In January 2008 Sean was evaluated by Dr. H from the polytrauma unit at the Sioux Falls VA Hospital. The polytrauma team is comprised of a medical doctor, social worker, physical therapy, speech therapy, psychology, occupational therapy, and recreational thereapy. He was also underwent a battery of tests including an MRI, EEG, and a neuropsychological evaluation. He was further evaluated by Dr. Z of neurologist and Dr. M of psychiatry.
Sean was diagnosed with post-concussive syndrome, or mild traumatic brain injury (TBI) due to a blast injury, the most significant damage likely occurring on March 25, 2006 (as described in the post "What Went on Over There?"). The blasts from these mortars send out shock waves which shake the brain and can cause bruising and tearing in the brain. Injuries such as these build upon each other and each subsequent incident causes further damage.
He had additional diagnoses of PTSD, depression, anxiety, tinnitus (ringing in the ears), residual abdominal pain subsequent to multiple bowel infections, persistent headache, recurrent skin rash on the legs, persistent nausea and dizziness, and irritable bowel syndrome.
Traumatic brain injury, or TBI, has been labeled a "signature wound" of the current conflicts in Iraq and Afghanistan due to the frequency with which it is being reported. TBI can occur in both open head injuries, involving some form of penetration of the skull, and closed head injuries, where there is no visible damage to the head. TBI can be an "invisible" wound which may not be detected in theater, but rather comes to light when the service member returns home and family members notice problems.
In Sean's case, the salmonella and c diff infections and subsequent GI symptoms masked the TBI symptoms. Unfortunately, that meant that Sean spent two years with an undiagnosed brain injury. It saddens me that he was struggling for so long and we had no idea why or how to handle the things that were going on.
Sean's attention, decision-making, information processing, and memory were impacted. While his long-term memory is good and intact, his short-term memory is poor. For example, he forgets what he is supposed to do, or asks how to do things he could previously do on his own. He repeats questions, "What is today?" "What do I have to do?" "Where should I go?"
Decision making is very difficult for Sean. He can't decide which brand of toothpaste to buy, or which shirt to wear. He questions the decisions he makes over and over.
Sean has trouble with multiple-step tasks. He needs more time to complete tasks and process information. He struggles with planning and organization.
He is unable to process information in new situations, especially if there is a lot of information to process at once such as busy stores, noisy situations, crowded areas. He is easily upset by strange noises, beeps, alarms.
Following the diagnoses, Sean was put on light duty a the fire department. He was allowed to keep his job with modified hours and duties while he waited for a decision on medical retirement. In June 2008, Sean was officially medically retired from the fire department after 14 years of dedicated service. This was a huge blow to Sean. He had been working as an EMT since he began volunteering with his hometown ambulance at age 17 and had worked his way up to the position of lieutenant at the Aberdeen Fire Department.
We began to structure his days, organize his daily activities, and tried to include exercise and recreation when he was feeling up to it. Many days the pain and fatigue made it difficult for him to do much. He was receiving physical therapy at the warm water pool and was using a cane to help with balance as he had been falling frequently. He started speech therapy to help with memory, and occupational therapy to help him with organization. He would continue to see psychology and psychiatry on a regular basis along with regular follow up with the polytrauma team.
Dr. H told us they would do the best to help him manage the pain and symptoms with medication and therapy, but he might never recover fully. We tried to change our focus from finding what was wrong and making sense of it, to finding a quality of life for ourselves and our children.