Here is a very interesting story about brain damage being caused
to modern troops in combat. The links to electromagnetic radiation
(EMR) being a possible cause to the problem have been highlighted and
enlarged. Another thing to consider whilst reading this story is the
amount of wireless equipment being used in battlefield conditions,
including various communications and radio systems, radar and
electromagnetic weapons. Troops are being exposed to higher levels of
electro magnetic radiation than ever before. If EMR is part of the
cause of this brain damage, it should be fairly simple to add EMR
protection to the kevlar helmets.
Victims of this brain damage should be warned to avoid EMR in
their home environment, cell phones, cordless phones WiFi and wireless
devices could all be making the symptoms far worse. Several of the
symptoms are similar to those of microwave sickness, so avoidance of
microwave radiation could be very important.
Thanks to Linda Sepp for sending me this item.
Brain injuries, whether blunt force, chemical, or electric in
nature, can all have similar results... Linda
Shock to the System
Soldiers who manage to walk away from explosions in Iraq may actually
be suffering terrible—yet invisible—brain trauma. Could blast waves be
fueling a new breed of injury?
By Eric Hagerman Posted 08.22.2008
http://www.popsci.com/military-aviation-%2526-space/article/2008-08/shock-system#
August 15, 2008— The first time Army Specialist Frederick Hussey “got
blown up in Iraq,” as he says, was on Easter Sunday, April 16, 2006.
Hussey was five months into his yearlong deployment as an infantry
medic when a cluster of anti-tank explosives jolted his Humvee off the
road some 50 miles south of Baghdad. The blast filled the cabin with
acrid black smoke, but Hussey was able to jerk the wheel back and steer
the truck to safety. “Everybody ended up being OK with that one,”
Hussey says. “You know—shook up and all, but there was no loss of life.
I would say that one just rang my bell really hard.”
Hussey stands a sturdy 5-foot-10, speaks with a Southern twang, and
prides himself on being the only guy the other guys will hug—the papa
bear to his fellow cavalry scouts. He worked for 13 years as a
grocery-store manager after returning from the Gulf War, and then in
2004 he reenlisted, asking to be a medic because he wanted to help.
The second, third and fourth times Hussey was hit, he was riding in
vehicles when they were destroyed by improvised explosive devices, or
IEDs, buried in the road. During one attack, he took shrapnel to the
cheek and was briefly knocked out. Another one earned him a patch that
reads “IED bait” from his buddies. But each time he managed to walk
away.
Number five was the worst. He and six others from his platoon were
patrolling on foot near their base when an IED blew everyone off the
road. “The last thing I remember was seeing my feet in the sky,” Hussey
says. “I could hear them hollering for a medic, so I got up, but I kept
falling over. I think that’s where my headaches and my hearing damage
came from.” He was back on patrol inside of a week.
Hussey was “functioning at about 75 percent,” he says, when two weeks
later a rocket-propelled grenade delivered his final blast of the war,
exploding against a cement wall 20 yards away as he tried to hustle an
injured soldier to safety. It knocked him down but didn’t knock him
out—another close call.
Or so he thought. Within a year of his return home, Hussey was told he
had post-traumatic stress disorder (PTSD), a psychological condition
that can develop in the emotional aftermath of a life-threatening
event. He was also diagnosed with a mild traumatic brain injury, the
medical term for concussion. Only there’s nothing mild about it. His
experience left him with constant headaches, nausea, garbled hearing,
insomnia and alarming memory lapses. Concussion symptoms are supposed
to clear up in a few weeks or months, but two years later, Hussey, 39,
still has them. “At first I thought I was doing OK,” says Hussey, who
is now posted at Fort Jackson, in his hometown of Columbia, South
Carolina. “But as time went by, it got to where I couldn’t remember the
names of guys I was deployed with. I was having difficulty
concentrating. It started snowballing, and I was forgetting things and
struggling to cope. It’s hard to explain, but it’s just affected
everything I do.”
Thousands of American soldiers are coming home with similar complaints.
