The high costs of brain injury

Terry McGowan is an intelligent, capable man with the vocabulary of a college professor. Listening to him talk, you’d never know he has dealt with traumatic brain injury (TBI) since he was 9 months old.

That’s when he was dropped from a two-story apartment. His TBI was further complicated by an adverse reaction to the smallpox vaccine at 18 months.

All his life, McGowan has had difficulty with paying attention, depression and impaired short-term memory. He uses two large whiteboards in his home to remind him of dates, appointments or simply who has called that day.

“Sometimes I have to retrace my steps to make sure there is nothing burning, hanging, or blinking,” he joked.

Temporal epilepsy is another symptom. It has caused McGowan to suffer seizures throughout his life. They range from full fledged grand-mal events that land him in the hospital to short, relatively painless seizures that happen while he is in mid-conversation.

“I could be having a seizure right in front of you and you wouldn’t even know it,” he said.

Even though McGowan has made adjustments to the way he lives, he still has difficulty in day-to-day activities.

“When you have brain injury, you tend to be isolated, depressed and you don’t eat enough,” McGowan said. “It’s hard for people to understand,” especially since there are no visible signs of injury.

McGowan is not alone. Some 1.4 million Americans are living with traumatic brain injuries, according to the Centers for Disease Control and Prevention. But this figure does include the large number of injured soldiers returning from the war zones of Iraq and Afghanistan.

A RAND Corp. study, titled “Invisible Wounds: Mental Health and Cognitive Care Needs of America’s Returning Veterans,” predicts a steep rise in the number of people living with brain injury as soldiers return from the front lines.

That’s because more of the injured are surviving, thanks to dramatic improvements in battlefield medicine as well as better helmets and body armor.

“Guys with injuries that would have killed them in Vietnam are now coming home,” Mike Olson, veterans’ resource specialist at Butte College, said.

TBI is one of the “signature wounds” of the Iraq and Afghanistan wars, the RAND study noted. Enemies’ widespread use of improvised explosive devices has made soldiers susceptible to head injuries. Interestingly, many of them are what are called “blast” injuries, which are caused by jolts to the head they result in permanent cellular destruction in areas of the brain.

As many as 300,000, or 20 percent, of Iraq combat veterans who regularly worked “outside the wire, away from bases,” have suffered at least one concussion, the New York Times reported. Many have been blasted several times.

Despite the huge number of vets who might have TBI, its prevalence is poorly understood, diagnosed and treated, leaving huge concerns about how extensive the problems—and costs—will be in the future.

“There are no reliable statistics as to how many veterans returning from Iraq and Afghanistan are suffering from TBI,” Olson said.

TBI can also be difficult to treat because the symptoms can either stay dormant for years after the initial injury or be confused with other war conditions.

“There is such a gray area of symptoms between a concussion, serious brain injury and even PTSD [post-traumatic-stress disorder],” Olson said. “Sometimes one can mask the other.”

Only slightly more than half the veterans receiving treatment for TBI receive minimally adequate care, according to the RAND study.

As soldiers return home and TBI patients grow in number, the estimated cost of treating mild TBI ($27,000-$33,000 per patient) and severe TBI ($270,000-$408,000 per patient) will hit hard.

The cost could be as much as $14 billion in the next 20 years, according to a report by Linda Bilmes of Harvard’s Kennedy School of Government and Joseph Stiglitz of Columbia University. However, no one can pinpoint the exact cost.

“It’s an integrative system of care,” Kerri Childress, communications officer and congressional liaison for the VA Palo Alto Healthcare System, said. “Rarely do we see a veteran with only TBI, so it makes it impossible to break down the exact cost.

“I can say this, when it comes to cost: The nation will be paying for many, many years because there is no such thing as a prosthetic brain.”

Olson did two tours in Iraq and now helps students at Butte College readjust to civilian and college life. He has worked with several students with TBI and sees the difficulties they face in school. “Every case is different. Some students may have trouble with their homework or listening in classes, while other students with disturbed sleep have trouble showing up to classes.”

Just recently, Butte College remodeled a classroom to create the Veterans Services Office, with computers, study kiosks and a full staff to assist those returning home.

Butte College also offers two Cognitive Skills classes to help improve attention, organization and memory.

They are taught by Myra Lerch, an instructor in assistive technology for disabled students. She has seen first-hand the misconceptions about the ability of people with TBI. Although her courses are academic, not rehabilitative, Lerch has witnessed remarkable development in her students.

“I continually learn from my students and have seen significant improvement well beyond the standard two-year window many people set as a limit,” she said.

Lerch’s interest in the issue extends beyond her work at the college. She is a cofounder of the Brain Injury Coalition, a group of volunteers that holds workshops every second Thursday at the Chico Branch Library about different issues associated with brain injury.

“The primary intent is educational; we try to bring the best speaker on a given topic,” Lerch said. “Second, it involves unstructured time for participants to network with each other.”

Terry McGowan has been attending the meetings for years and sees them not only as educational, but also as a community of friends.

“The meeting is a place to be with people who know exactly what you are going through, and that creates a bond,” McGowan said.

Another recently created support group meets the first Thursday of every month from 1-3 p.m., also at the Chico library.

Enloe Hospital also hosts a support group in its Conference Center every first and third Tuesday from 7-9 p.m. It combines educational and emotional support by offering occasional guest speakers, keeping a “resource file,” and allowing people and their families to vent frustrations.

Lerch and Olson are continuously attending seminars and workshops to better their knowledge and ability to help others with TBI. Olson hopes one day to hold a seminar at the new Veterans Center. For now, he’s just trying to bring awareness to the issue.

“Don’t be afraid of what you don’t know and acknowledge its existence,” Olson urged. “Anytime a group of people face a challenge like this warrants attention.”