Fort Sill's drill sergeant of the year is lucky he is still married. His wife is a very understanding and patient woman.

In 2005, Sgt. 1st Class Curtis Ratliff returned from his second Iraq deployment a different man. He was forgetful, losing his keys, wallet and cell phone on a regular basis, and his mood swings were unpredictable. It didn't take much to set him off on an angry tirade. His symptoms got progressively worse month after month. In 2007, he was bordering on abusive, and he knew he needed help when he almost hit his wife and child.

<b>TBI Diagnosed</b>
"I was like Dr. Jekyll and Mr. Hyde," Ratliff said. "I think anybody else would have left me, but she didn't."

He visited Community Mental Health, was administered a battery of tests and was diagnosed with a mild traumatic brain injury in conjunction with post traumatic stress disorder.

"In a way I was relieved to find out I had a traumatic brain injury because I thought I was going crazy," Ratliff said. "I didn't know what was wrong with me."

A mild traumatic brain injury simply equates to a head injury bruising on the brain. It's the equivalent of a concussion. It happens when someone receives a direct blow to the head or is knocked over by the pressure wave that results from a blast. Ratliff said he can't pin down when he received the injury that led to his TBI. He served two tours in Iraq as a combat engineer and was nearby multiple explosions and at least two improvised explosive device blasts.

<b>Mindset to 'shake it off'</b>
Julie Parkinson, a registered nurse and chief of medical management at Reynolds Army Community Hospital, said that is not uncommon since the military mentality is to shake it off and drive on.

"A lot of times they have an event, an injury that happens, but they're not totally knocked out and in a coma, so they get back up," she said. "Their buddy over there is bleeding from whatever injury he has, and they just march on. They think, 'I'm okay,' so they don't identify it. Then later on, symptoms start happening, which they don't necessarily associate back to the event."

<b>Symptoms can be subtle</b>
The symptoms of mild traumatic brain disorder can be subtle, said Dr. David Dodd, a clinical psychologist and chief of psychology services at Community Mental Health. Symptoms can include a decrease in mental efficiency, a decrease in awareness and reaction time, dizziness, memory loss, poor emotional control, reduced tolerance and [JUMP]patience, and anger and irritability. Making it even harder to identify, the symptoms of mild TBI often overlap with post traumatic stress disorder and combat stress.The good news is that most mild TBIs resolve themselves in three to six months, said Dodd, but that's not always the case. Ratliff's symptoms lasted for years untreated. But though he still has trouble with his memory, he said he is nearly 100 percent better. Armed with the tools given to him at CMH, he has learned to manage his memory and the anger is gone.

He said the key to healing was admitting he had a problem and then talking about it. That means visiting Community Mental Health, but some Soldiers would rather eat dirt. They are afraid their careers will be negatively affected, said Ratliff.

<b>Stigma</b>
He said the stigma associated with visiting behavioral health still exists in the Army.

"I never even told anybody that I was going and getting help," he said. "I always told them that I had an appointment. So I tried to keep it away from my work as much as I could."

He said he was worried that getting assistance with a mental problem could adversely affect his career. After all, he was a drill sergeant who dealt with trainees on a daily basis.

To help ease the stigma associated with going to Community Mental Health, Parkinson said Fort Sill is in the process of moving diagnostic services to primary care. Education is the key, educating health care providers to spot potential TBIs.

"This is a way to try to take the stigma out of it because then the Soldier is there with a primary care provider," Parkinson said. "We don't think we have enough demand to have a separate brain injury clinic here, so to the providers, when they feel like they have a patient who has PTSD and a history of a brain injury, they'll put a referral in to the case manager."

Soldiers are also being screened at the Soldier Readiness Point when they redeploy and at the Post Deployment Health Assessment.

"We're trying to catch the folks in the early screening, since symptoms typically last from three to six months," she said.

<b>Streamlining process</b>
Reynolds is also forming a TBI team to streamline the process of treating TBI.
"Our intent is to standardize the assessment and treatment pathway for all Soldiers who we feel will meet the criteria for TBI," Parkinson said.

The team will meet monthly to discuss all TBI cases. The team includes an internist, a neurologist, a Physical Medicine and Rehabilitation specialist, a TBI case manager, the chief of the TRICARE Case Management Branch, the mobilization case manager, the chief of the SRP site, the deputy chief of the Patient Administration Division, the administrative officer from Behavioral Health, the chief of Medical Records and a psychologist from Community Mental Health. The TBI case manager will work with the different team members to put patients through the processes the team establishes.

The TBI team has already been formed and is working on identifying the processes for treating TBI.

In addition to team members already at Reynolds, the hospital will hire a neuropsychologist and a speech pathologist, who treats patients who need cognitive therapy.

<b>Early detection vital</b>
Dodd said when mild TBI is caught early, the symptoms often resolve more quickly and are less intense. The most important thing for Soldiers to remember is that untreated TBI and post traumatic stress disorder will eventually have a negative impact on careers.

"You're only hurting yourself in the long run," he said. "If you think you have a problem, get seen. It's going to hurt a lot worse if you don't attend to it."

Page last updated Mon March 23rd, 2009 at 10:35