Research Links PTSD to Blasts in Comba

 

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Posted in New York Times, June 10, Pg. A19 | Alan Schwarz

 

They are among war’s invisible wounds: the emotional and cognitive problems that many troops experience years after combat explosions sent huge shock waves through their brains. Whereas the link between concussions and post-traumatic stress disorder has become clearer in recent years, a specific connection between PTSD and blast waves has remained elusive.

 

Now, a prominent neuropathologist who researches brain injuries among military personnel says his team has identified evidence of tissue damage caused by blasts alone, not by concussions or other injuries. The team’s study was published on Thursday in The Lancet Neurology.

 

The discovery could eventually lead to better treatments and to improved head and body protection for troops exposed to high-energy blasts, some experts said. Other researchers advised that these initial findings should be bolstered by more studies before veterans and their families read too much into them.

 

”We talk about PTSD being a psychiatric problem — how people responded to the horror of warfare,” said Dr. Daniel P. Perl, the neuropathologist who led the study. ”But at least in some cases, no — their brain has been damaged.”

 

”The real black box is to figure out who has this,” added Dr. Perl, who works at the Uniformed Services University of the Health Sciences in Bethesda, Md., the medical school run by the Department of Defense.

 

Even the tentative results provided some solace to Jennifer Collins, who was married to one of the five male military veterans whose damaged brains were examined in the study. Her husband, David, served 17 years in the Navy SEALs, enduring countless explosions in Iraq and Afghanistan. He retired in 2012, and steadily developed significant depression, sleeplessness and memory loss. He killed himself in March 2014.

 

”This is proof that this man died in combat,” Ms. Collins said in a telephone interview, sobbing and struggling to find words. ”It took several years to kill him, but he died in combat. This finding is further validation about what I know about my husband.”

 

It is unclear how many of the 2.5 million United States service members deployed to Iraq and Afghanistan were exposed to blasts. A 2008 report by the RAND Corporation suggested that the number could be about 500,000. But some estimates suggest the problem could be greater: For example, a 2014 study of 34 living veterans from those conflicts found that a majority had experienced at least five blasts.

 

Explosions from roadside bombs, grenades and other devices produce a wide spectrum of injuries. Beyond the shrapnel and other objects that impale the head and body, the hurricane-force wind can blow troops off their feet, causing fatal head injuries and concussions on impact.

 

Less understood is how the blast wave — the pulse of compressed air that shoots in all directions faster than the speed of sound and arrives before the wind — affects brain tissue after crashing through the helmet and skull. Blasts are also believed to compress the sternum and send shock waves through the body’s blood vessels and up into the brain.

 

[Video: VBIED Attack Watch on YouTube.]

 

The researchers examined the brains of the five veterans who had been exposed to blasts, and compared samples with those of 16 other veterans and civilians with and without brain injuries from military service or other activities. Scar tissue in specific locations of the cerebral cortex, which regulates emotional and cognitive functioning, was found only in the blast-injury cases.

 

All five of those men also suffered from the symptoms of PTSD, which, given the location of the scarring, suggests that a physical combat injury could have led to or exacerbated their psychological troubles, Dr. Perl said. Any such connection, now only speculative and needing further research, could lead to a better understanding of a link between combat and PTSD, said Dr. Ibolja Cernak, the chairwoman of military rehabilitation research at the University of Alberta.

 

Dr. Cernak likened the blast-injury study published in The Lancet Neurology to the first reports of chronic traumatic encephalopathy among professional football players, whose disease was linked to repetitive on-field brain trauma and helped explain some of their cognitive and emotional problems decades later. As with C.T.E., the damage connected to blasts does not appear on any magnetic resonance imaging test or brain scan and can be located only after death.

 

”This could be for the military population what C.T.E. was for football players — enormous,” Dr. Cernak said of the research.

 

Beyond treatment options, the findings raise the possibility that better head protection for active soldiers could ameliorate a blast wave’s damage. Dr. Ralph G. DePalma, a special operations officer in the office of research and development at the Department of Veterans Affairs, called that prospect ”probably the most important aspect of this paper.”

 

”Looking at the mechanism of how the injury occurs and possible interventions immediately, that’s something that the Department of Defense is very interested in,” Dr. DePalma said. ”We know that certain blast exposures, the angles at which the blast encounters the face and helmet matters. So you can look at protection.”

