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One Soldier’s Progress Against Traumatic Brain Injury

With the help of virtual-reality machines and a bevy of specialists, Sgt. Victor Medina’s thinking and speaking rapidly improved. But he’s among only a tiny fraction of brain-injured soldiers who get access to the most advanced treatment at military’s new state-of-the-art center in Maryland.   

Sgt. Victor Medina, who suffered a brain injury from a roadside blast in Iraq, walks down the hall while tossing a tennis ball from hand to hand working on dynamic hand-eye coordination at Mentis Neuro Rehabilitation Center in El Paso, Texas. (Blake Gordon/Aurora Photos)

When Army Sgt. Victor Medina returned home from Iraq in the summer of 2009, his life was a shambles. His tour had been cut short after he suffered a concussion during a roadside blast. Though his injury wasn't visible, he struggled with balance and noticed that his ability to read, think and even talk had changed for the worse.

But in the spring of 2011, Medina became one of the first patients at the National Intrepid Center of Excellence, the military's $65 million, state-of-the-art treatment center for brain-injured soldiers.

During his three weeks at the Bethesda, Md., center, the staff developed a rehabilitation program designed specifically for Medina. His recovery has progressed rapidly ever since, he and his wife, Roxana Delgado, told ProPublica and NPR.

Medina has continued to work from El Paso, Texas, by videoconference with a speech therapist based at the center, and he said his stutter is improving. After his injury, he had struggled to read more than a paragraph; now he says he can read and absorb two pages in one sitting. Medina also was ordered to stop driving after his injury, but he told ProPublica and NPR that he has regained his ability to do that, too.

"It's like night and day," Delgado said of his improvement.

The couple believes that Medina benefited dramatically from media attention. In June 2010, ProPublica and NPR published stories about the couple's struggle to get medical treatment for Medina at Fort Bliss, Texas, where he was stationed at the time. The Army's vice chief of staff, Gen. Peter Chiarelli, denounced the reports at a hearing before the Senate Armed Services Committee as a "disservice ... to everyone." But a year later, Chiarelli flew the couple to Washington so they could talk privately to top commanders about their battles at Fort Bliss, and how to improve treatment for troops with TBI.

Last year, Medina became one of NICOE's first patients. He received more than 100 hours of personalized treatment from neurologists, psychologists, physical therapists and others at the center, a NICOE spokesman said. Medina also had access to some of the center's virtual-reality equipment, which is used to simulate ordinary civilian activities like crossing the street and driving a car.

Delgado and Medina have become advocates for victims of traumatic brain injury, or TBI, the signature injury of the Iraq and Afghanistan conflicts. Last week, Delgado was invited to attend President Barack Obama's State of the Union speech as a guest of Rep. Silvestre Reyes, D-Texas, whose district includes part of Fort Bliss.

In an interview with ProPublica and NPR before the speech, Delgado said the invitation was "very empowering because it tells me that leadership and people in Congress are paying attention to traumatic brain injuries," she said.

But not every soldier with a brain injury has been as fortunate as Medina.

The National Intrepid Center of Excellence at Bethesda National Naval Medical Center, Md. (Department of Defense)Delgado told ProPublica and NPR that she frequently receives calls from military wives who've had a hard time getting their husbands enrolled at NICOE, which has treated only about 200 soldiers since it opened in October 2011, center spokesman Joshua Stueve told ProPublica and NPR.

By comparison, recent estimates show that nearly 230,000 soldiers have been diagnosed with traumatic brain injuries, Stueve said. "We aren't going to make a huge dent in that population," said Stueve. Most of the center's $35 million budget is spent on research, not clinical care, he noted.

To get into the program, a service member must be referred by a physician at his or her local military hospital, agree to live with other soldiers in a group house near the facility, and plan to continue military service after treatment.

Brain-injured troops who don't plan on staying in the military have to rely on U.S. Veterans Affairs Department hospitals for treatment once they get out. But VA hospitals don't have the same resources or equipment as NICOE.

Stueve said troops at NICOE benefit from being treated by an "inverted system" in which a soldier has the opportunity to work with perhaps 10 doctors at once, instead of being at a hospital where there might be just one doctor for every 10 patients. The advantage, he said, is that a patient isn't shuffled to separate referrals from multiple specialists over the course of treatment.

