'Silent epidemic': 10 percent of soldiers suffer disabling damage.
By Moni Basu
In the freezer at his parents' home in Catuala, Spc. Nicholas Boutin keeps a piece of his skull wrapped in a clear, plastic bag.
As macabre as this might appear, it is Boutin's effort to hold on to what he lost. Only 22, he already takes stock of his life with a sadness for what could have been. Once a National Honor Society student, he was his squad's designated marksman, a young man who dreamed of finishing college and starting a family.
A few seconds on a hot August day in Sammara, Iraq, set him on a drastically different course. An insurgent dropped a grenade into his Bradley Fighting Vehicle, showering the left side of his face and head with shrapnel. Boutin saw a white, blinding flash. Then his world went dark.
Sophisticated new armor and a Kevlar helmet saved his life. But he had suffered brain trauma, so common among soldiers in Iraq that it is often referred to as the "signature injury" of the war.
Makeshift bombs known as improvised explosive devices are the leading cause of death and injury among U.S. soldiers fighting in Iraq. The intense pressure in a blast zone can rattle the brain, as delicate and mushy as Jell-O, and result in concussions that range from severe to so mild that they are frequently undiagnosed in initial examinations.
In previous wars, 14 to 20 percent of wounded soldiers suffered traumatic brain injury, according to the Defense and Veterans Brain Injury Center. The center, funded by the Department of Defense, estimates the numbers are much higher in Iraq. In a study conducted at Walter Reed Army Medical Center, which serves more critically injured soldiers than most VA hospitals, doctors found that 62 percent of patients had sustained a brain injury.
Veterans for America, a Washington-based nonpartisan advocacy group, estimates 10 percent of all soldiers who have served in Iraq have suffered from some form of brain injury. It says the nation is unprepared to take care of a whole new generation of soldiers coming home with an anguish that cannot be readily seen.
"Brain injury is unlike other injury in that it is lifelong," said Dr. George Zitnay, who helped found the brain injury center. "You don't just put a Band-Aid on it or give a person a pill and send them home."
Survival 'a double-edged sword'
Boutin was comatose when his parents saw him -- his body swelled to sumo wrestler size and attached by snakelike tubing to life-saving machinery. In his head was an intracranial pressure monitor that reminded his mother of a turkey baster.
Doctors at the National Naval Medical Center in Bethesda, Md., told Robin and Peter Boutin, an Army sergeant major who was also serving with the 3rd Infantry Division in Iraq, that of all of their son's horrific injuries, the one they could not see would be life-changing.
The right side of Boutin's body was paralyzed. He could not speak, smell or taste. He could not remember the names of people close to him.
Brain-injured men and women can experience cognitive and emotional problems that keep them from fully participating in society. They can have a hard time concentrating and holding jobs and maintaining relationships.
Many have memory loss, impaired judgment, slowed ability to process information and communication difficulties. In some cases, post-combat stress symptoms, such as anxiety and depression, can be compounded by the physical damage inside their heads.
The physical ordeal includes constant pain, seizures, double vision and headaches.
In Vietnam, these soldiers might have died on the battlefield, but improved combat technology and medical care are now saving more lives in the war zone.
"We are doing a better job with the survival of patients," said Lt. Col. Rocco Armonda, one of Boutin's neurosurgeons at Bethesda and himself an Iraq veteran. "But that's a double-edged sword. It also means we are seeing a lot more patients who are severely injured."
The upper left side of Boutin's head is deformed. His left eye is missing, his nose is badly scarred.
He suffered hemorrhaging and swelling of the brain, which is why part of his skull was removed -- to relieve the pressure. But even when he was declared out of danger and began recovering physically, his mother sensed that something else was very wrong.
Her son could not remember names. Not even the name of his best friend Brian, who had been by his side in Iraq.
One day she wrote the word "Nick" on an index card. He wrote "Boutin" and handed the card back.
"We were so happy to see that he had some cognitive ability," she recalled.
Others with brain injuries have not had their faces disfigured or lost limbs.
"There is so much sympathy for amputees with artificial limbs, but why not for soldiers with brain trauma?" asked Robin Boutin. "Is it because they can't see the brain?"
When he covers his scars, a lot of people can't tell the extent of Nicholas Boutin's disabilities. When he talks haltingly, he said, "they just think I'm stupid."
Hoping for a miracle
There is no cure for a brain injury -- only treatment.
That fact never escapes Sgt. Brian Hall, a combat medic whose Humvee rolled over a bomb on a rural road south of Baghdad.
"There's a possibility that a miracle could happen and I could get better and they could put me back on duty," Hall said. "But last I heard, you don't grow brain cells back."
After his release from Walter Reed hospital, Hall, 31, a Georgia Guard soldier with the 48th Infantry Brigade, checked into the brain injury clinic at the Atlanta Veterans Affairs Medical Center on Clairmont Road.
