Traumatic Brain Injury in Veterans

Jake

Age at interview: 26
Outline: While still in service in the Marine Corps Jake began to notice symptoms like difficulty concentrating and easily feeling fatigued but assumed it was due to the nature of his work. During his time in service he suffered four concussions including exposure to a blast wave from an IED. Once he returned from deployments in Iraq and Afghanistan he began to notice issues with his focus and concentration that just seemed to worsen over time. It was then he that he sought medical help and was given a diagnosis of mild TBI. To cope with his symptoms, including pain and fatigue, Jake receives acupuncture and orthopedic massage. He also carries a notebook with him at all times to write down things he needs to remember.
Background: Military branch: Marine Corps 

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Jake suffered four concussions during his service in the Marine Corp, including in 2008, after being exposed to a blast wave when an IED blew up the command vehicle of his convoy 20 meters from where he stood, and in 2009, when he was thrown from military vehicle while mounting a machine gun on top. Both incidents knocked him out cold and left him dizzy, disoriented, and in pain, but he was back out on missions with little attention paid than being given some pain reliever and being told to “not make a big deal of it.” When he would find himself in pain or unable to sleep following these incidents he would just “pop some Motrin and try to sleep it off.”

Although he began to notice symptoms like difficulty concentrating and feeling fatigued very easily, he chalked it up to the hard work and long hours that were common to his missions. It never occurred to him that his issues might be stemming from the blast exposure and concussions he had sustained. He recalls that in 2008 TBI was not a common diagnosis and was not something that was talked about routinely screened for. “You just pushed on and if you were tired, too bad, everybody’s tired. If you’re not getting sleep, well tough, tough it out, figure it out.” It wasn’t until he returned from his tours in Iraq and Afghanistan that Jake began to suspect something wasn’t quite right with his body and brain. His symptoms worsened over time and was eventually evaluated at a TBI clinic, where he was given a diagnosis of mild TBI.

For Jake the hardest challenge is finding a direction while coping with his difficulties with concentration and focus, something he had no issue with before his injury. “I have always been just laser focused…I take on anything and just blaze through.” But now, he says, “the tough part is the laser focus is not there. That direction is not there.”

Although frustrated at times Jake says he understands that learning to cope with his symptoms will be a process. He carries a notebook with him at all times and reads over his notes and reminders multiple times to retain the information. He still deals with pain from his injuries and copes by using chronic pain injury management, acupuncture and orthopedic massage services. He also tries to keep his stress as low as possible by eating “extremely clean” and refraining from the use of alcohol, tobacco, and drugs. To those newly diagnosed with concussion or brain injury he advises “don’t get frustrated and don’t get caught looking back.”

 

Jake sustained his first TBI during an IED explosion in Iraq.

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Jake sustained his first TBI during an IED explosion in Iraq.

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OK, yeah. My first TBI was from an IED explosion in Iraq in 2008. When the IED went off in front of me, it blew up in front of me, about 20 meters, and I felt the concussion of the blast. It didn’t knock me out or anything, but I was really, you know, dazed, obviously concussed but you know adrenaline kind of took over. I didn’t think anything of it at the time, but my ears were ringing real bad. I was just, you know dizzy, disoriented, just kind of the memory, the best memory I can, the best word I can put to the memory, but again, adrenaline took over. I had a pretty significant role to play at the time, the command vehicle had been hit and I was pretty much the next person in charge to, to take over at that point and so I had, like I said, a pretty big job to be done at that point and it wasn’t until, later on that I started kind of feeling it, you know I was hurting. My head hurt. I didn’t, I can’t really think much of it beyond mentioning it, you know. No, no kidding, from what just happened, but there were guys that really got, you know, hurt from it and so you just kind of push on. You just kind of, well you know you pop some Motrin and you try and sleep it off.

 

Jake recalls that in 2010 much more attention was paid to more obvious physical injuries.

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Jake recalls that in 2010 much more attention was paid to more obvious physical injuries.

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But even though it’s 2010, and now people are starting to give a shit about, you know, traumatic brain injury, more publicly. And the commands are like being held responsible. I was not with my parent command. I was not actually with a command at all because I was at the at the training, you know, at the school house, and that was my last jump, so all they want to do was “here’s your certificate, here’s your wings, go back to your command.” So, I got back to the command. I told them “hey, this is what happened.” They’re like “OK, we’ll get you some crutches, we’ll get you a, you know, cast, we’ll get you whatever you need, you know, get you surgery and everything.” They didn’t really give a shit about the brain. Invisible injury.

