Thousands of soldiers live with 'silent epidemic'

Pressure to return to duty
Officers also face pressure to return troops to duty, said Jordan Grafman, a neuroscientist who studies TBI at the National Institutes of Health.

“People don’t want to lose these guys from their command — they can’t replace them fast enough,” he said.

During a surprise visit to Iraq with President Bush on Labor Day, Gen. Peter Pace, chairman of the Joint Chiefs of Staff, said the military was “much smarter about this now,” and urged troops to watch for signs of TBI and post-traumatic stress.

“They are every bit as much battle injuries as is a bullet or shrapnel. It is OK, it is OK to seek help for those kinds of war wounds, and I ask you all to help your buddies understand what you see in them,” he said.

But that was long after O’Brien was hurt. His TBI was not diagnosed for months, until his hip injury landed him back at Fort Campbell in Kentucky. By then, the Army needed help treating TBI cases and was contracting with private rehabilitation centers like Schneider’s at Vanderbilt in Nashville.

Malone and O’Brien were friends helping each other cope.

“They were sent to us together,” Schneider said.

'I have trouble with now'
“I’ll need to get milk and bread and eggs. Milk and bread and eggs. Next thing you know, I drive right by Wal-Mart,” O’Brien said.

“I can vaguely tell you what we talked about at the beginning of this conversation,” Malone said.

Memory trouble is a common sign of TBI. It isn’t like Alzheimer’s disease, where people are so disconnected with reality that they forget things like how a key works or where they live. It isn’t like amnesia, where a chunk of the past is missing.

“I don’t have any problem remembering the past. I have trouble with now,” O’Brien said.

Multiple or complex tasks confound and irritate people with TBI. Therapists challenge them through exercises, like a computer game where they run a hot dog stand and must manage inventory, set prices, do banking and anticipate demand according to the weather.

Other therapy focuses on life skills like following directions while paying attention to something else.

“I counted three trash cans,” O’Brien announced proudly after a scouting mission to find landmarks using a map, tallying cans along the way.

INTERACTIVE The brain An interactive road map to the mind

“I counted five,” said therapist Jenny Owens.

Improving these skills is key to living a normal life and being able to drive.

“Most of them don’t drive. A van brings them down. They were hitting mailboxes, they’d get lost. We draw them maps and they forget when they’re supposed to be here,” Schneider said.

The Army recently gave some soldiers Palm Pilots — handheld computers to help manage their lives.

“It costs them more for us to miss two appointments than to give us one of these,” O’Brien said.

But devices and mental exercises do only so much. Troops must be able to apply information and to reason, but TBI keeps some of them from being aware of their gaps.

“They don’t realize their judgment is impaired,” said Vanderbilt neuropsychologist Elizabeth Fenimore.

Training that helped them in combat situations hurts them now.

“These guys are taught to be alert all the time,” so they sleep poorly, Schneider said.

“Their nervous system becomes acclimated to being constantly on alert — fight or flight,” Fenimore said.

Malone knows it well.

“I worry about every little thing — people breaking into my house, loud booms ... I’m jumpy,” he said.

O’Brien soon will move in with Malone and Malone’s fiancee, Megan.

“Their friendship helped them get better,” she said, “just because they’re not going through it alone.”

Hopes of returning to battle
“I’m going to Afghanistan next year,” said O’Brien, determined to stay in the Army and support his two daughters, who live with his ex-wife in Texas.

“I’m trying,” added Malone. “They’re telling me they don’t think my brain can take it. I think, ’why don’t you let me decide?”’

Doctors do not know whether either will return. But after all they’ve been through, if one does and the other does not, “it’s going to be tough,” Malone said. “It’s going to be tough for whichever one stays back.”

MORE FROM MORE HEALTH NEWS

More Health News Section Front

Scientists find key brain circuits for attention Safer, easier blood thinners in late-stage testing Ravers lose vision at laser light show Docs pull screws, nails from metal-eating man USDA to name retailers during meat recalls Popular domestic caviar raises health concerns Teen with upside-down feet takes first steps Magnetic migraine zapper shows promise Athletes popping Viagra for an extra boost Boss of body parts ring gets 18-54 years More Health News Section Front   Add More Health News headlines to your news reader: