A profoundly disturbing report came out a couple of months ago, one that has ominous implications for hundreds of thousands of vets.

Basically, it says that everyone who suffered a brain injury — even a mild concussion – could be at risk of developing degenerative brain diseases later in life that can lead to memory loss, bad judgment, depression, outbursts of anger, thoughts of suicide and potential dementia.

That’s a huge concern because traumatic brain injuries are one of the signature wounds of our wars in Iraq and Afghanistan. According to the most recent Pentagon data, military doctors have confirmed traumatic brain injury in more than 244,000 of the 2.5 million troops who fought in those wars.   And the VA says that more than half the Iraqi/Afghan vets are seeking medical help after returning from service, and that half of them (28 percent of the returning 1.3 million vets) are seeking mental health treatment for PTSD, TBI or major depression.

This new study, “Chronic Traumatic Encephalopathy in Blast-exposed Military Veterans and a Blast Neurotrauma Mouse Model,” was released last May by a national consortium led by Boston University School of Medicine and the Department of Veteran Affairs.   It’s a very small study, comparing the brains of four dead soldiers, four athletes (three football players and a wrestler), and four others who had no history of brain injuries. But it’s a very significant study because, as one of the co-authors told me, it’s not easy for the family of a fallen warrior to donate his brain for research.

For years, doctors have believed that the brain heals itself after injuries. But this study casts doubt on that. It found evidence that even relatively mild brain injuries can worsen over time and end up as chronic traumatic encephalopathy (CTE), a degenerative brain disorder for which there is no treatment.

In all four of the vets and all four of the athletes, doctors found evidence of the beginnings of CTE: dead or dying brain cells, damaged axon fibers that communicate between nerve cells, and abnormal clumps of a toxic protein called protein tau. Protein tau is a normal part of the structure of nerve cells and provides what can be thought of as a railroad track providing nutrients to nerve cells; abnormal clumps of protein tau weaken the structure of nerve cells and reduce their flow of nutrients, according to Dr. Ann McKee, one of the study’s co-authors.

Those symptoms were not present in the third group with no reported concussions.

That merely confirms the conclusions already formed by McKee, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University. A doctor who also directs the neuropathology center for the New England VA Medical Center, McKee has studied the brains of 68 people diagnosed postmortem with chronic traumatic encephalopathy, including 21 military vets, three of whom had previously been diagnosed with PTSD.

“We can show an association, but we don’t understand why a brain injury can trigger progressive neurological degeneration,” McKee told me.

But the team took one additional (and critical) step by developing a blast tube that created a force equivalent to a 120-millimeter mortar round which they aimed at mice.  The study’s other co-author, Lee Goldstein, an Alzheimer’s researcher at the Boston University School of Medicine, told me that it’s important to note that the blast tube didn’t replicate the variable blast conditions in the field – rather it replicated the same brain injury in the mice that doctors had found in human victims. “A single blast imitates a military blast and replicates virtually all aspects of CTE neuropathology found in humans,” Goldstein said.

First a supersonic blast force (a sudden and abrupt release of energy within a localized area) passed through the mice brains, doing relatively little damage. Almost simultaneously, a blast wind of more than 330 mph shook the mice heads, creating what’s called a “bobble-head” effect.

“Even though a shock wave rolled through the mice heads at supersonic speeds, there was no bleeding, no contusions, no rips in the tissue,” said Goldstein. “They looked for all the world like what we see in human cases of traumatic brain injury – the invisible injury that people have been talking about since World War I.”

Two weeks later after blasting the mice, Goldstein and his team found they were experiencing losses of short-term memory and learning capability. Later, when the mice brains were examined under microscopes, scientists found the early signs of CTE, including specialized cells called astrocytes strangling blood vessels, axons crumbling, and long tangles of the tau protein that doctors had previously observed in human Alzheimer’s patients. Goldstein told me that the blast wind damaged two of the longer structures in the mouse brains: small blood vessels and small nerve cells, leading to neural inflammation.

The new study did say that long-term behavioral deficits in mice could be prevented by immobilizing the head, a finding that could be useful to military commanders.

“Our results provide compelling evidence linking blast exposure to long-lasting brain damage,” the study concluded. “Specially, our study raises concerns that blast exposure may increase risk for later development of CTE and associated neurobehavioral sequelae.”

Again, the risk is unclear. “The incidence and prevalence of this disorder are completely unknown,” McKee told me.

But it’s not only combat vets who are at risk. It’s also kids playing combat sports like boxing and football. “The effects of blast exposure, concussive injury, and mixed trauma (blast exposure and concussive injury) were indistinguishable,” said the report.

Finally, it potentially affects all the rest of us who have ever suffered brain injuries. Personally, a quarter of a century ago, I slammed on the brakes and went over the handlebars of a bike.  I landed on my head without a helmet (never again!) and was unconscious from about suppertime until I woke up in an emergency room about dawn the next morning. This report says an injury less severe would put me at risk.

