Brain Injury, PTSD All Too Common

By Olivier Uyttebrouck | Albuquerque Journal Staff Writer | Tuesday, November 13th, 2012

ALBUQUERQUE, N.M. — The explosive blast that forever changed Vanessa Molina’s life struck on a desolate road in Iraq in 2006 as she drove a gun truck guarding a supply convoy.

Molina, 30, described the roadside bomb blast as a “big, bright orange light that just lasted forever.”

The force knocked her 2 1/2-ton truck off the road, tore away the driver’s-side door and cracked Molina’s protective eyewear.

The blast “was horrible,” she recalled. “That’s what scares me, the force of that device – that much power.”

A U.S. Army Reserve staff sergeant with the 281st Transportation Company based in Las Cruces, Molina struggles with depression and memory problems that she now recognizes as symptoms of traumatic brain injury and post-traumatic stress disorder.

Molina is one of 2,461 veterans of the Iraq and Afghanistan wars treated for PTSD at the New Mexico VA Health Care System between Oct. 1, 2001, and June 30, 2012, according to a report issued last month by the Department of Veterans Affairs.

The report found that nearly 30 percent of the 834,463 veterans of the Iraq and Afghanistan wars treated at VA hospitals and clinics nationwide have been diagnosed with PTSD.

Immediately after the bomb attack, a commander asked Molina and two other occupants of her gun truck if they needed time to recover.

All three refused. Molina’s passenger suffered a shrapnel wound to her neck, but none suffered life-threatening injuries. Molina doesn’t know if she lost consciousness during the attack, but she said the explosion left her with a traumatic brain injury.

TBI is caused by a blow or jolt to the head that causes the brain to strike the inside of the skull and can change the way the brain functions normally, according to the Centers for Disease Control and Prevention.

After hasty repairs to their truck, Molina and her passengers were back on the road the next day.

“We didn’t have any time down,” she said. “They asked us if we wanted to have some time off. I think we all agreed we were OK, and we just pushed on. We just finished our tour as if nothing ever happened.”

Clinicians at the New Mexico VA Health Care System who specialize in the treatment of PTSD and traumatic brain injury, or TBI, say Molina’s experience is typical of thousands of veterans of the Iraq and Afghanistan wars.

Virtually all soldiers who experience a combat-related TBI also experience symptoms of PTSD, they say.

More than three decades after PTSD was first diagnosed, the VA has developed effective treatments for the illness.

“The good news is, we have these really, really powerful therapies that are very effective,” said Diane Castillo, the coordinator of the women’s trauma clinic at New Mexico VA.

Combat Stress

Roadside bomb attacks, similar to the one that struck Molina’s truck, are the most common source of TBI among veterans of the Iraq and Afghanistan wars, said Joseph Sadek, a VA neuropsychologist. Other veterans suffered brain injuries as a result of grenade and mortar attacks, he said.

Many suffer brain injury from the shock wave of an explosion.

“There’s no way to stop that shock wave unless you are behind a big barrier,” Sadek said. An armored vehicle may slow down but does not stop the shock wave, he said.

Veterans typically are referred to Sadek after complaining of memory problems, he said.

“For most of our veterans, it’s actually a mild brain injury,” he said.

“They will often feel the shock wave,” Sadek said. “They might get knocked out, but it’s very brief, and almost all of them are able to stand up and carry out their duties.”

For civilians, a mild brain injury typically heals with a full return of memory and thinking within a year, he said. But combat injuries are combined with the horror of combat experience and typically lead to symptoms of PTSD.

Among veterans who experienced a TBI, “almost 100 percent have an overlap with PTSD,” Sadek said. “It is the combat stress that causes post-traumatic stress disorder.”

Higher Suicide Risk

For Molina, symptoms of PTSD became impossible to ignore in 2009 when she resumed her job as a city bus driver for 10 months.

“That’s when I started noticing I was forgetting my routes,” the Albuquerque High School graduate said. “I was feeling nervous driving with a crowded bus. On city buses, you have to pull up to the curb to pick up passengers, and that was very hard to adjust to,” she said. “All these little things started triggering, and I knew something wasn’t right.”

Then she suffered a back injury carrying ammunition cases on her third tour of duty in Iraq in 2010-11.

Molina failed a physical exam after her return in August 2011 and lost her job as a bus driver in April.

“That just turned my world upside down,” she said. At 30, Molina was unemployed and increasingly depressed. Thoughts of suicide led her to call a crisis line in May.

“I didn’t come back the person I was before – physically, mentally,” she said. “I felt like a failure. Just worthless. Everything just started crumbling.”

People with TBI are 50 percent more likely than healthy individuals to die from suicide, according to a study released last year by the Center for New American Security.

Suicide is also more likely with PTSD, chronic pain, depression, sleep deprivation and other factors “widely associated with deployment experience in Afghanistan and Iraq,” the study reported.

The VA estimates that 18 veterans kill themselves each day, “but this number is extrapolated from extremely limited data,” it said. “Americans must have a more complete accounting of veteran suicide.”

Combat soldiers learn to bottle up the intense emotions they experience after surviving or witnessing terrible things, Castillo said.

“They never have had a chance to process the emotions they experienced with this horrific life-threatening event,” she said.

“They have to shut down their emotions in order to survive. And then they went into the next trauma, and the next one.”

Polytrauma Therapy

Molina credits therapy she receives at the VA’s polytrauma system with helping turn her life in a better direction.

She is one of 530 New Mexicans enrolled in the VA’s polytrauma program, intended for veterans like her who suffered multiple injuries from bomb blasts while serving in Iraq and Afghanistan.

In Molina’s case, the combination of PTSD and TBI makes her eligible for the VA’s polytrauma care. She now receives one-on-one therapy each week with a VA counselor and is enrolled in computer classes this fall at Central New Mexico Community College.

She recommends treatment to fellow veterans she served with in Iraq.

“A lot of these veterans are not coming out and getting the help they need,” she said.

“It’s their pride,” she said. “They think they’re OK, but they’re not the same people I knew before.”

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