The big mystery is why. Plenty of them have been hit in the head like
Hussey, but even those who haven’t are turning up with unusually
protracted symptoms that resemble those of a serious brain injury. One
tantalizing clue is that among the 2,500 soldiers who returned from
yearlong tours in 2006, 62 percent reported that they had been exposed
to two or more explosions, whereas only 2 percent had suffered gunshot
wounds. The trend has researchers wondering: Is there some
unaccounted-for mechanism in the blast itself that’s causing hidden
brain injuries?
Neuroscientist Ibolja Cernak, a medical director at Johns Hopkins
University’s Applied Physics Laboratory, is one of a handful of
researchers across the country trying to find out. She believes that
blasts may do more than just rattle the head; the shock waves also
compress the torso, which may cause pressure waves to ripple through
blood vessels like miniature tsunamis, rushing into the brain and
damaging tissue. Army Colonel Geoffrey Ling, a neurologist who has
treated troops in both Afghanistan and Iraq, agrees that there’s
probably more to war-zone head trauma than the blunt forces at play in
a car accident or football collision [see “Gridiron Gear Goes to War,”
page 86].
His own theory pinpoints
electromagnetic pulses as one possible culprit. Blasts emit intense
magnetic fields that may damage brain cells, he contends. “People are
seeing a syndrome among these returning veterans,” Ling
says. “The question I have is, what’s causing it? If I know the answer
to that, potentially I can prevent it.”
With 178,000 soldiers deployed in Iraq and Afghanistan, and thousands
more gearing up for second, third and sometimes fourth tours of duty,
these questions have sparked a surge in funding. Late last year,
Congress earmarked $300 million for basic science research on brain
injuries and PTSD. The National Institutes of Neurological Disorders
and Stroke recently called together more than 100 doctors,
neuroscientists, physicists and biomechanical engineers to review the
little that is known about blast-related brain injuries. And the
Defense Advanced Research Projects Agency, or Darpa, is in the midst of
a yearlong, $9-million effort, led by Ling, to study the effects of
blasts on the brain—from chemical and structural alterations to,
ultimately, behavioral symptoms.
Meanwhile, soldiers and their doctors are waiting for answers to
rudimentary questions about diagnosis and treatment. Above all, what
everyone really wants to know is whether blast exposure—with or without
direct damage to the head—triggers long-term neurological problems that
are waiting to ambush an entire population of veterans.
A Hidden Danger
Some 97 percent of American troops wounded in Iraq come home alive. The
survival rate is higher than in any other war, and is largely thanks to
improvements in body armor, evacuation procedures and medical care. The
Kevlar vests and helmets worn by today’s combat troops, for instance,
have saved soldiers who may have otherwise died from bullets and
shrapnel. The catch is that more of those soldiers are coming home with
permanent injuries from explosions than ever before.
There are many ways to be wounded in a blast. The detonation turns the
bomb material into pressurized gases that expand instantly, radiating a
supersonic wall of air many times as powerful as hurricane-force winds.
That primary blast wave leaves a vacuum in its wake, and the pressure
differential creates shearing forces that cause organs to expand and
then collapse, crushing lungs and bursting eardrums. Shrapnel and
debris can cause further damage, and there is always the chance of
getting burned by the heat or slammed into something.
What nobody knows is what all these forces do to the brain. A blow to
the head from a blunt object can cause a concussion, certainly, but how
is it that soldiers are coming home with brain injuries without ever
having been hit in the head? A military task force acknowledged in
April that the rate of traumatic brain injury “is thought to be
significantly higher than in any previous war.” In a report called
“Invisible Wounds,” the public-policy think tank the Rand Corporation
estimated that as many as 19.5 percent of soldiers—320,000 of the 1.64
million soldiers sent to Iraq and Afghanistan—may suffer from traumatic
brain injury. It’s impossible to say how many of them have actual
damage, though, because a diagnosis would require more tests, and 57
percent of the people in this group report that they have never
undergone medical evaluations for head trauma. “We have one in five
soldiers with a probable traumatic brain injury, and we just don’t know
what that means in terms of future impairments and needs,” says Terri
Tanielian, a Rand senior research analyst who edited the report. “The
unknown really is the public-health concern.”
