For the past several months, I’ve conducted interviews with a number of medical professionals to get their perspective on concussion and TBI.
This month I did something different. I spoke with a physician and a veteran at the VA in Martinez, CA. They gave their perspectives on brain injuries and how the Martinez VA is addressing these types of interviews. I interviewed physiatrist Dr. Hetal Lakhani and 38-year Army veteran, Richard Reyes, who sustained three brain injuries during his military career. (For more about his story, read my summary of it based on his interview here.)
TBI is often comorbid with depression, anxiety, and PTSD, particularly in service members and veterans. I thought it would be interesting to piece together an overview of the topic by looking at it from each of their perspectives. Of course, I encourage you to watch the interviews in their entirety. You can watch my interview with Dr. Lakhani and Richard Reyes here.
Neurologic or psychological? Sometimes hard to tell
Comorbidity of TBI with PTSD, depression, anxiety, and other mood disorders is easy to understand intellectually, but what is it like to really live it?
That’s the perspective Mr. Reyes gave us in his interview. He sustained three brain traumas in his military career and received medical attention for two of them at the time of injury. He believes it was the second of the three – when he fell from the second story set of a set of concrete stairs, injuring his shoulder, back, and head in the process – that was the worst.
In our interview, Mr. Reyes recounts one very illuminating story. He was on leave for two weeks and back with his family. His wife wanted to go to the mall but he didn’t want to go; he was angry, the mall was too noisy, there were too many people, anything could happen. Despite his reluctance, he accompanied his wife anyway.
He had a difficult time at the mall, lagging behind his wife who walked far ahead of him. He noticed he was hyperaware and was feeling very uncomfortable – Why is that man wearing a jacket when it’s hot out? Does he have a gun? Is something bad going to happen? He couldn’t explain what he was feeling to his wife, but it was intense. That night, he didn’t want to go to sleep. He was too wound up.
I think this anecdote is so revealing. It shows how Mr. Reyes felt disconnected from his wife, unable to communicate with her what he was feeling and why; he felt disconnected from himself, unable to “turn off” his hyperawareness and control his feelings; and his day-to-day life was negatively impacted by his symptoms, which made a simple trip to the mall an ordeal. This is just one example of the reality of living with the fallout of brain trauma. Is this neurologic or psychological fallout? It may be hard to determine, and it may be a combination of factors.
Diagnosing the problem
As a physiatrist, Dr. Lakhani’s specialty is physical medicine and rehabilitation (physiatry). An important step in the rehab process is correct diagnosis. She notes that comorbid mental health disorders are correlated with higher rates of post-concussion symptoms and poorer outcomes. For that reason, it’s important to identify any mental health issues. This occurs during the intake and evaluation process.
First, the patient takes a 4-point questionnaire to screen for TBI, which has been mandatory since 2007 for certain veterans seeking VA treatment, if they served in combat operations after September 11, 2001. If it’s positive, they get a referral to the TBI program. There they undergo a comprehensive TBI evaluation, including a 16-point neurobehavioral symptom inventory. The answers here, Dr. Lakhani says, aren’t definitive, but can jump-start a conversation on the topic and lead to correct diagnoses. Referrals to a mental health specialist may come next. There, veterans get a comprehensive biopsychosocial evaluation and are treated based on that. It’s a multi-step evaluation process that helps identify any potential emotional and mental health issues, even if the veteran didn’t come seeking treatment for that particular issue.
Watch this month’s interviews
Retired veteran, Mr. Richard Reyes and Dr. Lakhani share a lot more with me on the topic of veterans and brain trauma in our interviews. You can watch them here.