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Health and Fitness

Headstrong

Living with Traumatic Brain Injury

The last Sailor of the day holds an anti-tank rocket (AT4) launcher on his shoulder, pointing the business-end down range, ready for the order to loose its might with the push of a button.

Senior Chief Special Operator Edward Rasmussen, now retired, inspects the Sailor's firing position, ensuring that he has followed all safety measures to the letter. Once satisfied, Rasmussen gives the signal, and another eruption sends violent waves through his body.

Each student does this no more than twice a day. The explosions can compress the brain of anyone close to the rocket when it's fired and more exposure is considered unsafe. Rasmussen, the instructor, has 16 Sailors on his range today. Each one goes through this evolution twice.

At times, he feels dizzy after spending a hot afternoon on the range. He tells himself he should probably just drink more water. "We're practicing for war," he thinks. This is no time to complain just because you've gotten your bell rung.

Rasmussen would later learn that those hot summer days on the range, along with many other seemingly minor head injuries over his 26-year career, have left him with bruises that can't be seen. And that "getting your bell rung" actually means a concussion, a mild form of a brain injury.

In 2013, Rasmussen would learn he had suffered from a traumatic brain injury.

It Can Happen to Anyone

"Traumatic brain injury, also known as TBI, is the result of any blow or jolt to the head that disrupts normal brain function," said Dr. Scott Livingston, director of education for the Defense and Veterans Brain Injury Center, in Silver Spring, Maryland. "The most common symptoms are headache, dizziness and confusion. There may be some memory loss, difficulty concentrating, difficulty remembering people or places and irritability."

Not all TBIs are equal. Livingston said they are classified on a spectrum, from mild (also known as concussion injuries), to severe. Most TBIs in the military are classified mild, and these can usually be treated with rest and over-the-counter medication. However, suffering multiple mild brain injuries in short succession (less than a 12 month period), without proper diagnosis or treatment, can lead to long-term effects.

"Based on data from the Armed Forces Health Surveillance Center, a relative minority, less than 20 percent of the individuals, who have a mild TBI will experience ongoing symptoms," said Livingston. Most people with a concussion will recovery from their symptoms in 7 to 10 days. "For the smaller percentage of individuals who will have symptoms that last weeks or possibly months, other treatment options, such as psychotherapy, cognitive behavioral therapy and other medications, may be beneficial."

Rasmussen, like many service members, experienced a large number of minor TBIs over his career that went undiagnosed.

"I honestly thought that I had to be in a vehicle explosion, or a roadside bomb would have to go off," said Rasmussen. "That never happened to me, so I never thought I had a TBI."

As time went on, Rasmussen began to experience regularly occurring headaches, fatigue, memory loss, sleep issues and erratic emotions.

"I thought I was getting too old, and I was in my early 40s. I thought it was just age kicking in," he said. "My days weren't as full as they used to be. I had to start taking more time off [for medical visits]. That was taking away from me being an active member of the military."


Taking the Next Step

His wife noticed the change over time as well, and, increasingly concerned, she pushed him to seek treatment.

"The lack of sleep was frustrating: He had terrible migraines, terrible dreams," Mary Beth Rasmussen said in a video highlighting their story from A Head for the Future, a TBI awareness initiative from DVBIC. "I just started to talk to him more and more about it. After his last deployment, we had a long conversation, and when he started losing his memory, and it was getting really bad, I said 'What's happening here?'"

This experience is common. In a line of work that values self-sacrifice, the intervention of loved ones can be what finally convinces many Sailors to ask for help.

"It's often the spouse who will pick up on some of the personality and behavior changes, such as forgetfulness and problems with memory," said Livingston. "In a lot of cases, it's the spouse who encourages the service member to go get treatment."

For Rasmussen, seeking treatment for his TBI allowed him to live a productive life. He works from home, enjoys time with his wife and kids, and dedicates some of his free time to an organization benefiting the children of his fallen special warfare shipmates.
He says managing the injury is similar to dealing with seasonal allergies. For example, the TBI gives him motion sickness when he flies or goes out on his boat. Not to worry, as long as he remembers to carry motion sickness medication.

"I think I'm as good, if not better than I used to be before I knew about my TBI," said Rasmussen. "I don't get emotional like I used to and I don't forget things as much. If I do, it's written down somewhere."

One of Rasmussen's missions in retirement is to work with a group of Sailors to raise awareness of TBI. He wants his replacements to understand the risks they face and how to treat injuries before lasting damage is done.

"The most dangerous thing about having a TBI and not knowing is what it could lead to," said Rasmussen. "It could lead to suicide. It could lead to depression. It could lead to destroying your family. It could lead down a very, very dark road."

TBI and PTSD

Medical professionals often have a difficult time determining if patients are suffering from TBI, post-traumatic stress disorder (PTSD) or both, said Livingston. Many of the symptoms are similar, and both conditions are caused by trauma.

"There are overlapping symptoms, common to both TBI and PTSD," Livingston added, "Such as fatigue, sleep problems, trouble with attention and memory, feeling anxious, depressed or irritable."

He also noted, "There are unique symptoms to PTSD (such as flashbacks and nightmares) that are not seen in patients with TBI, and unique symptoms of TBI (including headaches, sensitivity to light or noise) that one would not see in a someone with PTSD."

In 2008, a Massachusetts Medical Society study surveyed 2,525 Soldiers returning from year-long deployments to Iraq. Researchers found 44 percent of those who suffered from mild TBIs also screened positive for PTSD.

Service members are more likely to experience both TBI and PTSD symptoms than other groups at high risk for TBI, such as football players.

This increased risk hit close to home for Rasmussen.
"My best friend committed suicide. He was dealing with TBI-related issues for a long time and we didn't really notice," said Rasmussen. "He didn't tell us until it was too late. He's not the first military person to take their life from a TBI or PTSD."

Military Health System providers recommend Sailors talk to a doctor if they experience persistent issues associated with TBI, PTSD or depression, however many won't seek the medical attention they need because they think such injuries are part of the job or are fearful that reporting symptoms will have a negative effect on their military career.

"Being in the community I was in, Navy special warfare, there was an understanding that, at some point we all get broken," said Rasmussen. "It's definitely worth it to get help. It's definitely worth it to seek treatment, and you're not weak for seeking treatment at all."

For Rasmussen, life after being diagnosed with TBI has been full. After he realized how his TBI was affecting his family, the choice was easy. Now, he wants everyone, from the freshest E-1 to the most seasoned admiral, to know that TBIs can happen to anyone. With the right treatment, they can often be easily treated.

"Don't be afraid to seek help," he said. "Don't be afraid to go to your senior leadership. Just talk to somebody. Don't let it go until it's out of hand. Don't wait till it's too late."