Stueve said the center "doesn't keep data" on how many soldiers are rejected, and handles only 20 patients at a time for about four weeks of concentrated treatment.

"The real story here is patient experience," Stueve said. "The service members, when they come here, they feel like they are in control, and they play a huge part in their own treatment."

Delgado agrees but said she knows "that's not the case for all service members, because some are denied a chance to go to NICOE. This should be the standard of care for everybody."

The Pentagon plans to expand the NICOE system to other bases, Stueve said, but that effort could be stymied by pending defense budget cuts. The defense department is drafting a plan to cut $259 billion from its budget over the next five years.

The military is already having problems with its budgets for TBI and post-traumatic stress disorder. In a recent report to Congress, the Government Accountability Office said the defense department can't provide reliable data on how it spent $2.7 billion allocated to treat soldiers with brain injuries and psychological health problems.

Barry Schmittou

Jan. 30, 2012, 2:25 p.m.

God be with you Sgt. Medina and everyone else who has TBI.

ProPublica wrote :

“In a recent report to Congress, the Government Accountability Office said the defense department can’t provide reliable data on how it spent $2.7 billion allocated to treat soldiers with brain injuries and psychological health problems”

(end of quote)

I believe our soldiers deserve much better than that. If we are to provide the best treatment then the government should know how the money is being spent.

How about you all offer a slot in this program to Scott Olson.  He is after all STILL defending this country.

There is plenty of money sucking programs in the Government and GS positions that serve no purpose. These positions can be done away with to treat America’s Heros. I can not speak for everyone, but if every tax payer was taxed according to their income, meaning the more one makes the more one pays, we would have a budget to pay for this care and balance the budget. These Soldier volunteered to leave their families to go and fight! And in my opinion they deserve the very best that money can buy, regardless the cost America owes them, All of America!!!!

Will Poole
CW3 (RET)
Ft Bliss TX

Hope he says NO to contrasted MRI’s that use the metal
GADOLINIUM, it accumulates in the body, he better check his kidney function, eGFR , Creatinine, BUN, alk Phos, D Dimer- DVT or lung clot

that metal will accumulate w decreased kidney function, it breaks apart and leaves the Gd+3 to cause fibrosis, it comes out in the skin, causes you walk like you have cerebral palsy, extreme Rib or hip pain,constant, decreased appetite, fatigue, so overwhelming you can’t believe it.

Then they try to give anti depressants and benzos and other neuro meds, gabapentin, (Neurontin) and xanax, klonopin to “cover up” these symptoms which mimic TBI or you could say Total Body Imaging, as they give freely radionuclides , sure to do you in. So you won’t burden the US Gov’t.

Read The Plutonium Files, substitute Gadolinium and the nuclear tracers,  TC 99 or technetium, cardiolite, sestamibi 9.9 , myoview, isovue, this junk accumulates . It’s a chelator around the Gadolinium metal which is not to be in the human or animal body. They are out of control.

Search Technetium and all names for it, brand, what it’s attached to, Search gadolinium and fda.gov, they have a black box warning and radiologists are using this nuclear waste product in increased doses, more than what is written on the med record.

Search your radiology reports for all contrasts, add them up. If you have sx that are mrisideeffects or gadolinium toxicity or TC99 effects, you are in trouble with your health.

Not a single mention of Hyperbaric Oxygen Therapy, what a disgrace. With all the evidence pointing to the benefits of this therapy for TBI, you would think they would be using it.

See side effects of hyperbaric oxygen, see side effects, adverse effects of every medication they give you. Ask for the MD version and read the ingredients. See if you recognize any of them.
Good thought, though..

I work as a rehab asst. with the spine and brain injured,,we get minimum wage,
  They are mostly from motor vehicle accidents,car vs. tree, car vs. pedestrian, these people will be affected the rest of their lives..some minor some quads, paraplegics, some just cant remember where their room is ( even though it’s been in the same place for years ) 
The auto insurance for long term care of these people,,,the government and insurance company’s are tying to do away with..We need to be aware that these people can’t speak up or defend themselves,,so when you hear about a person with a variation of this problem,,,,REMEMBER it could have been you or one of your loved ones…when it comes to the long term cost of this remember to let your congress that you are NOT in favor of changing this bill.

