Four years ago, a 28-year-old E4 (Specialist) soldier told me that he and his battle buddies during two combat deployments in Iraq called their exposure to IED blast explosions as “riding the white dragon.” Surprisingly, his description was filled with both humor and the bravado of an 11Bravo (combat arms) soldier.
“You never hear the noise of the explosion,” he said. What happens, he added, “is everything turns white.”
But, even in the face of sheer terror, knowing “you have just been blown up,” seeing the white light was better than not seeing or hearing anything. He was never certain he was unconscious; so much was happening “there was never time to think about or analyze yourself.” Sometimes he would be aware of hitting his helmet on the inside of a vehicle, a structure, or the ground. But if there were no obvious signs of physical injury the common phrase was “take a knee for a moment and then move on.” Riding the white dragon did not constitute a TBI or traumatic brain injury; not even a mTBI, or minor brain injury, which is the official Army designation for a concussion. Even when you rode the white dragon multiple times, sometimes more than once in a day, the soldiers carried on with the mission, though they did help their buddies with “real injuries” or with picking up body parts. This soldier and his buddies did not see a medic or a doctor after riding the white dragon. “You just don’t do that.” He just laughed when I told him, “After nearly 50 years of study I am convinced there is no such thing as a minor brain injury.”
This soldier had been an E5 or Sergeant but he was demoted during his 3-year stay in the WTU (Warrior Transition Unit) because he threatened to hurt his First Sergeant if he was forced to do his duty at the Charlie Company front desk. The soldier was paranoid as part of his PTSD and his social skills were not up to the in-your-face Army form of communication. He did leave the military with a medical retirement and strong VA benefits. However, he did not continue in treatment of any form; he does not trust anyone.
Slowly, the general population and medical science in the United States have come to have some insight into the fragility of the brain and the consequences of traumatic brain injuries. There is a common joke with a touch of reality that says in 1884 hockey players in the United States and Canada were mandated to wear cups—you know, to protect the family jewels in the nether regions. But it was not until 1994 that it was mandated that professional hockey players wear helmets. Never mind that the helmets they wear are totally useless in protecting the brain from injury. They might protect the head bone to a limited extent. Still, there is some progress, though “Big ARMY” remains in the m for minor TBI era.
In a recent edition of Neurology Times (7/08/15) there is a concise summary about this topic titled “Head Trauma and the Risk of Parkinson Disease.” [View article online.] Though I strongly disagree with the label of “extensive head trauma” the following is a getting close to state of the science. Samuel Pleasure, MD, PhD stated:
“It has long been clear that patients with extensive head trauma have a greatly increased risk of subsequent neurodegenerative disease, especially tau-based traumatic encephalopathy in the frontotemporal dementia (FTD) spectrum. This is being appreciated as sadly too common in ex-boxers and American football players as well as others with repeated head trauma or concussions. There has also been quite a bit of evidence that some patients with these risks also develop other neurodegenerative diseases, e.g. Parkinson Disease….One of the key questions for physicians in the community to determine whether less significant head trauma in older patients has a clear association with the onset of Parkinson disease.”
He cites a recent study by Kristine Yaffe and colleagues that found “TBI patients were 44% more likely to develop Parkinson disease in the ensuing several years.” However, there is, surprisingly no mention of the recurrent brain trauma sustained by soldiers in recent conflicts and the possibility of subsequent neurodegenerative disease. I know personally there are many dedicated, extremely knowledgeable neuroscientists working in military medicine who are concerned about issues of neurodegenerative changes after all forms of TBI. Still the Army and VA use the classification of minor, or mTBI.
However, the effects of riding the white dragon continue to evolve. In an extremely important report published in the 1 June post online Brain, A Journal of Neurology [View article online.] and headlined in a story in the June 1st edition of USA TODAY by Gregg Zoroya [View article online.] a group of neuroscientists at the Boston Veterans Administration Medical Center have “discovered signs of early aging in the brains of Iraq and Afghanistan war veterans caught near roadside bomb explosions, even among those who felt nothing from the blast.” It seems that years after the blast exposure veterans are experiencing neurodegenerative changes. The lead author of the study, Benjamin Trotter noted, “Generally as we age, the connections (in the brain) deteriorate. But in those people with blast exposure it appears as though it’s happening faster.”
Other significant findings indicate that there may be lack of awareness of a blast injury. “Many veterans studied said they never felt concussion-like symptoms such as dizziness, headaches or loss of consciousness. Others complained of those symptoms, but eventually saw them go away and military doctors concluded they had fully recovered.”
The impact of these findings are compounded by previous findings published in November of 2014 revealing that there was evidence of lack of communication between areas of the brain “according to scans taken of troops who had been within 30 feet of an explosion.” William Milberg of Harvard Medical School summarized the findings with this statement: “The most important message of these two studies is that they show for the first time in a large cohort of (Iraq and Afghanistan) veterans that exposure to explosions in combat effects the brain whether or not the soldier showed symptoms of a concussion at the time of the explosion.”
This is not rocket science and it does not take a neurosurgeon to figure it out. There is no such thing as a minor brain injury.