Part of the difficulty facing researchers and doctors is that the
military’s concusssion-screening questionnaire asks soldiers to report
events they may well have forgotten. Even in the hospital, symptoms of
mild traumatic brain injuries are easy to miss because the subtle
bruising or swelling rarely shows up on scans, and in many cases there
may be no gaping wound to call attention to the problem in the first
place. So doctors are left to work backward from symptoms: A soldier
with a traumatic brain injury might complain of headaches, sleep
disturbances, and sensitivity to light and noise, and
neuropsychological testing may reveal cognitive sluggishness. Not
surprisingly, these changes can make people irritable and transform
their overall personality, jeopardizing their relationships and jobs.
“They come home a different person,” says Hussey’s doctor, Steven
Scott, who runs the brain-injury clinic at the James A. Haley Veterans
Hospital in Tampa, Florida. “Almost everyone is willing to accept that
there’s an emotional component, but they don’t feel that’s the only
explanation. When you look at the power of these blasts, it makes so
much sense.”
Confounding the diagnosis in blast victims is the overlap with PTSD.
It’s possible that a violent explosion could cause both physical and
psychological trauma. “We do the best we can to try to sort them out,”
says neurologist Gary Abrams, who heads the rehabilitation center at
the San Francisco Veterans Administration Hospital, “but it’s very
difficult.”
As a result, soldiers with undocumented brain injuries may never get
the right medical benefits and care. The military is wrestling with how
to determine whether soldiers who seem fine after surviving an
explosion should return to combat. After all, if every IED victim were
evacuated, the loss would gut the military’s fighting capability. And
from a tactical standpoint, the military needs to know what’s causing
these injuries before it can design better gear to protect soldiers.
Aftershocks
Specialist Hussey keeps a hectic schedule these days. He and his wife
are separated, and he takes care of his two teenage sons in a small
apartment close to Fort Jackson. Aside from his duties as a single
father, his weekly roster of appointments includes 15 to 20 clinical
visits—to a neurologist, psychologist, psychiatrist, occupational
therapist, physical therapist and pain specialist, as well as PTSD and
Alcoholics Anonymous group meetings. The passenger seat in his car used
to be littered with appointment slips before the Army issued him a PDA
to keep track of it all, as it has started doing with brain-trauma
patients.
Probably because his symptoms are so broad, it took a while for Hussey
to realize that there might be something wrong beyond the PTSD and
physical wounds. It was about five months after he returned from Iraq
that he first began to notice mental lapses. He and a fellow medic were
catching up, and his buddy mentioned a story about the day they met at
a patrol base south of Baghdad in 2006. A mortar had landed inside the
compound, and instead of hitting the deck, the Iraqi soldiers with them
had fled. “It was kinda comical when it happened,” Hussey says. “It was
like throwing a wolf into a chicken coop. Those guys just took off.
They were running outside the damn patrol base!” But when his friend
told the story, Hussey didn’t laugh. He was alarmed, because at first
he couldn’t recall it ever having happened. “He kept trying to convince
me and remind me, but I just had absolutely no recollection
whatsoever,” Hussey says. They went over and over the incident until
Hussey eventually pieced together the memory.
Not until Hussey joined an AA program at a Veterans Administration
mental-health clinic a year after he returned did he discoverer that he
had a brain injury. A nurse who gave him a routine screening test for
mild traumatic brain injury—standard for patients at the
clinic—diagnosed him on the spot. A doctor at the clinic confirmed the
diagnosis, and Hussey was sent to the brain-injury center in Tampa,
where he spent two weeks undergoing a battery of tests: brain scans,
psychiatric evaluations, EEGs. That’s when he met Scott, who mapped out
a rehabilitation program for Hussey. Mostly it includes managing
symptoms such as chronic pain, headaches and insomnia, and offering
ways to organize his life.
Aside from the PDA, Hussey’s strategy for dealing with his spotty
memory is low-tech. “You just make a list and try to get into a
routine,” he says. “There’s a certain way I drink out of my coffee mug,
a certain way I turn the lid. I am routine to hell and back.” The
repetition strengthens his memory.