Barry Schmittou

Feb. 2, 2012, 6:28 p.m.

Paula,

Thank you for sharing your experiences.

I hope sometime soon wonderful health assistants like you will be paid more. Thank you for helping those in need !!

Learning first hand TBI is no picnic.  Mind was from impact with a car windshiel vs head and classified severe.  SSG Medina’s sounds to be classified moderate with Severe symptoms.  Propublic’s initial impression is that our troops are not being cared for.  I for one disagree, to a certain degree.  I know from a personal stand point thru DOD POINT OF VIEW when others were doing minimal or rather limited intervention the military was seeking out TBI victims and have Identified 120,000 plus.  Initially my own VA provider commented on the VA limited care available, which being ironic since initially it was a VA Physician that started the initial hunt for TBI victims.  Fortunatly having never been exposed to an IED DO NOT HAVE that mechanism of injury.  Yet with first hand knowledge have become very familiar with the TBI world and what the other 5 million experience.  Feel normal but actions, thoughts, speech and concentration are like a stroke victim.  I am able to cope as a 60 yr old, but my heart goes out to our young warriors who have many years ahead of them.  Those that have added or coexisting PTSD need doube the support.  With the current trend for budget constraints and downsizing I would hope that the needs of the injured and vets doesn’t get forgotten.  There is a lot more from a rehab view that needs to be accomplished.  Research is starting to see new light and progress, even the sports world is starting to take notice.  Mine is addressed by the federal work comp FECA but they have yet to utilize HBOT, VIRTUAL Reality, and Cognitive Rehab.  Everytime I bring it up they tell me thats what Neuropsyche is for.  My fortunate recovery was obtainable thru the techs, assistants, rest and immediate or first hand intervention and extreme advocacy from my spouse.  The family and community advocacy, ombudsmen and support will be the holding power for our soldiers and civilians affected by TBI.  A big thanks and salute goes out to our soldiers, sailors, airmen and women.  May the TBI progress and awareness forge ahead.  This is an opportunity for military medicine to make an impact in todays treatment of TBI.

Just remember TBI is traumatic brain injury, neurological.

Those “magic” scanners and specially built PET and SPECT scanners using radionuclides and and MRI’s use gadolinium metal will ensure that the radioactivity and GADOLINIUM metal they will give to you for MRI scans that can track metabolic function and biological functions will be sure to give you TBI= total body irradation, too.

Gadolinium metal injected for the magnets in the MRI will also mimic stroke like symptoms, seizure, extreme fatigue, weakness, nausea, vomiting, muscle pains, skin changes , tightness, contractures, tremors, extreme mental fog, though you are totally clear headed, everthing is an effort.

It will also cause walking difficulties and falls, that can kill you. You can have elevated D Dimer- clotting , alk phos elevations, creatinine serum, blood in your sputum, GI tract,  KIDNEY injury, chronic kidney disease, and acute kidney failure.

This contributes to neurological changes, all of which they will recommend another MRI, in order to keep you loaded with Gadolinium, which accumulates in the bones, disrupts immune system, check your IgG’s and IgM, A, E, etc and subclasses.

They will be sure to recommend a 3 month f/u in order to give you more Gadolinium metal, with the chelator, DTPA, which is the radioactive part that dissociates from the toxic GD+3 and wreaks havoc in your internal organs, all of them. The FDA’s def of DTPA is aka Deceptive Trade Practice ACT.

It causes inflammation and fibrosis, and you are told you have nothing wrong with you, except, Depression, fibromyalgia, allergies, chronic fatigue or even Multiple chemcial sensitivies, in which Gadolinium metal does cause sudden allergic reactions which you’ve never had in your life. They Rx meds to “cover up” the symptoms of radiation poison.

