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Treating Traumatic Brain Injury and Caring for Our Veterans

Dec 14, 2015
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On Friday, Dec. 4, I had the privilege to visit the Palo Alto VA facility and Stanford University to learn about their neuroscience programs, especially how those programs may apply to veterans returning from combat with war injuries that relate to brain functioning and veteran well-being. It was a heck of a visit, and I can tell you, the enthusiasm that everyone showed was highly infectious. One reason for my visit and for their enthusiasm is that I wrote and passed the Traumatic Brain Injury (TBI) law to provide resources for research and treatment of this injury, the signature injury of the Iran and Afghanistan wars. I also wanted to see how the resources are being used.

We first arrived at the Palo Alto VA campus to an awaiting group of scientists including my daughter, M. Windy McNerney, a neuroscience post doc at the VA and Stanford. I was escorted up to the 4th floor, the nerve center of the War Related Illness & Injury Study Center, or WRIISC, (pronounced ‘risk’), and got to meet the entire staff consisting of scientists, medical professionals, and technicians. As the name indicates, WRIISC’s mission is to help veterans returning from combat through both conducting research to find new treatments and applying known treatments.

The staff, led by J. Wesson Ashford, MD, PhD, had prepared a viewgraph presentation for me consisting of 50 slides. The presentation outlined the WRIISC program and its accomplishments, the types of symptoms veterans experienced were identified and quantified, and the some treatments were described. Following that, some specific cases were discussed illustrating how combat incidents impact the brain, how diagnostic tools are being used, and the research to improve diagnostics and treatments.

I was also impressed with a discussion of concussions, which are related to TBI. Apparently, concussions involve accelerated stretching of the neuronal axons, particularly within the white matter of the brain. This causes damage, which takes time to heal. Repeated concussions, especially if there is not sufficient time to heal, compound the damage and weaken the structure of the axons. Ultimately, with repeated or strong enough stress, axons, which are only about 1 micron thick, will break, causing permanent damage. When enough axons are damaged or broken this way, brain performance can be greatly diminished. Recognition of where the damage in the brain had occurred and appropriate treatment can provide significant relief or improvement, as indicated in one specific case that was illustrated.

After the presentation, I met with several veterans who were patients at the hospital. It always touches me to see these young men and women who have sacrificed so much for our nation, and the support their families show.

Out of time for our VA visit, I was whisked off to Stanford for a town hall lunch with students and faculty, mostly from the neuroscience field. The discussion was wide-ranging. Some focus on the importance of science policy and research but, interestingly enough, the dominant subject was the problems caused by  our broken campaign finance system.

After the town hall meeting, I had the opportunity to visit the laboratory of Professor Bill Newsome. He has some fascinating work measuring how the brain responds to visual stimulus, especially in regard to decision-making.

Following that, we visited Davis Camarillo’s lab, which is focused on measuring concussions of football players by using upper jaw mouth guards to measure impacts which are later correlated to measurable concussions. This can be used to help identify concussions in real time so players can be removed if needed before more serious injuries occur, to design better protection, and for other purposes.

Dr. Jennifer Raymond, who I had met at the Washington D.C. neuroscience conference last January and who helped organize the trip had me in her office to describe her work, which involves how the visual system and the rear of the brain, the cerebellum, are used in learning. We had the opportunity to visit one of her labs to witness how direct stimulus impacts learning in mice.

Our last lab visit was to an imaging center, where student volunteers use a 3T MRI to better understand brain imaging. They use commercial MRI hardware, but have written their own software controls.

My last visit of the day was with the center directors for a briefing on their programs and how they relate to veterans. The directors had a significant ask: They are facing mountains of red tape in transferring patient information from the VA to Stanford, where significant resources can be brought to bear in treating the veteran community. There are about 10 academic institutions around the country that have partnerships, like the one between Stanford and the Palo Alto VA, to help treat veterans. If some exemptions can be found so that data can be more readily transferred between specific VA centers and their academic partners, treatments and outcomes can be greatly improved.

It was an honor to meet with so many prominent scientists who graciously spent time with me to share their work, both at the VA and at Stanford. I also am grateful to Stacy Moeder at the VA and Tanya Raschke at Stanford for hosting me and making the visit smooth and productive.