His lasting physical wounds include a broken nub of bone and cartilage
at the base of his sternum, a scar under his eye from shrapnel, a
cracked cervical vertebra that sporadically numbs his arms down to the
elbow, and nerve damage in his eye that his neurologist blames for the
headaches.
Hussey’s case is complicated—but far from unique—and those are the
challenges military doctors face in diagnosing battle-related brain
injuries. Perhaps even more challenging is pinpointing how the damage
happens in the first place.
The Blood-Wave Theory
Scientists have been studying blast waves since the dawn of ballistics,
but they have never really looked at what pressure waves do to the
brain. The conventional military wisdom is that although the eardrums,
lungs and bowels are vulnerable to bursting, the brain—protected as it
is by the skull and helmet—is relatively immune.
Not true, says Johns Hopkins’s Cernak, who worked as a doctor and
researcher at a military hospital in Belgrade from 1986 to 2001 during
the Yugoslav wars. When I visit her at her office, she looks formal in
her gabardine suit, but her manner is warm (her colleagues call her
“Ibi”). Trying to match her brisk stride, it’s not hard to picture her
on the battlefield collecting blood samples from soldiers, as she did
in Belgrade. That’s when she first noticed soldiers with unexplained
brain injuries.
Cernak conducted a series of intensive tests on 1,300 soldiers who had
survived an explosion with extremity wounds but no visible head trauma.
She found that half of the soldiers had internal blast injuries that
would have been missed without close inspection. But what really caught
her attention was that a surprising number of this group complained of
neuropsychiatric symptoms such as vertigo, headaches, nausea,
dizziness, nightmares, and lapses in memory and concentration.
Blood tests revealed that many had altered brain-hormone levels, and
EEG tests showed that 36 percent of the blast-injured group had
abnormal brain-wave activity, as did 12 percent of the group with only
extremity wounds. When Cernak’s team re-administered a battery of
neurological and psychological tests up to a year later, 30 percent of
the injured group still showed neurological damage, along with 4
percent of the other group. In other words, she found signs of
long-term physiological changes in the brains of soldiers who never
suffered head wounds. “The major point is that these people did not
show improvement, even after one year,” Cernak says. “The implication
is that even the slightest damage due to a blast may go together with
brain dysfunction. But what is the mechanism if the person didn’t get
hit on the head?”
Ever since her pioneering study, Cernak has been trying to prove her
theory that blast waves indirectly damage the brain, and to figure out
how. She is now the medical director of the national-security
technology department at Johns Hopkins University’s Applied Physics
Laboratory. She spends much of her time working with the engineers in
the APL’s Impact Biomechanics Test Facility, which houses a hydraulic
impact sled for testing car seats and a 60-foot-long steel pipe called
a shock tube that simulates the force of a blast wave.
From the protection of the impact lab’s control room, one of Cernak’s
colleagues punches in a computer command to fill a chamber at one end
of the shock tube with compressed air and then fire it down the tube at
760 miles per hour. Today’s target is a pink plastic torso complete
with synthetic organs and dozens of pressure and acceleration sensors
to measure the impact of the blast. But Cernak’s usual mark is a rodent.
In one of her most cited studies, Cernak compared the brains of rats
whose entire bodies were exposed to the blast with another group whose
heads and necks were protected with steel helmets. She found that even
animals whose heads were perfectly immobilized and shielded develop the
biological hallmarks of traumatic brain injury: broken-down nerve
pathways, swollen brain cells, accelerated cell death, and the buildup
of gunk you would expect to see in a brain-tissue sample of an
Alzheimer’s patient. The findings suggest that helmets alone may fail
to protect the brain from a blast. If true, then combat vests may not
only need to deflect the shrapnel from an explosion but also dampen
blast-wave frequencies.