Mitt Romney may also have cause for concern. The Republican presidential nominee, famous for his explosive temper and his verbal gaffes such as introducing vice-presidential nominee Paul Ryan as “the next president of the United States,” was knocked unconscious in 1968 in an auto wreck in France that was so severe that he was mistakenly declared dead at the scene.

It’s unclear how many people afflicted with this kind of head injury will develop a degenerative brain disorder. “We have no idea of the level of risk,” said McKee. “All we can say is that we have identified it, and it is a problem with some individuals.”

Goldstein, however, said the study marked an important step in understanding this injury. “Now we have a mechanism and a model,” he explained, “so we’re well on the road to developing methods of prevention, treatment and rehabilitation.”

Last week, I wrote about alternative therapies for post-traumatic stress disorder and got a number of very interesting responses. We’ll delve into some profoundly troubling research and some promising future remedies in the next few weeks.

But today’s column is about one of the therapies I mentioned last week, a small hand-held device called Alpha-Stim that clips onto each earlobe and blows an alpha wave across the brain.  The alpha wave, the same wave produced during deep meditation, calms hyper-active patients and allows them to sleep. I saw it used at the Rimrock Foundation in Billings, Mont., where the founders raved about it.

But my column drew an anguished blast from Dr. Daniel Kirsch, chairman of the board of Electromedical Products International, which produces Alpha-Stim. He charged that the federal Food and Drug Administration has been trying to shut down his product and others like it, which are called cranial electrotherapy stimulation (CES) devices, even though they’ve been safely used by thousands of patients over the past 40 years.

By coincidence, Stars and Stripes also wrote about the controversy last weekend.

According to its article, the FDA has been regulating medical devices since 1976, but the Safe Medical Devices Act of 1990 required it to evaluate even devices that had previously been grandfathered in to determine which classification they should carry: Class I, II, or III. Class III is considered a life-sustaining or life-support device.

The FDA concluded earlier this month that CES devices were Class III, which requires extensive and expensive trials for market approval. And it concluded that it couldn’t use previously conducted research. “FDA reviewed scientific literature provided by CES manufacturers and other available information, and concluded that the effectiveness of CES has still not been established by adequate scientific evidence,” said the FDA in a statement provided me in lieu of an interview with the official who signed the order.

“They threw out all our studies, which left us with no research,” said Kirsch.

That’s a problem because CES sales to the military have grown steadily in the past five years. EPI has filled 3,000 prescriptions for the Department of Defense, Tricare and the Veteran’s Administration in that period, and the Army Office of the Surgeon General’s Pain Management Task Force recommended CES for pain management in 2010.

According to Stars and Stripes, Jerry Wesch, director of the Warrior Combat Stress Reset Program at the Darnall Army Medical Center at Fort Hood, Texas, called CES a key component of PTSD treatment, as well as pain management. “I am reluctant to treat PTSD in our population without this tool in the mix,” he wrote the FDA, adding that about 80 percent of the 500 soldiers who completed the program had decided to continue to use CES devices during their follow-up treatment.

Dr. Stephen Xenakis, a retired Army brigadier general and psychiatrist in Washington, D.C., told Stars and Stripes he had been prescribing CES devices for about two years. “I like it for patients who’ve been on many drugs and you don’t want to give them another drug,” he said.

It’s an issue that has come to public attention because PTSD and traumatic brain injuries are the signature injuries in our wars in Iraq and Afghanistan. According to the most recent Pentagon data, military doctors have confirmed traumatic brain injury in more than 244,000 of the 2.5 million troops who fought in those wars.   And the VA says that more than half the Iraqi/Afghan vets are seeking medical help after returning from service and that half of them (28 percent of the returning 1.3 million vets) are seeking mental health treatment for PTSD, TBI or major depression.

“We are working as expeditiously as possible towards final adjudication of these devices and the other remaining Class III pre-amendment device types to minimize uncertainty for industry and other stakeholders,” said the FDA’s statement.

“My feeling is, from the standpoint of the military, we’re facing what I’d say is an epidemic,” Xenakis told Stars and Stripes. “We’ve got hundreds of thousands of people with problems with alcohol and misconduct and suicide risk, all those kinds of things. We’ve got treatments that are safe that might work. We’ve got to jump on it.”

I couldn’t agree more. Sleep is the time when the brain repairs, rewires and heals itself. And a device that calms an agitated, anxious soldier down enough that he can sleep at night is a valuable tool.

There’s been a long silence between my last two posts. I’d like to apologize … and explain why.

Living in West Virginia now, we got slammed by the June 29^th derecho. Susie and I were on the eastbound Amtrak that day, heading up to Connecticut to see our children and granddaughter. The storm – 600 miles long with winds up to 80mph – was actually chasing us east, but we didn’t know it. In Virginia, we saw the westbound Amtrak pass us; later, I learned that the train was stopped by downed trees in West Virginia and that 320 passengers sat on the train for 20 hours waiting for crews to clear the track.

