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HERALD EXCLUSIVE: 'Signature wounds' of the war

As National Guard and other troops return to the Red River Valley after combat duty in Iraq and Afghanistan, physicians and social workers are finding that many of those soldiers may suffer from traumatic brain injuries caused by exposure to expl...

As National Guard and other troops return to the Red River Valley after combat duty in Iraq and Afghanistan, physicians and social workers are finding that many of those soldiers may suffer from traumatic brain injuries caused by exposure to exploding roadside bombs that left them otherwise uninjured.

Often difficult for doctors, family members or the troops themselves to recognize, TBI has become the "signature wound" of the Iraq war, partly the consequence of improved body armor that helps soldiers survive such attacks.

"Right now, I'd say we have close to 200 initial screenings that were positive" for TBI, said Deb Kunkel, a social worker and manager of a program assessing returning troops for the Fargo Veterans Administration Medical Center.

Screening veterans

The VA hospital began screening returning veterans last April, she said. The soldiers are asked a series of questions to determine whether they had been in or near explosions, whether they had suffered physical injuries and whether they were experiencing effects that could indicate a brain injury, such as forgetfulness, irritability or problems with sleep or balance.


Some of the symptoms of brain injury are similar to those associated with post traumatic stress syndrome, Kunkel said, "so it can take some time to sort out."

Soldiers who test positive in the initial screening at Fargo now are referred to a trauma center in Minneapolis for further testing. But Kunkel said the Fargo center plans to establish its own poly-trauma team by early summer, allowing veterans identified through the initial screening to continue testing closer to home.

"We weren't sure what to expect, but we're surprised the numbers are this high," Kunkel said. She said that one 24-year-old soldier reported being involved in 10 explosions while in combat.

Some of the soldiers may have been involved in falls or other accidents, she said, but the bulk of those identified through the screening were in explosions from roadside bombs or rocket-propelled grenades.

"This is a wonderful group of soldiers, so appreciative of the information and referrals we're able to provide them," Kunkel said. "Their stories are just remarkable."

Blast injuriesAccording to the Defense Department, 60 percent of troops wounded in Iraq sustained blast injuries, such as those from improvised explosive devices, and two-thirds of those blast survivors have some level of traumatic brain injury.

The injury has been likened to shaken-baby syndrome, as an explosion's shock wave may cause a violent jostling of the brain inside the skull. Months later, soldiers may appear to be fully recovered, but their memory and problem-solving ability has deteriorated.

"I don't think you can go through a blast like that without being affected," said Staff Sgt. Nathan Modeen, East Grand Forks, a Minnesota National Guard soldier who finished an extended deployment in Iraq in late July.


Modeen did not suffer blast injuries, but he said that he knew of soldiers in his unit "who went through three, four IEDs" and who are being evaluated at military hospitals and clinics.

Social workers in Grand Forks also confirmed that they are working with potential TBI cases.

Full effects not clearThe full magnitude of the problem may not be clear for some time. According to national results of the screening test developed by the military, the number of soldiers referred for mental health care six months after their return from deployment was three times higher than when they first returned.

The number reporting relationship problems had quadrupled in that time, the Los Angeles Times reported late last year.

Just this week, a new study published in the New England Journal of Medicine reported that about 16 percent of combat troops in Iraq have suffered at least one concussion, many from roadside bomb explosions, and that could increase their risk of PTSD and other neurological problems.

Soldiers who sustained concussions were more likely than other injured troops to report problems with sleep, balance and headaches after they returned home, according to the study. They also were at higher risk for PTSD, which has such symptons as flashbacks, irritability and problems sleeping.

Psychologists studying the problem at the Walter Reed Army Institute of Research hope that earlier detection will avoid some of the long-term mental health problems faced by many Vietnam veterans.

A higher profileTraumatic brain injury gained a higher profile after journalist Bob Woodruff was nearly killed in early 2006 by a roadside bomb in Iraq. Embedded with troops, he and his camerman both suffered traumatic brain injuries.


Woodruff has spoken frequently about his injury and recovery, and with his family, he's started a fund to assist injured service members. Working with private industry and government, the fund seeks to promote public awareness, research, prevention and improved diagnosis and treatment for the injured and their families.

For more information on the Woodruff fund, log on to http://www.bobwoodrufffamilyfund.org/

The New England Journal of Medicine report is at http://tinyurl.com/yr2cbm

Reach Haga at 780-1102; (800) 477-6572, ext. 102; or chaga@gfherald.com .

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