Outlook: Iraq's Invisible Brain Injuries
Monday, April 9, 2007; 11:00 AM
Doctor and Vietnam hospital veteran Ronald Glasser was online Monday, April 9 at 11 a.m. ET to discuss the neurological damage caused by blast waves created by improvised explosive devices, a threat that could be affecting as much as a third of Iraq veterans.
A Shock Wave of Brain Injuries ( Post, April 8)
The transcript follows.
Glasser is a pediatric nephrologist and the author of "Wounded: Vietnam to Iraq," which was published last year. From 1968 to 1970, he was deployed at the U.S. Army Hospital, Camp Zama, Japan, treating U.S. soldiers wounded in Vietnam.
Monroeville, Pa.: In addition to topic to be discussed, from the perspective of a 60-year-old Vietnam vet who had his jaw shattered and teeth extracted by a land mine 40 years ago, is it possible to now be experiencing hearing loss? Thank you.
Ronald Glasser: Yes ... age plus injury can lead to late hearing loss.
Springfield, Va.: Dear editor: Thank you for the Shock Wave article. One serious error: Dr. Glasser's use of a pediatric disability term, "mental retardation," to describe adult neurological deficits post-TBI. I understand his pediatric mind-set, but you both need to get the language right. Use the term "cognitive impairment," and have Dr. Glasser talk with Dr. Jim Malec, Mayo Clinic TBI Researcher in Rochester, Minn., and a member of Brain Injury Task Force, American Congress of Rehab Medicine. On March 21, Dr. Malec and I presented a two-hour seminar, "The Walking Wounded," at the Armed Forces Institute of Pathology at WRAMC campus. The Post's blind use of the term mental retardation just branded with a hated stigma the wounded warriors with brain injury ... The Post needs to apologize to the 1,800 survivors with penetrating TBI (Bob Woodruff), and the likely 300,000 who are the "walking wounded," not yet receiving appropriate medical or rehab care.
Ronald Glasser: I didn't use the words mental retardation ... I believe that was the neurologist who was quoted ... take a look at "Wounded:Vietnam to Iraq" ... mental retardation is never used...
Ann Arbor, Mich.: I am a PhD in Psychology and Social Work who practices at a nonprofit medical center near Ann Arbor, Mich. We have an acute rehabilitation service, which historically has included a certified traumatic brain injury program (both in patient acute hospital based and outpatient). I believe we are an underserved resource in aiding our returning injured vets. What can be done to bring programs like ours into the system of treating returning warriors?
Ronald Glasser: The VA has to be willing to offer your services and then they have to be willing to pay for it ... Congress has to appropriate more money and the Pentagon and the VA have to spend it ... no one can do this on their own...
Arlington, Va.: What if any measures are being considered in Congress to address some of the issues you point out? Also, are veterans able to get care outside military facilities? It seems that a lot of the speech therapy, physical/occupational therapy, etc. would require a specialized center.
Ronald Glasser: Outsourcing by the VA is problematical at best ... but yes, you are right ... these patients need very specialized care and the VA has to provide it ... either through their clinics and hospitals or through the private sector...that means Congress must provide the money and the VA has to spend it...and veterans can get outside care through TriCare ... but many private organizations don't participate because reimbursements are so poor...
Washington: In your article, you say that the Iraq War has brought back the World War I problem of Shell Shock. I sort of assumed that Shell Shock was just an early term for Post Traumatic Stress Disorder. Could could explain the difference between the two and why Shell Shock is being seen again in Iraq?
Ronald Glasser: Originally "shell shock" was thought to be due to trauma to the brain ... even though a significant number of patients had true PTSD ... the consensus now is that concussions as well as psychological trauma can result in similar symptoms ... take a look at the Chapter in "Wounded:Vietnam to Iraq" on PTSD...
Santa Barbara, Calif.: I incurred a penetrating temple wound, RPG fragments, in RVN, 1969. After months of hospitalization, I was placed on the TDRL and finally permanently retired. The army neurologist at Brook army hospital advised me to smoke marijuana for my condition, as it would be much more "forgiving" compared to the Dilantin he was prescribing. After trying both, I took his advice and find my life a lot more livable. Have you heard of this? Would it be helpful for our new brain trauma victims?
Ronald Glasser: Yes, I have ... but the medicinal uses of marijuana has been clouded by the legal aspects of using it...
Virginia: Hello. From 1962 to 1973, what were IEDs called in Vietnam? Detonators?
Ronald Glasser: Booby-traps ... whatever they were called, they did not have the explosive power of the roadside bombs used in Iraq and Afghanistan...
