Archive for March, 2018

Dr. Rauch, Clinical Director of Emory Healthcare Veteran’s Program, talks about Veterans reintegration and mental health.

Most servicemembers will have some type of adjustment period after returning home from deployment. For each person the process is different depending on different variables during and after deployment. Mental health issues, traumatic brain injury and military sexual trauma can make that even more difficult. The Emory Veterans Program is here to help them reclaim their lives.

Question:
How long does it usually take to adjust to normal life again? How long should I wait to see someone if I’m still not feeling like my normal self?

sheila-rauch-avatar

Dr. Rauch:
That is a good question. If at any time you’re having issues that you feel that you need or want help with, you should come see us. Readjustment often takes a year, and for some people longer, to feel like they’re really back in their life. The readjustment process is different for every individual and often depends on life’s variables, such as your job, social support and your family. It’s never too early to come talk with someone familiar with military service and deployment about your experience. Reintegration can be a difficult process. Mental health issues, traumatic brain injury and military sexual trauma can make that even harder. The Emory Veterans Program is here to help you reclaim your life.

Question:
My brother has seemed moody and depressed since he got back. Is there a good way for me to help him or encourage him to talk to someone about how he’s feeling?

sheila-rauch-avatarDr. Rauch:
It is common for returning veterans to have problems talking with people who have not deployed. While most veterans returning don’t have mental health issues, a significant minority may have problems with depression, posttraumatic stress or traumatic brain injury. Letting your brother know that you’re willing to listen or help is probably the best thing you can do. Sometimes it just takes patience to allow someone to open up.

 

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Traumatic Brain Injuries (TBI) Explained

Severe traumatic brain injuries affect people of all ages and are a leading cause of death and disability among young adults and adolescents. According to the Centers for Disease Control and Prevention, traumatic brain injuries were involved in 2.5 million emergency room visits, as well as the death of nearly 50,000 people in 2013. Motor vehicle accidents account for the majority of these injuries, but they can also result from falls and violence. Regardless of the cause, treatment is divided into three stages: early management of life-threatening conditions, prevention of secondary injury and long-term rehabilitation.

Early Management of Life-Threatening Conditions

Immediately after a trauma, paramedics identify injuries and begin treatments to stabilize a patient’s breathing and blood pressure. The patient is then rapidly transported to a trauma center that quickly diagnoses and begins treating a wide variety of injuries. Shortly after the patient arrives in the emergency room, a CT scan of the brain is obtained to identify life-threatening blood clots within the skull. A fracture of the skull or a torn artery can cause bleeding on top of the covering of the brain known as an epidural hematoma. Epidural hematomas are often emergencies requiring immediate surgery to remove the blood clot and stop the bleeding. Similarly, bleeding can occur underneath the covering of the brain and lay directly on top of the brain itself, which is referred to as a subdural hematoma. Subdural hematomas can occasionally resolve without surgery; however, many are large and require surgical removal. Surgery to remove blood from inside the skull is an emergency, with untreated patients suffering permanent disability or death.

Prevention of Secondary Injury

Once the life-threatening injuries have been treated and the patient has stabilized, doctors then focus on preventing “secondary” brain injuries. Just like your arm, when the brain is injured it can form a bruise and swell. If swelling becomes severe, pressure can build inside the skull and cause damage to the previously uninjured brain. It is often necessary to place a tube into the brain, called an external ventricular drain, to monitor the pressure inside the skull. This tube also drains spinal fluid to help decrease pressure. If the swelling continues to worsen despite this treatment, a decompressive hemicraniectomy may be necessary to temporarily remove a portion of the patient’s skull. This allows for the brain swelling to continue and not cause further damage to the normal, healthy brain. This stage can persist for over a week.

Long-term Rehabilitation

As swelling begins to recede and injuries to other parts of the body are treated, the focus shifts towards maximizing a patient’s long-term recovery. This often requires a prolonged period of inpatient rehabilitation with vigorous physical and cognitive exercise, as well as a slow and frustrating process lasting for months.

The most important aspect of caring for patients with traumatic brain injuries is having an experienced and cohesive team capable of delivering rapid, high-quality care during all phases of a patient’s recovery. The first few hours and days can be stressful for families and loved ones as the patient’s condition changes rapidly while the later stages require patience as the progress is slow. It is important to ask questions of your doctors to understand the current goals of therapy. Taking notes and writing down questions can be helpful, particularly early on as you will meet many doctors and nurses with different roles. Many patients, especially young adults often affected by severe traumatic brain injuries can make remarkable recoveries with aggressive treatment.

Emory Rehabilitation for Brain Injuries

At Emory, we understand the complicated needs of patients during this recovery process and have a dedicated group of physicians and therapists focusing exclusively on rehabilitation following a severe brain injury. To learn more information about our rehabilitation services, visit www.emoryhealthcare.org/rehab.

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About Christopher Deibert, MD

Christopher Deibert, MD, is an Assistant Professor of Neurosurgery at the Emory University School of Medicine. His specialty interests include malignant and benign brain tumors, high and low-grade glioma, metastatic brain cancer, trigeminal neuralgia, hemifacial spasm, traumatic brain injury, acoustic neuroma, carpal tunnel, normal pressure hydrocephalus, Chiari malformation, idiopathic intracranial hypertension, spinal stenosis and degenerative disc disease.

