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By Lisa Morris Bonsall, MSN, RN, CRNP

Lisa Morris Bonsall, MSN, RN, CRNP is the clinical editor for Lippincott's NursingCenter.com. Lisa has been a nurse for 15 years with experience in critical care and women’s health.

Created: 08/12/2010
Last Updated: 08/01/2012

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Q: I’m so grateful to have my husband home from Iraq in one piece. But, since his return, he has had trouble sleeping and trouble remembering simple things. And, he seems down to me. These symptoms seem different from what I know about post-traumatic stress disorder. Of course, he doesn’t want to go to his doctor. What can I do to help?

You are wise to ask about these symptoms – and there likely are others you may not be mentioning or haven’t noticed yet, such as short-term memory loss, fatigue, dizziness, attention problems, irritability, or severe headaches that may get worse with strenuous exercise.

Do you know if your husband was exposed to an explosion or blast during his tour of duty? If so, he could be suffering from one of the most common injuries inflicted by these wars: traumatic brain injury or TBI. Traumatic brain injury—sometimes called closed-head TBIs (rather than penetrating traumatic head wounds), happen when the body (and brain) is exposed to a blast or an explosion and the “blast wave” that follows. After an explosion, a shock wave of high pressure is quickly followed by a shock wave of low pressure – sort of a reverse blast wave. These rapid changes in pressure are believed to lead to brain trauma such as concussions, brain swelling and stroke. Of course, the blasts also can cause bodily harm from flying objects or as a result of being thrown through the air.

Your husband’s medical record should indicate if he was involved in any blast-related incidents and possibly screened for TBI at the time. Among all wounded troops, the incidence of TBI may be as high as 22 percent, according to experts familiar with contemporary combat injuries. Traumatic brain injury can go unrecognized and untreated, particularly if there are no other obvious traumatic wounds involved—and, sometimes even when there are. Symptoms of TBI can be similar to post-traumatic stress disorder, but this is a different war-related condition and needs to be evaluated and treated differently.

It’s understandable that your husband is reluctant to talk about his symptoms. TBI-related symptoms can be difficult for veterans to acknowledge because they may consider the symptoms minor compared with injuries they’ve seen fellow troop members suffer. However, when left undiagnosed, TBI symptoms can begin to significantly interfere with daily life, lead to anxiety, depression and possibly drug and alcohol problems, and can put added stress on relationships. You and your husband deserve to have him evaluated for TBI. Simple and effective strategies exist to cope with his symptoms and, sometimes, medication may be recommended. Coping strategies suggested by your health care team may involve one or more of the following:

  • Making and relying on lists instead of short-term memory
  • Creating a sleep environment without any distractions or noise and using stress-reducing exercises like deep breathing before bedtime
  • Reading for short periods of time twice a day to improve attention
  • Asking for and reviewing information about TBI to better understand how the condition may be affecting your husband and you.

It’s important to work with a health care team who is knowledgeable about brain injury. A number of resources are available through the Veterans Administration. I recommend starting with the Defense and Veterans Brain Injury Center: www.dvbic.org. There is good news: most people with mild TBI return to their normal functioning over time, though you and your husband may find some symptoms persist.

For more information on this topic and related conditions, visit our Military Veterans' Health and Wellness Center.