August 20th, 2007 Post From Pat Dollard’s Blog.
Lance Cpl. Brian Vargas at Scripps Memorial Hospital
Having been hit by two IEDs large enough to blow me out of fully up-armored humvees, and having suffered my own medical consequences, this is an issue that is near and dear to my heart. And the Marine Corps is taking it quite seriously.
From The Marine Corps Times:
ENCINITAS, Calif. — It’s been a difficult six months for Lance Cpl. Brian Vargas, a young rifleman whose combat tour in Iraq was cut short by an enemy 7.62mm bullet. Evacuated to the U.S. after the January incident, Vargas endured several surgeries to repair damaged tissue and muscle in his torn hand and face.
But his combat wounds are more than skin deep: The shot threw his body forward, knocking off his helmet and slamming him and his exposed head onto a roof’s hard surface.
He was diagnosed with moderate traumatic brain injury, which is quickly becoming the signature wound of the Iraq war.
TBIs are caused by trauma or a concussion that can rupture blood vessels or bruise the brain, which can result in various disabilities affecting skills such as memory, communication, mental health or other behaviors. Patients with severe forms of TBI can lapse into a coma.
Six weeks after he was shot, Vargas began a new recovery program of intense days of therapy and rehabilitation at an Encinitas, Calif.-based outpatient treatment program geared toward combat-wounded vets like him. Since entering, he’s formed tight bonds with other wounded service members.
“It helps a lot,†said Vargas, with 3rd Battalion, 4th Marines. “It’s kind of like therapy, but it’s not. It’s kind of like life. It’s like, hey, this is what I used to do, hanging out with my friends.â€
The brain injury rehabilitation program was designed for TBI patients by medical teams at Camp Pendleton and Scripps Memorial Hospital-Encinitas, which is 14 miles from the base’s main gate. The program can accommodate up to 50 patients at a time.
As of mid-August, the program had “graduated†about two-thirds of its wounded military personnel, returning 22 of the first 31 active-duty patients who suffered closed-brain injuries back to full-time duty, hospital officials said. Several other patients have left the military and re-entered civilian life. So far, patients have spent an average of 12 weeks in the program, said lead therapist Jessica Martinez.
Small steps, big payoff
The partnership stems from a decade-long relationship between the Marine Corps and the hospital, which has treated Marines and sailors from Pendleton under an ongoing agreement with TriWest Healthcare Alliance. Scripps Hospital’s rehabilitation treatment programs are accredited by the Commission on Accreditation of Rehabilitation Facilities.
The first goal, Martinez said, is to educate the patient — who remains assigned to his local unit or the Marine Corps’ new Wounded Warrior Center at Camp Pendleton — about his injury and help him to explain it to his unit. Often, she noted, “their unit asks, ‘Why are you going down there?’ I think the unit support is a really big piece†of the rehabilitation.
TBI patients often suffer from memory loss and poor concentration — functions critical to keeping up with their rehabilitation and eventual return to their unit or the civilian work force.
“At the beginning, it’s hard for them to understand,†Martinez said. But memory “really improves in time.â€
To help them keep appointments, each patient gets a notebook and personal data assistant. They work on specific job-related tasks, such as studying combat vehicle manuals or creating a course of instruction for a class; build cognitive skills, such as sequencing skills and vocabulary; and do physical exercises, including boxing and “boots and utes†runs outdoors.
“We kind of do it gradually,†Martinez said.
Therapy also focuses on rebuilding patients’ everyday functional skills, such as paying bills, cleaning the house, scheduling appointments and even remembering to call Mom on her birthday.
Vargas spends three days a week at the hospital — 9 a.m. to 3:30 p.m. — then catches a shuttle van back to Pendleton’s Wounded Warrior Barracks where he lives. Visible signs of his injuries include the T-shaped scar between his left thumb and forefinger and a squiggly scar stretching about three inches across his right cheek.
On this particular morning, Vargas joined several patients on a 90-minute, 4.5-mile hike at Torrey Pines, a nature preserve that stretches across the picturesque bluffs along the Pacific Ocean several miles away.
On the hike, each patient wears a heart-rate monitor. Kirsten Chesney, an occupational therapist, said a patient often guts out some exercise but finds he’s petering out when his heart rate shoots up.
It’s been a steady road to build up patients’ physical endurance as they must retrain their heart and brain, not just their muscles. Most TBI patients initially experience balance issues, and it takes time to get their heart and brain accustomed to physical exertion.
The good and the bad
“I think that’s a huge obstacle for these guys — the pain, headaches; [they can be] severe,†said Chesney, who’s been working with Vargas since he began the therapy and who led patients on that morning hike.
“It’s really fun to watch, the sense of humor comes back out, the personality comes back out,†she said. “The anger starts to fade … you see the person start to accept and figure out what they’re going to do.â€
Patients are encouraged not to just ignore or “deal with†the pain, but to use it as a guide through the rehabilitation so they can heal and improve.
“We try to help them through that process, because through the last however many years, he has been taught to follow all orders and tough out pain,†Chesney said. “That is not something that is feasible right now. He’s got to go out there and be an advocate for himself medically.â€
The bullet damaged some of Vargas’ nerves, and subsequent scarring restricted the range of motion in his thumb.
But Vargas chuckled while explaining how he figured out how to use his four fingers to grab and grasp things. “I got kind of good, I don’t need this thumb,†he said, smiling.
Still, his thumb isn’t healed enough to let him play his favorite sport, football.
But Chesney is hopeful.
“The more he utilizes it, the better,†she said. “It’s still somewhat of a fresh injury. So there’s still a lot of room for improvement. There’s still time.â€