You see the psychiatrist/psychologist to ensure you are still endoctrinated with info that radiation is safe. Read The Plutonium Files, declassified in lat 1990’s. Read DEADLY MONOPOLIES.
We do not have a humane, compassionate healthcare system anymore. There is no healing, cures, or treatments. You are a specimen and a nuisance to them, as your condition makes you a drag on society, you are poor, your ethnicity, disability, gender, chronic illness, terminall illness , single, pregnant, immoral, uneducated piece of **** to the societal elite that have to interact with you, God forbid.

This was then and it’s now, I’ve seen this similar content when a Cystic Fibrosis site requested donations , the comment was why give? They are a bottomless pit. 2010

TC 99 or technetium, is a nuclear waste product used in CT scans. It is combined now with gadolinium metal. TC is made from nuclear fission, molybdenum/MOLY COW generator. If poor quality, MO breakthrough, deadly sooner than if higher quality made/purified.

Is is no wonder they keep after you to get all these scans, for every body part, when in fact, one dose circulates throughout the body and stays in the body, for months, but they keep giving it to you several times.
By the time you’ve been treated with IV antibiotics, you may have decreased, permanent kidney function and also diabetes, from the TC 99 which is a known cause. There are numerous types of radionuclides and tracers.

MD’s and hospitals will continue to tell the public they are low dose radiation exposure from the scanners, except CT, because they INJECT the higher dose inside of you!

I have seen VA patients at the DENVER VA with TBI (brain) who have not been paid, treated and they are struggling.

But to have a brain injury and give GADOLINIUM metal and TC99 whatever form, is extremely cruel and a sure death. Do NOT defend the VA. The active duty military in 1993 held regional conferences that they were NOT going to treat TBI’s in the “next war”. I was given 1st dose of gadolinium in 1993 and did not know or remember. I knew that an xray showed the same result in 1980.

Soldiers would be discharged to the civilian system , medicare, medicaid and rehab or nursing homes. I attended that 2 day conference.

Shame of the US Military and DOD/Congressional planners. This next generation of soldiers, who knows what’s in store for them. With frequent Gadolinium and nuclear tracer exposures, and it’s put in common oral meds, lotions and not on the label or package insert, this upcoming generation WILL NOT be able to function. And are not protected from radiation exposure.

The US HAS NOT stopped injecting people with radiation since the Manhattan Project, using plutonium. They laughed at patients then, watched them suffer, did NOT provide relief from suffering, nausea, hair loss, wt loss, teeth loss, internal organ damage, tumors, sores, vomiting. Instead, they chose to give them MORE plutonium, recorded the “symptoms” of this cruel and inhumane experiment that extends today. SAY NO to all contrasted scans. Say no to radiation , all unnatural , medical radiation.

get tested for circulating Gadolinium at http://www.maymedicallaboratories.com for skin biopsy, which is the diagnosis and urine, 24 hr and random for gadolinium and kidney function as well as blood testing for circulating gadolinium. I have + skin biopsy and blood levels and skin sores currently. I had the last MRI in Sep and Dec 2010 at Denver VA. I have dec kidney function, that the eGFR is not always reliable, but infact, the kidney function is lower. I had the above symptoms and still do, they are to Rx NAC, not the NAC w the L in it pre CT scan, there are patents on detecting gadolinium and alleviating the gadolinium toxicity on freshpatents.com

@Janet,  sorry but I must comment.  Reading your posts brings to light many issues.  I fore one applaud your effort and message with caution and it drives me to consider more research or self learning.  I am afraid along with the insight and knowledge your comments are contaminated by the Axe to Grind impression you portray. 

I have been associated with AMEDD, Military since 1970.  Those in the trenches would like to use technology as a routine tool,  Yet, the trench medicine must and should rely on the Specialist and Scientific Experts that our society allows funding support.  The way I see it the military primary job is protect the public masses.  They do this within constraints of a budget.  Unfortunately the VA has the same perameters and limitations.

You have valid concerns. The military’s primary job is accomplishing the mission and the soldier insures this occurs.  The technology may not be as clear cut as one likes, but it is a start.  Awareness is our key. 

I see you mention Denver VA.  Are you a member of you sates local Brain Injury Association?  Colorado has BIAC,  No. Carolina has BIANC,  ETC.  These are civilian platforms for education and support.  But I feel that without positive attitude the negativeism stops the greasy wheel.

