A Question and a Sample

I’ve been contemplating creating a membership option and using Patreon to earn funds with this blog to invest in the nonprofits I have mentioned. It would allow you to contribute and help support my blog, my books and my nonprofit endeavors. My thoughts are that all of this money will be spent quarterly to contribute support these organizations. I support the Heritage Foundation because of the quality of their research (they publish a military assessment study annually), Matrix Lifecare Pregnancy (a nonprofit that supports parents through pregnancy and early childhood), I contribute toiletries, etc. to the local Veteran’s Home, Chaplain Alliance for Religious Liberty, the American Center for Law and Justice (I love their mission), and Vision of Hope Treatment Center.

I would like to share a section of a book I am writing about traumatic brain injury in relation to the military. Traumatic brain injury occurs within the police force and fire stations as well; but those deserve their own separate books. This is a section of my interview with the first neurologist I interviewed.

“One area related to traumatic brain injury which is somewhat unique to veterans is moral injury.  The closest “civilian” parallel would be the police force.  I had never heard of this before reading Care for the Sorrowing Soul by Duane Larson and Jeff Zust and Signature Wounds:  The Untold Story of the Military’s Mental Health Crisis by David Kieran.  Care for the Sorrowing Soul addresses moral injury throughout much of the book while Signature Wounds focuses more on veterans who have committed suicide.  There are varying views here:  some promote the idea that suicide is more prevalent amongst veterans and active-duty military; while other statistics suggest that the rate of veteran suicide is “on par” with the civilian world.  One veteran that I interviewed told me that at the time he sustained his brain injury, he was questioned; but all brain injuries were treated like PTSD even though moral injury and TBI are not the same.  “Once the conversation turns to religion – natural for funerals and such! – the vet often says “God will never forgive me for what I had to do,” though the active-duty combatant usually resists using the God word…  She or he has been carrying the invisible wounds of war.” ( Larson, Duane and Jeff Zust.  Caring for the Sorrowing Soul.  p. 1)

Though this book is meant to be for those facing traumatic brain injury; I did ask my own neurologist – has he treated moral injury?  Police officers may face it too.  I wanted to know if the MRIs are different.  Thus, I sought out the perspectives of two neurosurgeons: one from St. Vincent and the other is from I.U. Health. 

The first doctor I interviewed is Dr. Richard Rogers.  He completed a fellowship in NeuroCare at the University of Miami and now practices neurosurgery at St. Vincent Hospital in Indianapolis; specializing with surgery involving neurotrauma related to the brain and spine.  I have included some questions and his responses below. 

1. How can different areas of the brain being affected cause different symptoms that patients may experience (i.e. vision, loss of hearing, loss of mobility)?  Most are mild.  C sub concussive injuries comes into play in contact sports where they bang heads all the time.  The part of the brain varies depending on type of injury.  [An] older person falls and hits their head on the ground; the back & front of the brain will be injured by the bounce.  Specific impact will cause injury to specific area of brain.  Acceleration/deceleration injuries can cause injuries to [the] fiber of brain throughout.  [They] can cause deep injury which can lead to deep coma. 

2. I remember that the severity of the injury is determined by how long a patient is unconscious.  What effects can be caused by the severity of the injury?  It can vary a lot.  First is the initial impact.  A mild injury results in mild aftereffects; which can also vary by what happens right after event.  If it’s mild [we] don’t worry about swelling or inflammation.  Aftereffects are the secondary injury.  [We] can manage modify secondary injury; but it varies from patient to patient.  Each patient has their own specific injury.  Blood pressure, swelling, inflammatory events.  [The goal of inflammatory] surgery [is] to relieve pressure to evacuate clots and make room for brain to swell.  Swelling will go away with time.

Later in the same chapter, I continue speaking with a second neurologist.

“I also interviewed Dr. Khaled Hammoud.  He completed a fellowship in Neurophysiology at the University of Chicago and now works with Unity Healthcare in Lafayette, IN.  I posed some similar questions to those I asked Dr. Rogers.  My first question was about how different areas of the brain being affected cause different symptoms that patients may experience (i.e. vision, loss of hearing, loss of mobility).  I remember that the severity of the injury is determined by how long a patient is unconscious and asked about any effects that may be caused by the severity of the injury.  Dr. Hammoud stated, “Different areas of the brain are responsible for different functions. For example, the occipital area (back side of the brain) is responsible for the vision and the frontal region is responsible for decision making, behaviour and planning. Hence, injury to the occipital region can lead to vision loss and injury to the frontal region can lead to difficulty with planning, change in behaviour and irritability.   I am not aware of data linking duration of being unconscious after TBI (traumatic brain injury) to severity of outcome. However, if a patient is comatose after TBI, it is likely that his/her brain injury is more severe.”   

I did find a study backing this.3  The Brain Injury Association of America focuses on brain injury survivors and their families.  The study defines the stages of brain injury as mild, moderate and severe.  Mild brain injury is defined as “involving brief, if any loss of consciousness”, “Vomiting and Dizziness”, “Lethargy” and “Memory Loss”.  Moderate brain injury includes “Unconsciousness up to 24 hours”, “Signs of brain trauma”, “Contusions or bleeding” and “Signs of injury on neuroimaging”.  Symptoms of severe brain injury are “Unconsciousness exceeding 24 hours (coma)”, “No sleep/wake cycle during loss of consciousness (LOC)” and “Signs of injury appear on neuroimaging tests”.”

All of this brings a verse to mind – Philippians 3:12 – 14 (NASB). NASB stands for New American Standard Bible: “Not that I have already grasped it all or have already become perfect, but I press on if I may also take hold of that for which I was even taken hold of by Christ Jesus.  Brothers and sisters, I do not regard myself as having taken hold of it yet; but one thing I do: forgetting what lies behind and reaching forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus.”

Philippians was written by Paul while he was in Philippi (there are still ruins in Northern Greece).

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