How can a blast jump-start brain decay? Cernak theorizes that the rapid
compression of organs and tissue in the torso sends a spike of energy
rippling through the vessels, including those that loop through the
brain. She envisions tiny bursts of pressure that squeeze brain cells
and warp the connections between them in ways that are too subtle to
show up on standard MRI scans. It’s the cumulative result of stretching
nerve endings, she believes, that triggers a domino effect of chemical
and molecular changes that damage brain cells and disrupt the normal
flow of information. It takes time for these changes to snowball, and
she thinks this explains what she calls a “slow cooking” of lab
animals’ brain cells that can lead to long-term tissue degeneration. It
might also explain why some soldiers’ symptoms never seem to clear up.
School of Hard Knocks
Cernak’s lab is not alone in the search. Among the experiments in
Darpa’s program, called PREVENT (for Preventing Violent Explosive
Neurologic Trauma), researchers are exposing pigs to live munitions and
then analyzing their brain tissue for damage. During the explosions,
sensors record the full range of physical characteristics of the blast,
including peak pressure, the frequency of the blast wave, the
electromagnetic pulse (EMP) generated by the blast, the burst of light,
the volume of noise, and even the gases generated.
Geoffrey Ling, who oversees PREVENT, believes
that most scientists are focused too narrowly on the effects of blast
pressure. He’s not at all convinced that it’s the culprit—or at least
not the only one. He points out, for instance, that an electromagnetic
pulse could affect electrochemical impulses in the brain, but nobody
has studied this possibility. Ling notes that steel helmets worn in
World War II and Vietnam reflect EMPs, whereas today’s Kevlar helmets
don’t. “A 155-millimeter artillery shell sends out an EMP so strong
that it will short-circuit our radios,” he says. “If there is something
that could short-circuit an electrical pathway in the brain, that could
disrupt function, I really want to rule that out.”
Pig data is telling, but there’s no substitute for a controlled study
on humans. One of the most promising is a clinical trial involving
breachers. These are the soldiers who blast down doors to storm
buildings and, as a result, are guaranteed to get their bells rung on a
regular basis. Lee Ann Young, a mechanical engineer who works for
Albuquerque defense contractor Applied Research Associates, is studying
a group of Marines as they go through breacher school at their base in
Quantico, Virginia. Before, during and after their training, they will
undergo MRIs and neurobehavioral testing for hearing and balance.
They will be outfitted with pressure gauges to measure the strength of
each of up to 40 blasts that they will be exposed to over a two-week
period. “They’re very low-level blasts,” Young says. “I’ve been in the
room, and it doesn’t feel that much different than the thump of a
speaker at a loud rock concert. The question is whether it’s causing
some sort of cumulative neurological impairments.”
As more stories like Hussey’s come out, some experts worry about
fomenting fear of a mysterious widespread epidemic. Many make
comparisons to the controversy over Gulf War syndrome, a much-debated
affliction marked by fatigue, headache, dizziness and respiratory
disorders. But although numerous questions remain about what Cernak
calls blast-induced neurotrauma, she believes that if scientists accept
it as a possibility, there is hope that it can be diagnosed and
treated, and perhaps even prevented. “It is not a doomed message,” she
says. “It is not that you were exposed to a blast, therefore you have a
brain injury. But if you don’t do anything, the potentially reversible
changes can become irreversible.”
It’s possible that mental exercises such as the ones Hussey practices
could improve some cognitive symptoms, given the brain’s marked ability
to heal itself. But the best medicine of all, Hussey says, was simply
getting medical validation of his problems. “I wanted things to make
sense to me,” he says. “My two weeks down in Tampa answered a lot of
questions—a lot of it about my own sanity. I was wondering if it was
just me. I don’t feel hopeless anymore.”
How Blast Waves Ambush the Brain
It’s not just flying shrapnel and brute force that cause concussions on
the battlefield. Pressure waves may also play a role.
Here’s how
An explosion begins with a powerful pulse of hot compressed gas that
radiates outward, generating a wave of pressure that can travel up to
1,500 mph. The bigger the bomb, the faster and more forceful the wave.
A vacuum of air trails this initial wave, creating a violent suction
force that can shear organs.
But little is known about how blast waves damage the brain. Shock waves
rattle the head but may also compress the torso, transferring energy to
blood vessels. One theory is that the oscillating waves travel through
the bloodstream and into the brain, where they twist and kill neurons
over time.