Dr. Deibert’s research interests focus on neurocognitive outcomes in patients with brain tumors, functional applications of radiosurgery and clinical applications of fiber tractography/diffusion-tensor imaging. Dr. Deibert completed his neurosurgical residency at the University of Pittsburgh Medical Center, where he also received his medical doctorate.

Sleep Apnea and the Gender Difference

What is Sleep Apnea?

Sleep apnea is a common disorder where one’s breathing involuntarily and repeatedly starts and stops during sleep. There are three different types of sleep apnea with separate root causes:

  • Obstructive Sleep Apnea (OSA)– the most common form that occurs when the throat muscles relax
  • Central Sleep Apnea – occurs when the brain does not send the correct signals to the muscles that control breathing
  • Mixed Sleep Apnea – occurs when someone has both obstructive sleep apnea and central sleep apnea.

Obstructive sleep apnea can have serious health consequences including high blood pressure, heart disease, stroke, pregnancy complications, metabolic disorders, and cognitive and behavior disorders, and higher risks for car crashes and work-related accidents. Central sleep apnea has health consequences associated with heart failure, opioid use, strokes, and brain injuries.

Signs and Symptoms

Commons signs:

  • Reduced or absent breathing
  • Frequent loud snoring
  • Gasping for air during sleep
  • Restless sleep

Common symptoms:

  • Excessive daytime sleepiness and fatigue
  • Decrease in attention, concentration, motor skills, and verbal and visuospatial memory
  • Dry mouth or headaches when waking
  • Decreased libido
  • Waking up often during the night to use the bathroom
  • Irritability due to fatigue
  • Loud snoring followed by a period of silence

Did you know that sleep apnea in women is different compared to men?

Sleep Apnea in Women Compared to Men

Sleep apnea in women differs from men due to their individual set of hormones. Women’s sleep cycles are typically shorter and women deal with sleep deprivation differently compared to men. However, the prevalence of obstructive sleep apnea in women is similar to men after women experience menopause.

Studies have shown that women are less likely to be diagnosed with sleep apnea because of the subtle symptoms they experience, therefore many go undiagnosed. The signs in a female may not be as obvious as it is for men. It is commonly mistaken for depression, hypertension, hypochondria, and other disorders. Women experience subtle symptoms including:

  • More insomnia
  • Daytime sleepiness and fatigue
  • Trouble functioning during the day
  • Morning headaches and moodiness
  • Anxiety
  • Sleep disruption

If you think you are potentially suffering from sleep apnea, please call HealthConnection at 404-778-7777.

About Emory Sleep Center

The Emory Sleep Center provides state-of-the-art care for all types of sleep disorders, with the goal of providing expert service in a relaxed environment with comprehensive diagnostics and therapeutics. We offer all forms of sleep diagnostic testing, as well as traditional and cutting-edge therapies.

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The Impact of Brain Injury on Veterans

Nearly 20% of deployed military personnel experience traumatic brain injury (TBI). TBIs are any brain injury caused by an outside force. These injuries can be “closed,” such as from a fall or motor vehicle accident or “open,” like from a gunshot wound.

Traumatic brain injuries range broadly from mild to severe. People with mild TBI (also called concussion) often fully recover within days to weeks, while those with severe TBI may have significant and sometimes permanent impairments. Fortunately, 70 – 90% of all TBIs in military personnel fall within the “mild” range.

Symptoms of Mild TBI

Traumatic brain injury can cause physical, cognitive and emotional difficulties.

Typical symptoms of mild TBI/concussion include:

  • Looking and feeling dazed
  • Being uncertain of what is happening; feeling confused
  • Having difficulty thinking clearly or responding correctly to simple questions
  • Being unable to describe events immediately before or after the injury occurred

Complications of Mild TBI

Although most with mild TBIs fully recover within a matter of days, a small percentage have symptoms that persist for months or even years. What causes this? Research shows outside factors may interfere with the brain’s recovery. What begins as a neurologic injury is complicated by other non-neurologic factors, such as chronic pain, side effects of medicines and psychological distress—all of which cause similar symptoms to TBI.

These outside factors are commonly experienced by veterans because in many cases their brain injuries were the result of a blast that also injured other parts of their bodies. In addition to their physical pain, injured veterans also commonly experience posttraumatic stress disorder (PTSD), anxiety disorders and depression.

Brain Injury Awareness Month: Not Alone

The Brain Injury Association of America (BIAA) leads the nation in observing March as Brain Injury Awareness Month. They work to build awareness of the condition and support individuals with brain injuries and their families.

Help for Veterans with TBI

Emory Healthcare Veterans Program offers expert and collaborative care to help heal the invisible wounds of war. Our comprehensive approach combines psychiatry, neurology, rehabilitative medicine and family support to help veterans reintegrate and reclaim their lives.

A coordinated treatment plan may include:

  • Cognitive rehabilitation
  • Education about typical recovery and common barriers
  • Management of orthopaedic injuries and chronic pain
  • Medication management
  • Psychotherapy
  • Complementary medicine (yoga, meditation, acupuncture, sleep medicine)

 

 

Learn more about the Integrated Memory Care Clinic

Call for more information, call 888-514-5345