Washington: What was the biggest hospital in South Vietnam for U.S. forces who were wounded? Saigon? Why did they go to Japan?
Ronald Glasser: There were large Evacuation Hospitals in Vietnam ... the wounded were sent to Japan to keep open the beds in Nam for new casualties and the fact that the States were a very long way ... the Navy and Marines went to Yokuska and the Air Force wounded to Clark in The Philippines ... and then eventually home.
Silver Spring, Md.: What is the impact of these shock waves on the local population?
Ronald Glasser: The same as our troops.
Raleigh, N.C.: Good morning. This may sound like an arcane question, but I don't think it is. Do you think the federal budget should include present and estimated future costs for Iraq war veterans suffering from long-term injuries? It likely would alter the war debate, but I don't know if the change would be, to put it in criminal trial terms, probative or prejudicial. So I'm interested in your opinion. Finally, do you fear that if the money was budgeted up front, that that could lead to neglect in the future? ("Why do we need to allocate more money for that? We funded that back in '07.")
Ronald Glasser: That study already has been done ... Kennedy School of Government ... Blime is the author ... the costs are staggering ... some $700 billion over the next 40 years for disabilities (if everyone leaves by 2008) and another $800 billion or so for medical treatment ... someone should pay whether now or later.
Fairfax, Va.: Thank you for your exceptionally informative article. Has the information you conveyed been provided to our leaders who continue to pursue the Iraq occupation, or are they unaware of the devastating consequences of putting our troops not only in harm's way but apparently anywhere near harm's way?
Ronald Glasser: I wrote my first article about casualties in Harper's in July 2005 ... "a war of disabilities" ... no one listened then ... those of us who have written about the real costs of this war feel as if we were reporters in New Orleans after Katrina ... standing in the water with bodies floating by and everyone in Washington telling us that everything is fine and on course ... it would help you to understand if you'll get "Wounded:Vietnam to Iraq" and "365 Days" ... the chapter on Medics...
Ellicott City, Md.: Is there any "exit interview" given to all soldiers who are in Iraq or Afghanistan to ensure that they do not have any underlying neurological dysfunction from serving? If not, why not?
Ronald Glasser: They fill out a form ... but if they fill it out with evidence of problems they are not sent home ... but more and more troops are filling the forms out honestly ... but a certain percentage of those with PTSD or concussions from TBIs do not become evident for months...
Albany, N.Y.: Do you believe that many of our Vietnam era veterans who are described as having PTSD may actually have sustained TBI?
Ronald Glasser: I think so ... though the diagnosis was difficult to make back then ... I have seen patients who have considerable cognitive difficultly after what appeared to be minor head trauma...
Washington: What is the most promising route for prevention of TBI? Neuro-protective agents (some good ones in the pipeline for stroke), equipment, or robotic soldiers?
Ronald Glasser: So far ... with the strength of the explosive charges ... don't be near the blast wave.
State College, Pa.: Dr. Glasser: Are there any parallels between your research on blast-effects and the work on "normally-induced" concussions (such as those often observed in high-collision contact sports)? It would seem that the symptoms of both blast effects and concussions do share some similarities (loss-of-memory, depression, etc.).
Ronald Glasser: Yes ... they do share similar characteristics ... there is a baseball player here in Minneapolis who fell backwards last year trying to catch a ball and didn't even hit his head on the ground ... but had a whiplash injury and lost most of his co-ordination.
Arlington, Va.: What do you think either the Department of Defense or Congress should be doing to address this issue?
Ronald Glasser: That is simple ... provide more money.
Ronald Glasser: Thanks for your questions ... "Wounded: Vietnam to Iraq" will give you a more in depth picture of the casualties of this war and the advances in battle field medicine that brought the numbers of casualties to fatalities to the extra-ordinary 16 to 1 ... but I do have to say this: there are none of us who have written about Vietnam ... in my case "365 Days"... whoever thought we would have to write anything similar during the rest of our lifetime? Thanks again.
Albany, N.Y.: Large funding streams attract all kinds of providers --- good and bad. Any advice on how to assure that our military personnel receive quality services?
Ronald Glasser: start working through the different veteran's groups...again, no one can do this on their own...
Fairfax Va.: Are you aware of any programs to prepare more rehab personnel for the numbers that need them?
Ronald Glasser: most of the casualties are still either within the DOD or VA system and have not yet entered the private sector...there appears to be no enthusiasm for increasing the numbers of personal to care for these patients because of the concern about having funding available...right now the VA is some 400,000 disability claims behind and some 100 of their medical facilities have no PTSD capacity..
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