The TBI side, alongside the PTSD, this is what I’ve come to learn is, if you’re dealing with anything else, alongside it, it’s pushed aside. If it’s the only thing you’re dealing with, then people will maybe give you the time of day. But if I have a physical injury and I have, you know, and I and I have a PTSD question and I have a TBI question, I’m only going to get attention for, you know, my shoulder or something like that. It’s, I mean, I’m not saying that that’s always the case, but more than likely, at least for one year in service and push back to 2010, definitely the case.  So that’s what it was. “Oh, you broke a rib. Oh, you tore your abdominal muscles. Oh, you broke your, you know, ankle, O.K., we’ll take care of all that. We’ll patch you all up because we need you to be good to go, you know. Never mind your brain, it’s kind of a big deal.”

From the time that this had happened until the time I made it back to my parent command had been a couple days. So, I mean, I don’t, I’m not, I don’t know how much would show by then. I don’t know, I’m not really familiar with the testing and everything, but I don’t remember doing anything really, by the time I got to medical. So, I was just like “yeah, patch me up, give me crutches, give me, you know, oh I need to have surgery? Oh yeah, you know, blah blah blah blah blah.” No idea. No idea besides hey my head hurts like this has gotta, I gotta stop hitting my head on shit.

 

Jake says that when he was injured in 2008 they didn’t really screen for TBI, but after 2010 it became more of a thing.

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Jake says that when he was injured in 2008 they didn’t really screen for TBI, but after 2010 it became more of a thing.

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But push back to 2008, you know, we didn’t get really screened. I mean I don’t remember ever even hearing the words TBI screening or anything like that. I just don’t remember it…I’m not really familiar with the testing and everything, but I don’t remember doing anything really, by the time I got to medical. I’ve done plenty now, it’s like, I mean because I eventually got to the TBI clinic, so I’ve done plenty of testing now. But I just, I didn’t, again though, I didn’t think anything of it because I didn’t know, you know. Looking back, I understand that 2010 is kind of a big year, at least that’s what I’ve been told, it became more of a thing, but I didn’t know at the time.

 

On his good days, Jake feels like people treat him like they used to, but on his bad days, people get frustrated and “baby” him.

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On his good days, Jake feels like people treat him like they used to, but on his bad days, people get frustrated and “baby” him.

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And having good days and bad days and even good times and bad times is extremely difficult and frustrating because friends, family, doctors, employer, I mean, anybody that you, anybody whose opinion you value is so important, such, so difficult, because one minute you know you can actually have a legitimate conversation and they treat you like a human being. They treat you like, if, I mean if you knew them before they treat you like they used to. Or if you didn’t then they you know like I said they treat you like normal. Or if you’re not doing so well they easily get frustrated or you know they, they’re going to baby you. Not baby you but they’re just like, they have to take extra time out of their day. And whether they show frustration or not it’s just like that’s one more thing about, you know that’s something about you that they have to make time for, make room for, you know, it’s just, it’s - I don’t know, it’s frustrating. And you don’t you don’t have any control. That’s the frustrating part is, it doesn’t matter how hard you try or how much you pride yourself on doing well for yourself or doing good things or caring about somebody or anything like that, like I said your family, you know and you value them more than anything, but if you can’t remember what they said to you earlier they think you weren’t listening, they think you don’t care, you know.

 

Jake used to blaze through tasks at work, but now has trouble concentrating and lacks the laser focus and direction he once had.

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Jake used to blaze through tasks at work, but now has trouble concentrating and lacks the laser focus and direction he once had.

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Direction. And I think a lot of that comes from the focus and the concentration because the under stimulation and the inability to focus. I’ve always been, I’ve always been just laser focused. I’ve always been, I take on a task or I take on a goal, I take on anything and I just blaze through. That’s why I was always in charge in the Marine Crops. I was always in the lead and I always, that’s what made me good at my job. And now I just kind of stumble around or it’s like I get stuck in bed because of the pain and then it’s like “this is, this is really all you, this is really all you got, you’re going to let this beat you?” You know. And then it’s me arguing with myself, like “get up” you know and I try and it hurts more, like even more, and it’s like you’ve spent your entire life, this included, doing mind over matter and all the pain management, everything that you taught yourself, and all the meditation, that’s another thing I did at the TBI clinic was meditation and stuff - and I mean I’ve done so much and then it’s like, and find more, and it’s always rise above you know and, and it’s not like I just, “oh, you got blown up, came over” or you know, “oh you fell, you hurt yourself, boohoo put a Band-Aid on it and cry about it,” you know.

Its every moment since, I’ve been trying to, its been leading up to like you know getting past this stuff and that’s the thing is just, I don’t feel like it’s going to be, and I’m not stupid enough to think it’s just going to be like oh one moment, you know. It’s going to be this time or this day, this year is going to be the day that it all just gets better because I made it better or because you know this this something makes it better. No, I understand it’s going to be a process and I’ll eventually you know get to where I need to be. But, it, I’m not feeling any frickin’ breakthroughs that are going to get me there. And that’s the tough part is that laser focus is not there. That that direction is not there.

 

Jake hopes to overcome the pain and cognitive challenges he faces so that he can finish school and get a good job.

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Jake hopes to overcome the pain and cognitive challenges he faces so that he can finish school and get a good job.