 

Some experts are concerned that as significant as identifying blast-related damage in the brain can be, linking it to PTSD is premature. For example, Mr. Collins’s brain also showed signs of C.T.E., which has been found in previous autopsies of military veterans and could have contributed to his psychiatric condition. One of the other four subjects in the study had very small signs of C.T.E., but the other three showed none.

 

”We have to be very certain — it’s about not jumping the gun, not jumping to conclusions about the significance of the changes we find in the brain in terms of a person’s prognosis or their symptoms,” said Dr. Ann McKee, the chief of neuropathology at the V.A. Boston Healthcare System. She and others at Boston University have identified C.T.E. in the brains of about 100 former N.F.L. players and some military veterans.

 

”Until we really understand how those changes come about and what the changes really mean,” she added, ”we won’t understand the clinical factors that lead to disability from these diseases.”

 

Dr. DePalma added that even if no treatments could be developed for years, soldiers should not assume that they would emerge from combat with damage from blast waves. Genetics are believed to influence whether a football player will develop C.T.E., so military combat may pose different risks to different people.

 

”It’s not, ‘Oh my God, if I’m exposed to blasts I’m going to go crazy,”’ Dr. DePalma said.

Feet on the ground in Bagdad

Authors name is kept anonymous. This came from a very reliable source.

Gents, thought you might want to hear from the front. Just returned from Baghdad day before yesterday checking on my folks. This is as current and objective as I have seen to date.

The current situation in Baghdad is best described as tense. Mass media coverage over the last few days of unfolding events has seen a run on supplies/fuel/at banks by civilians who are preparing in the event the worst does happen. It is not yet to the point of a panic but locals are nervous. The airport is extremely busy and flights elsewhere (especially to the Kurdish Region) are far overbooked. The overall situation in the country can only be described as very serious and with yesterday’s ‘call to arms’ by Ayatollah Sistani, the prospect of a sectarian civil war is the highest it has ever been – and has the potential to even be worse than the 2006/2007 era.

But – before going any further – it is worth putting the overall situation into context, and describing the ISIS ‘advance to Baghdad’ thus far. The portrayal in the media since this situation broke five days ago has been one of a relentless advance by ISIS. According to CNN etc, ISIS began by capturing Mosul, then advanced in a Blitzkrieg movement south, routing the Iraqi Army and capturing vast swathes of terrain as they went. This continuous sensationalization by the mainstream western media is the number one driving factor for the tension in Baghdad rather than a true appreciation of fact.

While the reporting of the folding of the Iraqi Army in Mosul and areas north of Baghdad is accurate (and is the reason why this situation has developed as it has), the rest of it is far less simple than is widely portrayed in the western media, and the true facts need putting into context. Most of this has already been covered in the GW Daily Reports from Jun 10-14 inclusive, and summarized in the GW weekly released last night. It is recommended these documents are reviewed for a balanced understanding of what has transpired so far. But to put some key points down on paper:

The last week in May/first week in June saw a substantial increase in insurgent activity across the country. Bombings and spectacular attacks ranged across the country, from VBIEDs near Karbala and Najaf, an assassination of a senior Sahwa commander in Anbar, an assault on Sammara and finally the attack on Mosul which caused the rout of the Iraqi Army and everything that then subsequently unfolded over the course of the last five days. The key takeaways, however are:

The ‘advance’ from Mosul to the outskirts of Baghdad has been blown out of proportion. What in actuality happened was ISIS were masterful in capitalizing on their success in Mosul and then gaining and achieving momentum. But rather than a straightforward advance to Baghdad, it is more realistic to consider that news of the Mosul success and fleeing Iraqi Army traveled fast throughout the Sunni dominated areas north of Baghdad. ISIS units already in situ in their traditional locations rallied behind their flag and mobilized in their local areas all at once. Similar news spread amongst the Iraqi Army, whose commanders were the first to flee, which caused the mass pullout/desertion/withdrawal. ISIS then moved into the Iraqi Army positions, taking the majority of them without a fight or meeting only mediocre resistance. What is extremely import to note is: ISIS have yet to move outside of areas where they have always been traditionally strong. In addition, ISIS have met no resistance from the predominantly Sunni population in these areas – who have been downtrodden and marginalized to the point where they are at least passively supporting ISIS, maintaining a laissez faire outlook. Some of this support though is no doubt through fear – ISIS will have presented them with a ‘You are either with us or against us’ ultimatum. In the total absence of official law and order, most Sunni locals will have little choice but to along with it – for now. It should also at this point be noted that ‘ISIS’ is not just ISIS. Other militant organizations and local Sunni tribes who are ‘going along with it for now’ are involved. These ultimately are not interested in the level of radicalism that true ISIS demands – so this is a fragile alliance at best, which will no doubt come to the fore once true resistance appears, or when ISIS start summarily executing peop0le for crimes and issuing strict laws on how to live etc (and we are already seeing evidence of this in Mosul and Tikrit).