In the doctor's office, there were only two giveaways to his injuries: a slick new palm-held device firmly planted in his right hand and the jarring horseshoe scar on his head.
In his blue jeans, black Army T-shirt and boots with shiny brass Cavalry spurs, Hall sat on the examination table and checked his notes on the electronic gadget that has become an extension of himself. He uses it to remember when to pick up his 2-year-old daughter Madeline from day care. Or to recall what problems he should discuss with the doctor.
"It's completely random what I remember and what I don't," Hall told Dr. Krishnakutty Sathian.
He described sleeplessness and migraines. He told Sathian how he tried to resume work as a plumber but realized that he couldn't do it the day he went to his truck to get a tool and couldn't remember which one he needed. He said he used to run 15 miles a day but it hurts now to go up and down the stairs.
He would like to stop taking painkillers and anti-depressants but knows the pills will probably be unending. "I will deal with this for the rest of my life," he said after the exam.
President Bush visited Hall at Walter Reed to pin on him a Purple Heart. Now, Hall is back in Douglasville, struggling to be a husband, a father and the man who marched off to war 18 months ago. The Army has declared him 30 percent disabled.
"That's kind of funny because, as far as the Army is concerned, I am 70 percent all right," Hall said. "But I have a hard time doing just about anything.
"If I had lost a leg, it would be cut and dried," he said. "Nobody takes into account the things you cannot see."
New chapter in war medicine
In the early months of the war, brain injuries were mistaken for psychological conditions such as post-traumatic stress disorder because many of the symptoms can be the same: depression, anger, sleeplessness, memory loss.
A study published in August by Dr. Deborah Warden of the Defense and Veterans Brain Injury Center suggested that mild and moderate closed brain injuries, in which there are no physical wounds, are the most commonly undetected injuries. In Iraq, no protocol exists for screening soldiers in blast zones.
During a demobilization process at Fort Stewart in May, Hall's unit and others in the 48th Brigade were screened for combat stress but not brain injuries, even though many, especially frontline soldiers, had been exposed to blast zones in Iraq.
"Just because you are not physically injured does not mean you do not have brain damage," said Steve Robinson, legislative director for Veterans for America.
Veterans groups nudged Congress to pass legislation this fall that makes screening mandatory. But the Pentagon has not yet implemented a plan.
At issue still is federal funding for the brain injury center, which runs 10 treatment facilities across the United States, including four at military hospitals such as Walter Reed. A version of the House bill halves the center's budget from $14 million last year to $7 million, even though the center lobbied for $19 million.
Emory University neurotraumatology professor Stuart Hoffman called the funding debate absurd.
"I couldn't even guess why this is an issue," said Hoffman, who recently accepted a job as director of research for the brain injury center.
"These are young people," he said of returning soldiers. "If they cannot function, think about it: The costs to society are immense."
Each year, 1.5 million to 2 million Americans suffer brain injuries. A survivor of moderate to severe brain injury faces five to 10 years of intensive rehabilitative services at an estimated cost of $4 million, including loss of income, according to Dr. Inge Thomas, who launched the traumatic brain injury clinic at the Atlanta VA hospital.
"We are doing our very best to be prepared," said Thomas about the disability that doctors often refer to as the "silent epidemic."
With the ongoing wars in Iraq and Afghanistan, hospitals are likely to see increasing numbers of brain-injured soldiers.
Struggling through child's book
After a year of treatment and therapy -- and a lot of determination -- Nicholas Boutin can walk and even drive a car. When he leaves the house, he puts on an eye patch -- the SpongeBob patch that his mother gave him is his favorite -- to cover the empty left socket.
Recently, at a speech and pathology center in Columbus, the children in the waiting room stared at Boutin. He kept his composure, but sometimes the attention makes him angry and frustrated. He once popped his fake eyeball out and let it roll across a restaurant floor in front of a kid who was making fun of him.
When Boutin started sessions with Dr. Susie Ford last November, he could not say simple words like "brush." He had forgotten his multiplication tables.
A gifted writer in high school, Boutin now wrestles to construct a simple sentence from a series of jumbled words.
Ford said Boutin's reading abilities are nearing eighth-grade level. He is struggling to get through a Harry Potter book.
"I can write now," he said. "But Mom has to take a look at it."
He stutters on certain words and cannot properly pronounce others, but for a man who could not say anything a year ago, the improvements are miracles.
Deep down, though, Boutin knows that life will forever be a series of adjustments.
He would like one day to work as a mortician or perhaps a veterinarian. Those professions, he thinks, would not require him to interact much with people.
For the time being, he wakes up every morning and checks in by phone with supervisors at Fort Benning.
"Hey," he tells them. "I'm still alive."
-------------------- We all need someone to lean on! Posts: 418 | From: Nashville, Tennessee | Registered: Jul 2006
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