When we got home five days later, we found that a big oak had crashed across our driveway, five others were down around the house, and a dozen more trees had been blown over on a ridgeline just behind our house. Some had been uprooted, but many trees were just sheared off midway, leading 20-foot-tall stumps.

Mercifully, the house and garden were undamaged.

However, we were without power for 13 days and without internet/cable/telephone for 15 days. In fact, our main power line was repaired by 10 emergency crews on loan from New Orleans.

So it has taken some time to catch up on the many things that needed to be done while we were without power, phone and internet. And that also explains the long silence.

—–

I’d also like to fill you in on an ambitious campaign by my publisher, Idyll Arbor Press, to get copies of my latest book, Faces of Combat: PTSD & TBI, into the hands of as many veterans as possible.

Idyll Arbor is sending a copy of my book to every VFW state headquarters.  And it promises to donate one book to a VFW post for every book it sells.

So if you haven’t read Faces of Combat, this is a great time to do so. If you buy a copy today, Idyll Arbor will send a free book to a VFW post where it can be help vets and their families understand the emotional and neurological injuries they may have brought home from combat.

Or if you’ve already been moved by Faces of Combat and want to make a donation, Idyll Arbor has an even better offer. “If someone wants to buy a few books to donate somewhere, we’ll give them a 50% discount and send out the same number of books to VFWs,” says my publisher, Tom Blaschko. “It’s like getting four books to people who can use them for the price of one.”

So please help us get more of these books into the hands of vets and their families.

Combat veterans who suffer from post-traumatic stress disorder or traumatic brain injury could benefit from some non-traditional treatment that could be approved under legislation now pending in Congress.

But all vets need to be alert because the Senate is poised to undermine a very important PTSD/TBI treatment expansion initiative that has already been approved by the House of Representatives.

Congressmen Mike Thompson of California and Pete Sessions of Texas added language to the National Defense Authorization Act (HR4310) that would create a new five-year, $10 million pilot program to ensure that alternative therapy treatments are available for active-duty soldiers and veterans.

Called the “PTSD/TBI treatment expansion initiative,” the pilot program would encourage vets to seek treatment from private providers outside the Department of Defense and the Veterans Administration.

If a patient can prove a demonstrable improvement, the pilot program would pay for the treatment.

Furthermore, the program would be required to report its progress annually to Congress. And the secretaries of Defense and Veterans Affairs would also be required to report how they planned to incorporate successful alternative treatment methods into their own medical facilities, thus encouraging a constant flow of innovative and effective treatments.

All too often, government treatment for vets has been limited to pharmaceuticals and group therapy. This bill could open the door to therapies like eye movement desensitization and reprogramming, emotional freedoms techniques, and the Alpha-Stim device, which have not been available to many vets through government programs.

“Our troops and veterans have earned the very best treatment and care that we can provide,” says Thompson, co-chair of the bipartisan Military Veterans Caucus. “But sometimes the best treatments aren’t available at military and veterans medical facilities. My amendment will make sure that our heroes who return from combat with TBI and PTSD have access to the highest quality care that our nation has to offer.”

The treatment expansion initiative was part of the National Defense Authorization Act which passed the House last May 12. It was then sent to the Senate Armed Services Committee, which passed it out June 4.

But the Senate version is far different — and substantially worse .

In the Senate version of the bill, the Secretary of Defense would be required to devise a plan to streamline programs “that address psychological health and traumatic brain injury among members of the Armed Forces.”  It would require him to fill any gaps in service and eliminate any redundancies, but there’s no mention of alternative treatments.

The secretary would also be authorized – but not required – to carry out a research program with community partners to “engage in research on the causes, development, and innovative treatment of mental health and substance use disorders and traumatic brain injury in members of the National Guard and Reserves, their family members, and their caregivers.” But there’s no funding attached to the so-called research program.

Finally, the Senate bill only deals with active-duty soldiers, not with vets being treated by the VA.

As of last year, 1.3 million of the 2 million-plus soldiers serving in Iraq and Afghanistan since 2002 had left military service and were eligible for VA health care. About 700,000 of them (53 percent) have sought health care from the VA.

According to the VA’s statistics, 367,749 Iraqi and Afghan vets have sought mental health care treatment. That’s 51.7 percent of the total caseload—and also 28.2 percent of the returning 1.3 million vets—a number that’s sure to grow larger as those who returned home recently begin acknowledging cases of delayed PTSD. It’s common for vets not to begin experiencing combat until after the euphoria of being home has waned, typically six months to a year or more.

For years, vets have complained that the treatment options offered in military and VA clinics have been inadequate, that they should be able to explore alternative therapies being offered by primary care providers. Under the House bill, that would have been possible.

So this is a time for all vets to write their senators and tell them that they should amend the National Defense Authorization Act to restore the Thompson/Sessions language in the House bill.