Case Study: “Duane"

When Duane, a veteran who had returned from Iraq in 2007, came to us in 2011, his headaches and nightmares were destroying his capacity to function during the day. The headaches were constant, but varied in presentation. Most of the time there was “just” a constant dull throb “wrapping around” his entire head, but at least once each week he would have a full-blown migraine that could last anywhere from a few hours to a couple of days.

As for the dreams, they were all the same – an unknown evil force was looming behind him, threatening to annihilate him and everything he cared for.

Military physicians had prescribed a medication that stopped Duane from dreaming. It blocked his brain from dropping into the rapid eye movement (REM) portion of sleep. That took care of the nightmares, but it created new problems because the REM stage of sleep is necessary for the brain to process the day’s events and lay down memory to be retrieved later. Although he reported getting eight hours sleep most nights, he was sleep deprived; not feeling restored by sleep. Anxiety was building and he was having problems both at home with his large family and on the job with a variety of challenging personalities and demanding tasks.

While serving in Iraq & Afghanistan, he was close enough to three different High Order (HE) blasts to be knocked off his feet. Any one of those could have caused – or at least contributed to – his problems. Although he walked away from each of the incidents, other members of his unit weren’t so lucky. Duane had tremendous survivor’s guilt and minimized his problems when he compared them to the sacrifices his buddies had made.
Another factor in his health profile was exposure to burning oil fields. He reported it was impossible not to inhale at least some of the pollutants that were ever-present.

Returning one week after his first neurofeedback session, Duane reported he wasn’t feeling as tense; his headaches were reduced; he had slept a little better and his anxiety was more manageable, stressing that all the changes had been subtle. He also reported feeling more emotional, having cried while watching a program on TV. He also reported noticing more sugar cravings.

For some people, neurofeedback seems to take care of cravings; for others, it’s just not as helpful. Just as no two brains are the same to begin with, no two brains respond exactly the same way to our interventions. But there is another possible explanation – when people do neurofeedback, they often become more self-observant. Duane was “waking up” and noticing more about his own behavior and how his choices were contributing to his situation.
By Duane’s fifth visit, he reported his week had been “great” with only one nightmare and no sleep medication. He still was waking three to five times/ night, but was able to return to sleep easily. Tasks that he had rated as difficult, such as driving and talking with his kids, had become “ordinary”.
Soon after, Duane’s progress started to stall out. Although he was much better, there was other work than neurofeedback to be done. We discussed Duane’s eating habits again and noted he was still consuming an excess of simple sugars. Both Duane’s parents were practicing alcoholics which would predispose him to blood sugar dysregulation. In addition, his waistline measurement suggested Syndrome X, also known as Metabolic Syndrome.
Duane worked with naturopathic physicians who hypothesized exposures while in the military to environmental toxins (burning oil fields) as well as extensive inoculations were contributing factors to Duane’s problems. (In addition to the standard vaccinations for diphtheria, MMR, polio, and tetanus, he had also received shots for typhoid, smallpox, yellow fever, anthrax “and more” although the military did not divulge what those others were.) The goals with his naturopaths were to detoxify his liver, decrease his waist circumference and maintain steady blood sugar levels, all of which contributed to him being able to make significant strides, especially in his relationships with wife and their teenage children.

 

Brain damage can be caused by exposure to explosives even when there is no “contact” made with the head. In High Order Explosives* (HE) blasts - which are seldom seen outside war zones - supersonic, over-pressurized shock waves that move rapidly, much like a tsunami wave front, shatter objects in their path. These shock waves can affect any body part, although gas filled structures are the most vulnerable.

• Lungs – pulmonary barotraumas or “blast lung”
• GI tract – abdominal hemorrhage and perforation
• Middle ear – tympanic membrane rupture and other damage
• Kidneys – acute renal failure
• Brain – concussion, often without any sign of physical injury, “air embolism-induced injury” “brain blast”

It is hypothesized that the waves move through tissue, pushing gases ahead, forming bubbles. As the bubbles reach a critical volume, they pop, damaging surrounding tissue. [click for link]

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“It's a type of injury (“brain blast”) some military doctors say has become the signature wound of the Iraq war." [click for link]

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Whether a person is affected by blasts seems to be more a function of physics than anything else, with considerations such as distance from the blast and the angle of approach of the wave pre-eminent but essentially uncontrollable.

One thing that can be controlled is whether a helmet is properly padded. A point I find unconscionable is that optimally padded helmets are not, at least at the time of this writing, standard issue in our military.

*TNT, C-4, Semtex, nitroglycerin, dynamite and ammonium nitrate fuel oil (ANFO) are examples of High Order Explosives.

Syndrome "X" Chart