I can relate so many ways 1. TBI reviewer since 2007, 2.  Sustain a Severe TBI, Glasscow 3 Coma in 2009.  3 yr into recovery since injury following 2 week coma.  The initial MRI and Cat Scans missed my Traumatic C5 C6 Herniation until I regain consciousnes and told them to repeat than under went emergent C ervical Fusion.  I was on Dilatin and Fentynal patches,  wouldn’t come out of Coma.  The UNC T rauma team could only scratch their heads when they told her we don;t know why he won’t wake up.  See instructed to discontinue F-PATCHES and dilitan.  When she return next day I was out of coma.  Transfered home at Civilian facility received piece meal post stroke rehab.  Many diagnostic tests followed to include 3 cSPINE MRI s, a Diffusional MRI, a shoulder, a knee MRI, Left wrist MRI.  and a formal Spectscan.  A chestFloroscopy to see inferior vena cava basket.  All these were for diagnostic or therapeutic.  I have most of the classic symptoms mention in you post,  but told I am dpressed and TBI causeschronic fatigue, drowsiness and insomnia.  I had preexisting   Fibromyalgia symptoms prior to injury .  Than last year it was pblished that radiology was not monitoring Xray amounts acquired by patients who got CT Scans and MRIs.  With all the glow no wonder I have INSOMNIA.  aJOKE!  Did have lower leg abrasions sores rashes now resolved but again have Type II DM.  We in the military can only make do with what we are given.  Awareness, Research and funfing is needed both for our 120,000 military TBIs and 5 Million Civilians.  Maintain a positive attitude the best we can

A positive attitude can be maintained by not using Gadolinium metal.
Period. They know what it does and the outcome. There is trigger point fibroymalgia. I have that, but do not have the “neurotic fibromyalgia” that is diagnosed to cover the true symptoms of MRI metal, gadolinium.
You have had too many MRI’s and CT scans.

TC99 is known to cause diabetes. technetium. YOU need to get on the professional sites, those doctors will deny it flat out. All of them unless you can find a derm who will do the testing. Do you have tremors and tightness in joints, sunburned with sand on your skin? skin sores , hair loss, nausea, pain in ribs or hips? Gadolinium causes inflammation and that causes fibrosis of heart valves, kidneys, skin, lungs, diaphragm, muscles, permanent tendon shortening, extreme pain on extension of arms, legs, ankles, it goes to previous sites of inflammation, too.

Have you read about Gadolinium toxicity, side effects or anything about technetium? YOU NEED TO as do all the other soldiers. I ‘ve put this on the GulfWarRegistry site the VA had up for a month. I have it in my VA records and the VA doc agreed w me in person, but not on paper and he’s fired, too. Total idiot/liar. He knows I think this about him.
YOU are sicker now than before, right? traumatic brain injury can cause the same symptoms of Total Body Irradiation as in The Plutonium Files. I suggest you read it and get your blood tested for gadolinium levels at Mayo, yes they need to use the special Royal Blue topped vial, no metal and special needle to draw, all other lab vials, red tops, etc have zinc, lead, etc in them. Get a skin biopsy with the mayo requisition and special specimen container that mayo will send to your doctor at no cost. the skin biopsy costs $291., you need 2, one for slide/stains and the 2nd for the nitric acid dilution test or spectroscopy, which ever they do for the 2nd skin biopsy. It destroys the specimen.
Damn it , listen to me. They do moniter mSV of radiology and it’s reported to an agency that logs it. Radiation does not make you glow as in the comic reports or the luminous watch dials, but it does destroy your immune system, extreme fatigue, depression, nausea,insomnia, deep bone pain, hips or ribs, vision glares,halos/pain aka Fuchs corneal dystropy, which I was dx’d with, but do not have, and will prove it w DNA. It’s the metal in my eyes. Research/funding is adequately provided.

I told you I attended the 2 day conference that the AD military is not going to pay for the “next war w TBI”. That was 1993!
Yes, they will kill you and watch you suffer with the above sx you describe due to the excessive gadolinium and technetium levels you have in you. SEE your radiology reports, types of contrasts used, see your creatinine levels and eGFR which are often lower than reported.
It’s The GADOLINIUM Files and other metals/radionuclides, now.