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I’m definitely trying to get a better hold on my pain. Trying to get a better hold on some of the cognitive, I really hate to use the word limitations because I don’t like it, but challenges and cognitive challenges that I’m facing. And I’m working with a cognitive rehab specialist here, help me with some of that. And just always trying to challenge myself. I’d like to eventually finish school, and employment is obviously the goal because I need to make, I need to make money, because I want to continue living, you know. I mean if there were a way to continue living without, you know, working a job, you know I don’t know that I could go without doing something, you know. I think I would be bored out of my mind. I am bored out of my mind in a way. I mean I’m so over work in my own mind, I guess, because I’m always trying to do something. And the appointments and everything keep me busy.

But I feel like I need more stimulation, I need more. I need a job. I need a career. I need a hobby. I need something more. I need a project, not a hobby. I need a project is what I keep saying. Everything is too damn slow. It’s killing me. But it’s not just being back. Everything’s been too slow for years, and so that’s why I’m a little bit worried about school. And I did my associates online, but going and sit in school, I don’t know. So, I mean it worked online, just do it in pieces like I did my associates. But yeah, I want to continue my education because I love learning and why not, why not get the piece of paper, you know that you’re supposed to have, while I’m, while I’m doing it. And I guess the goal, the career, success. I mean it doesn’t have to be specific for a job career but success, because without that you can’t, you know, really live. I want to overcome some of the challenges that I’m facing.

 

 

After trying several medications and finding no relief, Jake worries he has run out of options.

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After trying several medications and finding no relief, Jake worries he has run out of options.

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They put me on Gabapentin for a while. An extremely high dose, and I don’t remember a couple months, because I just I couldn’t feel anything, I couldn’t, I couldn’t you know like physically or emotionally, and it wasn’t really that it “numbs” me because I know there’s plenty of SSRIs and other shit out there that will do the same thing but it just I literally didn’t notice anything around me. [And then, there was a time when] I didn’t have refills for about a week and so I came, I came off of them. And for that week I was, all of the sudden I, I just like realized, it was like opening a window and looking out and seeing like the world around me, and I realized that I’d been, yeah it’s like I’d been stored in a stuffy room for a month or two, and that’s exactly what it was. It was taking away all my sensory, you know, and it made me extremely dizzy, and I was I was stumbling, I was running red lights, it was because I wasn’t, all my senses were off. And, so I spoke to my primary care team, and said “I don’t want, I don’t want to be on this. We got to find another way.”

But, I mean, the narcotics weren’t good for me [either], and the DOD had just given them to me for years. And, and I told them the same thing, I don’t want to be on this stuff. There’s got to be, you know, why don’t we, why don’t we take the time, give me, you know, a MRI or something, you know, take a look, or, I don’t know send me to Ortho, something, but I’d been moved around to so many different commands so, you know, I could never stick with one doctor. That was the issue, but yeah like I said, even the even the narcotics kind of almost helped better than the Gabapentin. I said I want off this shit and my primary care doctor said basically “this is the end of the line, there’s nothing else we can do for you.” I said “there’s no way you just said that to me. There’s 7 billion people in the world, and you’re telling me that I’m the, I’m the, I’m the tip of the iceberg. You’re out of your mind.” And I looked back through my notepad. And I said “our last conversation you said there was, the next medication was this, so there’s no way, and it was clear-cut, it was it was the, the next med, the next newer Gabapentin, you know, it’s the one that’s five times stronger and used for fibro and used for, you know, diabetic nerve pain and all this other shit. It’s, it’s that the VA doesn’t normally cover it because it’s expensive. And I was like fucking “dude, you talked about it last time so you’re going to do it,” and it took weeks, and I was in excruciating pain for weeks. I spent most of my time in bed, trying, I was trying so bad but it was just terrible. Finally got on Lyrica, and it helped but gosh it messed me up. I was running red lights again. I was slightly dizzy, but nothing like the Gabapentin, but my senses were off, and then my body got used to it and I was right back to where I started.

My body got used to that low dose after a month, maybe not even. And so I was like “what are you doing? You gonna bump me up every time this happens, or or are we going to do some diagnostics?” And his response was always “well you don’t treat constant pain with meds” and I said “no shit that’s what I’ve been saying all along, is stop treating me for chronic pain, and send me to Ortho, send me back to pain, you know, the Pain Clinic or whatever.” Because the Pain Clinic, kind of went through the same thing but they recommended, they’re the ones that originally recommended, “hey, let’s see what Gabapentin does and let’s revisit.”“Well we failed that drug so maybe we should revisit.” But that wasn’t his answer. Anyways, so he bumped me up on the Lyrica, and that’s where I’m at now. But my body’s getting used to, like I, I have days where it breaks through and it puts me in bed. I have days where it’s so bad, but yeah, there’s no, there’s no next line in my notepad for this one. There’s no next conversation…

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