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The Gazette, April 25, 2010

Brain injuries emerging as concern due to roadside bombings in Afghanistan

The theory was that massive blasts rattled people's brains to the point of injury, but the technology to provide proof didn't exist

By Ryan Cormier

The roadside bombs of Afghanistan are brutal and destructive, though the injuries they cause, both in brain and body, can be subtle.

Since 2003, the Taliban's consistent use of such explosives has killed 84 of Canada's 142 fallen soldiers, and has made amputees of many others. Often, the bombs tear apart soldiers and local Afghans alike. They have been known to lift 70-tonne tanks off the ground.

A U.S. Department of Defence study indicated that 140,000 U.S. soldiers were concussed in Iraq or Afghanistan between 2001 and 2009. In April 2008, international concern hit a high note when a Rand Corporation study from the United States found that 20 per cent of deployed soldiers from that country suffered a concussion.
...
The new survey found that 6.4 per cent, or 116 soldiers out of 1,817, were concussed while deployed.
The Gazette, Apr. 25, 2010

Now, there is international concern that such blasts may also cause less obvious injuries, particularly concussions, that are passing unnoticed. Such injuries may have profound, long-term health effects, though the Canadian Forces say it is too early to tell.

In 2005, U.S. researchers found many soldiers returning from Iraq or Afghanistan had undiagnosed brain damage discovered once they returned home. It's possible the injuries had been overlooked in the rush to save lives and limbs.

Preliminary warnings surfaced that all soldiers hit by a blast likely had brain injuries. Soon after, media reports labelled traumatic brain injury, or concussions, ``the signature injury of the war.''

A U.S. Department of Defence study indicated that 140,000 U.S. soldiers were concussed in Iraq or Afghanistan between 2001 and 2009. In April 2008, international concern hit a high note when a Rand Corporation study from the United States found that 20 per cent of deployed soldiers from that country suffered a concussion.

Those numbers grabbed the attention of the Canadian Forces, though they were skeptical, says Dr. Bryan Garber, a deployment health specialist.

``It became apparent, when we started hearing these reports, that a lot of it wasn't grounded in strong scientific research,'' he says. ``How big an issue this was, when you dug down to the hard scientific data, was very fuzzy.''

Military concussions have been around as long as gunpowder, Garber points out, leaving the Canadian Forces to determine what has changed, and if they should change with it.

So the Canadian Forces in January began surveying returning members about possible brain injuries.

Soldiers were asked to self-identify their injuries on a questionnaire each one completes after a tour. Questions were added about explosive injuries, and asked soldiers if they experienced unconsciousness, memory loss or other concussion symptoms.

The new survey found that 6.4 per cent, or 116 soldiers out of 1,817, were concussed while deployed. That was lower than U.S. estimates, a fact the Canadian Forces expected and attribute to shorter deployments.

However, medical staff in Afghanistan have noticed an upward trend in brain injuries, says Capt. Mike Penkman, of 1 Field Ambulance in Edmonton, who worked on the trauma team at the Kandahar Airfield.

``Most of our soldiers now, even opposed to a few years ago, are being injured by (improvised explosive devices),'' he says. ``People come in, and at first don't appear injured at all, but because of the strength of the blast they're receiving, we're actually seeing some people with significant injuries to their brain.''

Elusive injuries from blasts aren't restricted to the skull. Soldiers like Trooper Bill Geernaert, who survived a blast in August 2009, can suffer multiple injuries that initially go unnoticed. Medics in Kandahar diagnosed him with a concussion and perhaps pinched nerves.

``I never saw anything physically wrong with me and neither did they,'' says the member of the Edmonton-based Lord Strathcona's Horse. ``I didn't realize I had internal injuries.''

Later, after his left side had gone rag-doll, Canadian doctors realized he had a fractured pelvis, a spinal injury, widespread nerve damage and loose joints. But immediately after the blast, Geernaert and fellow soldiers thought he was fine, to the point he fought in a battle for nine hours afterwards.

Though anecdotal evidence is abundant, the Canadian Forces say they don't believe they yet have the numbers needed to make policy or medical decisions.

They only have surveys from one half-year rotation of Edmonton soldiers. Large groups of soldiers only come home every six to nine months, leaving long waits between new information.

To further confuse the issue, post-concussive symptoms mirror those of post- traumatic stress disorder, says Lt.-Col. Rakesh Jetly, of the directorate of mental health.

``Months afterwards, the symptoms are headaches, irritability, sleep difficulties, which are all fairly non-specific. There's a lot of overlap.''

The lines blur further because a blast survivor is more likely to get post- traumatic stress disorder, says Commodore Hans Jung, the surgeon general. Such a blast easily qualifies as a traumatic incident, which is a required element to diagnose PTSD.

For now, the Canadian Forces won't step beyond a cautionary approach of surveys and treating only specific symptoms, such as headaches.

``This is not as simple as saying `You had a blast injury so you're going to have permanent brain damage.' I'm really uncomfortable with that,'' says Jung. ``Until we get definitive, scientific information, I would rather treat people with the goal of making them better rather than relegating them to a permanent, irreversible injury.''

There hasn't been this much international attention paid to military concussion since the World Wars. Then, thousands of people were thought to suffer brain impairment, or ``shell shock,'' from massive bombardments of populated areas. The theory was that massive blasts rattled people's brains to the point of injury, but the technology to provide proof didn't exist.

``It's kind of interesting that at the end of the century, we're revisiting the issue,'' Garber says.

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