Marines Who Fired Rocket Launchers Now Worry About Their Brains
Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK
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Two Marines who used to fired rocket launchers think they already know.","publishDate":1532621210,"status":"inherit","parent":443616,"modified":1532621314,"caption":null,"credit":"Sarah Gonzales for NPR","description":"Can troops sustain brain injuries from firing certain powerful weapons? 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And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The military is trying to figure out whether troops can sustain brain injuries from firing certain powerful weapons. Two Marines who used to shoot these weapons think they already know.","status":"publish","parent":0,"modified":1532621576,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":78,"wordCount":1929},"headData":{"title":"Marines Who Fired Rocket Launchers Now Worry About Their Brains | KQED","description":"The military is trying to figure out whether troops can sustain brain injuries from firing certain powerful weapons. Two Marines who used to shoot these weapons think they already know.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Marines Who Fired Rocket Launchers Now Worry About Their Brains","datePublished":"2018-07-26T18:00:46.000Z","dateModified":"2018-07-26T16:12:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443616 https://ww2.kqed.org/futureofyou/?p=443616","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/26/marines-who-fired-rocket-launchers-now-worry-about-their-brains/","disqusTitle":"Marines Who Fired Rocket Launchers Now Worry About Their Brains","nprByline":"Jon Hamilton, NPR","nprImageAgency":"Sarah Gonzales for NPR","nprStoryId":"632243103","nprApiLink":"http://api.npr.org/query?id=632243103&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/25/632243103/marines-who-fired-rocket-launchers-now-worry-about-their-brains?ft=nprml&f=632243103","nprRetrievedStory":"1","nprPubDate":"Wed, 25 Jul 2018 23:41:00 -0400","nprStoryDate":"Wed, 25 Jul 2018 12:47:00 -0400","nprLastModifiedDate":"Wed, 25 Jul 2018 23:41:33 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180725_atc_marines_who_fired_rocket_launchers_now_worry_about_their_brains_.mp3?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","nprAudioM3u":"http://api.npr.org/m3u/1632411345-1c0e90.m3u?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","audioTrackLength":434,"path":"/futureofyou/443616/marines-who-fired-rocket-launchers-now-worry-about-their-brains","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180725_atc_marines_who_fired_rocket_launchers_now_worry_about_their_brains_.mp3?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chris Ferrari was just 18 the first time he balanced a rocket launcher on his right shoulder and aimed it at a practice target.\u003c/p>\n\u003cp>\"Your adrenaline's going and you're trying to focus on getting that round to hit, and then you go to squeeze that trigger and, you know.\"\u003c/p>\n\u003cp>Boom!\u003c/p>\n\u003cp>The report is loud enough to burst the eardrums of anyone not wearing military-grade hearing protection. And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443616/marines-who-fired-rocket-launchers-now-worry-about-their-brains","authors":["byline_futureofyou_443616"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1413","futureofyou_1358","futureofyou_141","futureofyou_1408","futureofyou_61","futureofyou_1047"],"featImg":"futureofyou_443617","label":"futureofyou"},"futureofyou_437552":{"type":"posts","id":"futureofyou_437552","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437552","score":null,"sort":[1513090813000]},"guestAuthors":[],"slug":"just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","title":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","publishDate":1513090813,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fpfN1gUvcMM6xziiLMO3LOmy1Q3hTGxh\"]This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n","blocks":[],"excerpt":"The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned diagnosing brain injuries into a guessing game. Researchers are now looking into making it more precise.","status":"publish","parent":0,"modified":1513354898,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":47,"wordCount":1679},"headData":{"title":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK | KQED","description":"The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned diagnosing brain injuries into a guessing game. Researchers are now looking into making it more precise.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","datePublished":"2017-12-12T15:00:13.000Z","dateModified":"2017-12-15T16:21:38.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437552 https://ww2.kqed.org/futureofyou/?p=437552","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/12/12/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok/","disqusTitle":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","source":"KQED Future of You","nprByline":"Julia Vassey\u003cbr />KQED Future of You","path":"/futureofyou/437552/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437552/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","authors":["byline_futureofyou_437552"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1413","futureofyou_717","futureofyou_1414","futureofyou_1275","futureofyou_80"],"featImg":"futureofyou_437555","label":"source_futureofyou_437552"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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