Back to the ‘Advance on Baghdad’. Understanding the above – it should now be clear that ISIS have not yet set one foot outside areas where they have traditionally been strong. Which is why the ‘advance’ has stalled in the area of Samarra/Balad. In Diyala with its more mixed populace, they have not even ‘advanced’ that far south in parallel – Shia militia groups such as AAH are openly fighting them and the Iraqi Army is maintaining a presence there also. Not to mention in Northern Diyala, the ‘limits of control’ are tested between ISIS/Peshmerga – testing the Peshmerga are currently winning as they consolidate positions and expand their region (they will likely be the ultimate winners in all of this). The minute they step off their traditional turf into areas where they have no popular support (i.e. Shia parts of the country – northern Baghdad for instance….) we will see how well they do trying to fight conventionally….

The massive Shia mobilization that is currently occurring in Baghdad and the south means that the ‘advance’ in a conventional sense, is likely to remain stalled where it is if not beaten back some in the coming days.

So what’s the realistic prognosis of the situation for Taji and Baghdad?

Taji has become the main reception point for falling back troops and the point from where counter offensives will be planned and organized. On current available information, the massing troops there and the size of the facility means that ISIS as yet will have very little chance of attacking it in a conventional sense, so will get back to what they do best – car bombs, suicide attacks etc, along with IDF. The fact that the group has consolidated ground now with a ‘frontline’ behind which they have almost unrestrained freedom of movement means that supply lines will be extended so possibly we will see the frequency of these kind of attacks increasing. Not to mention the masses of military equipment (and cash) they have captured (although it appears much of it has gone to Syria – which is indicative that the campaign there may be of greater or least equal importance to the movement). Same goes for Balad airbase to the north of Taji – as yet the facility has not been directly attacked despite ISIS proximity, and both will be extremely well defended but no denying the facilities will be ISIS priority targets.

It also goes for Baghdad itself. In addition to the northern ‘axis’, we need to consider what is happening Anbar to the west (and the linked Jurf al-Sakhr district of Babil province to the southwest of Baghdad). There has been a noticeable drawing back of Iraqi Army units from Fallujah (presumably so properly battle hardened veterans can redeploy elsewhere). The has led to more freedom of movement for ISIS/anti govt elements – again with the implication of being able to stage closer to Baghdad. But again even from this axis – at this juncture we are talking increased unconventional guerilla attacks in the capital rather than the media ‘Lets all drive right into town’ sketch. I do see increased suicide attacks, car bombings – possibly even IDF on the BIAP and IZ (and maybe even increased conventional clashes in Abu Ghraib and therefore encroaching on the outer BIAP perimeter), but based on current info, not a conventional type assault as the press is talking. Baghdad is absolutely teeming with Iraqi Army troops and now, Shia milita of all kinds, including the now gloves-off Jaish al Mahdi (JAM) and Asaib Ahl al Haq (AAH), and I don’t doubt (as with some other parts of the country) Iranian Quds force too. Iranian involvement is set to increase as this progresses.

So to conclude – for ISIS to just go strolling into Baghdad as they have in a similar fashion in the areas where they’ve always been strong is currently completely unrealistic (again, media to blame for it). However what is likely is an increase in car bombings, suicide bombings, IDF threat to BIAP and IZ. Short notice lockdowns throughout the city are also possible, as is the potential for short notice vehicle movement restrictions and curfews (already one in place from 10pm till 6am). The other major burning issue right now – is the mass Shia mobilization and the fighting that is to follow north of the capital: Once this begins, we are going to hear many reports of atrocities committed against both Sunni and Shia communities as such a mass, fast mobilization means that training will be poor as will discipline. And we already know what the other side is capable of. This has the very real potential to spark bitterness and a renewed civil war period. In Baghdad, this may well translate as mass sectarian killings on either side on the streets in capital in conjunction with attacks on Mosques etc (as happened in 2006/2007) depending as to what transpires over the coming days .

I hope that helps clarify the current situation.

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