miss a big piece of them, and they see the combat stress syndromes as the isolated stressful event that happened and the things that happened thereafter. But realistically speaking, if you talk about a Marine who is on a 6- or 12-month deployment and who is outside the wire on a daily basis, their brains get rewired for the ability to actually be that vigilant. The ability to constantly assess the risk that's around them and to respond to that, individuals brains change to the point where driving down a busy street in Iraq up on a Humvee on top of a 50mm machine gun, after a while that feels normal. Unfortunately, when you come back it doesn't feel normal to go to Walmart anymore because you're still doing the risk assessment piece. So, whereas the blast definitely seems like it could cause a mild traumatic brain injury or concussion, the prolonged exposure to significant physical danger and harm and the ability for the human mind to actually adapt to that is amazing. Unfortunately, it looks like the human mind and the brain don't turn it off very well and then carry that forward as individuals come back. If there are people out there who are watching this, please get help. Please know that you're not the only one out there who's dealing with this. There are literally thousands of other individuals just like yourself. There is help available at your local VA. Please contact the OEF/OIF team there, and they will get you plugged in for care.
Posted on BrainLine September 27, 2012.
Shane McNamee, MD serves as chief of Physical Medicine and Rehabilitation at the Richmond VAMC and has worked extensively on the development and implementation of the Polytrauma System of Care in the Veterans Health Administration.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.