@Janet Thank you for your commment and advise.  Yes many of my ailments you describe are present.  This is why awareness and education can be effective as an adjunct to treatment.  For myself this is both challenging and a mission.  But, my trust in the scientific and Army Medical world over rides my questioning which is more of a life long flaw, yet has gotten me here so far.  A little too much good can be bad.  I have voiced to many this whole TBI / PTSD BUSINESS is a “Catch 22”  IN OTHER words to provee there exist a TBI problem medical requires that it is proven not to be a blood clot, aneurysm, tumor or bleed.  Therefore the use of MRI/CT yet the medical field has the knowledge and understanding to go by a blood sample for TAU and history of mechanism thus decreasing the potential for further injury but doesnot answer the whole question,  is it only a TBI.  Unlike Sen. Gifford and her rehab not everyone can afford that care.  And neither Congress, insurance companies or the military will pay for appropriate rehab, rather HBOT, PT/OT or Cognitive Rehab.  Yes, its no surprise they won’t pay for TBI IN THE NEXT War.  The nation will be too involved paying for those that will develope Parkinsons, Early onset Dementia AND Alsheimers Tremors and Seizer Disorders now common to mTBI including MOD AND SEV TBI.  My case was a catestrophic federal work comp.  With wc they find the problem attempt resolution and turf.  Therefore the rampant apathy and obstacles to care.  It seems your issue with scans would make a good subject for another story.  Again thanks for info.

There already are ongoing reports about the MRIs even on Propublica.org, Jeff Gurth’s articles, see them.
You have mri side effects. I will not and cannot get anymore MRI,CT or xray due to the metal in my skin and body/blood. Do you understand?
Until you get skin symptoms or tightening of your skin, or tremors, difficulty walking, or if you already have these, you need a skin biopsy and review /total all your MRI contrasts , types and doses and check your kidney function by eGFR/creatinine on the basic metabolic panel. It’s hidden in the report. You still need to do this and read those scans for any fibrosis or dysfunction. You may have had these sx, but you will not know until you look for the before and after MRI and injuries. You’ll figure it out. They already know. They think you won’t know or do anything about any skin lesions as they’ll attribute it to your injury or just being “over there”. You are just one of many.
My A**H**** VA “doc” dropped me, canceled Rx and wouldn’t renew until I got my Congressman’s VA liaison involved. The new “doc” I requested is just as much a jerk. He believes me off record, but what he wrote in my record is BS. I went elsewhere and have + skin/blood for gadolinium. I will see a new kidney doc soon.

I will need to check into this.  My recovery is on an upslope a very long upslope.  Early on I came to realize TBI like stroke is a life long condition and one will do better if a person maximizes their strengths.

Good, cause when you die, it will be recorded as maybe, complications of TBI.  The 1993 conference referred to the next war as the Enduring Freedom, Iraq and Afgahnistans wars we are currently withdrawing from now. NOT THE NEXT war that all the glbt have been allowed to “join the military” to serve their country. We don’t know what’s in store for them. Yet.  I do not get anymore xrays, scans, etc due to the metal in my skin, it will cause radiation burns as the metal heats up ,, it retains heat /cold. You can not see the metal, it’s nanoparticles, but can see the reactions and the skin sores still present. Do not get anymore scans, a simple xray will show what any CT.MRI can do. You do have it in your system if your kidneys have dec function and they most likely do. Thank you for heeding my advice, see civilian derm, MD. Tell them all your scans, skin sores , any muscle tremors, do not be brushed off about the brain injury, yes, the sx overlap, but it can be determined about the gadolinium , which you need to know, as this will do you in before the brain injury or impending stroke that can happen with a brain injury, just because of the severity, in addition to the contrast material. Good for you!

This article is part of an ongoing investigation:
Brain Wars

Brain Wars: How the Military Is Failing Its Wounded

The military has failed to diagnose brain injuries in thousands of soldiers returning from overseas.

The Story So Far

Traumatic brain injury is considered the “signature wound” of soldiers fighting in Iraq and Afghanistan. Official military statistics show that more than 115,000 soldiers have suffered mild traumatic brain injuries since the wars began. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.

More »

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