Reynolds Army Community Hospital expert weights in on TBI
March 14, 2013
FORT SILL, Okla. -- March is Brain Injury Awareness Month. To help address this complex and sometimes confusing medical condition, the Cannoneer interviewed Dr. Jason Albano, clinical neuropsychologist at the Fort Sill Traumatic Brain Injury Clinic.
This is the first story in a two-part series to raise awareness concerning diagnosis and treatment of this condition.
Cannoneer: What is the purpose of Brain Injury Awareness Month?
Albano:"We are having Brain Injury Awareness Month to get the information out there that, even though you have sustained nonvisible injuries combat stress and concussions you can definitely recover from those. Both of those conditions are treatable."
Cannoneer: Why is TBI such a difficult condition to diagnose?
Albano: "People say, 'Well, you look fine. You're talking and walking. You don't seem to be hurt.' But, they are the most difficult issues to treat, because there is a stigma attached to them. Soldiers are afraid of being labeled so they keep quiet about their problems."
Cannoneer: What is the current state of treatment for TBI? Are we making progress here at Fort Sill?
Albano: "We are still doing in-depth work when it comes to treating and assessing Soldiers for their traumatic brain injuries. We're doing what we can. At the TBI clinic, we are not going to reduce services. The Soldiers aren't going to lose any access to our clinic. We are going to create spots where we haven't had them before, and that's the bottom line."
Cannoneer: How are you expanding services with limited staff?
Albano: "We are training other health care providers to do assessments, and look for signs of TBI and other behavioral health issues in returning Soldiers. I recently did four training sessions with hospital personnel regarding evaluation and assessment of concussion. That's still very much a priority; to accurately diagnose and assess Soldiers who experienced blasts or concussive injuries. The overall awareness is improving, but the issue is still getting the message to the Soldier at the right time."
Message to Soldiers
Cannoneer: Explain what you mean by getting the message to the Soldiers. What's the message?
Albano: "The message is to create an expectation of recovery, because we know that a concussion is definitely a type of injury where people can get better.
The analogy is that of a bruise. If we give a bruise a chance to heal, it will get better. The same is basically true with a concussion; it will get better with time and rest. But, concussions are also different from a bruise, in that they happen in a military setting and are usually attached to a life-threatening event. And, here is the complex part of the assessment for head injury: Individuals who had a concussion due to a blast also had their life threatened, which leads to many adjustment issues.
"The symptoms for combat-related stress and concussions are very similar. Those show up in many of our clinics and care facilities. Sleep disturbances are epidemic around here, but it is also part of the military culture. They are Soldiers 24-hours a day. So they are in a state of hyper vigilance, and this colors everything in their lives, such as marital issues. Sleep is a critical piece of the behavioral health puzzle."
Cannoneer: Can you give an analogy of how lack of sleep causes these problems?
Albano: "Sure. If I'm running on empty constantly, my engine will not work right - the engine being the brain. If I don't give it a chance to rest, things will start to break. One of those things is mood. A lot of people have a very strong, negative reaction to lack of sleep. That causes them to have memory problems. 'My memory is broke, doc,' is what I typically hear from Soldiers. They want to associate memory loss back to a concussion event.
"We do testing to assess for that, but often it can also be related to the two hours of sleep they have gotten in the past six months. So we work to get their sleep back together, and get a plan to help them get back to a recovered state, not a sick state. But, my fear is we let some of them get through, not slip through, the process and don't identify them appropriately."
Through the gap
Cannoneer: How do Soldiers slide by the process of being evaluated?
Albano: "I often hear Soldiers say, 'You're not taking me out of the fight.' They don't want to let go of being in combat. Many Soldiers will deny symptoms while they're deployed, but what happens to them post-deployment when things slow down? Suddenly the adrenalin is not flowing as much as it was when they were deployed, and all of the symptoms of concussion and PTSD come back, but at a much higher intensity. I talk to these Soldiers when they come back and I ask them 'What's the one thing you would like to do today?' Their response is, very often, 'If I could go back to the fight, I would feel normal again. I would feel good if I could be back over there.'"
Cannoneer: What can be done on the medical provider level to help take the pressure off of these Soldiers when they return home?
Albano: "I think the best thing that we can do as treatment providers is to really work with them, not push them out to medical appointments too much, because that emphasizes to them 'I'm broke' and I think there is a point in time where some Soldiers just want to throw their hands up and say 'Well, if I'm broke, then nothing is right. So I'll just be real broke.' What we need to do is encourage them to see that there is an expectation of recovery.'"
In the second part of this series for brain injury awareness month, Albano identifies more specific symptoms of TBI and what Soldiers, family members, friends and other medical providers can do to help military personnel deal with the effects of concussion.
You can also find valuable information on how families and friends can help Soldiers who are dealing with this condition by going to the Defense and Veterans Brain Injury Center at www.dvbic.org. There are useful resources for health care providers, primary care givers and especially family members to help Soldiers deal with their issues.