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Shortly after he'd been exposed to not one — but several — improvised explosive devices (IEDs), Chris Riga realized something wasn't right.
"The first time I noticed, we had been through multiple IED strikes within a week period years ago in Afghanistan. And, unfortunately, I was at a memorial ceremony, and I couldn't keep my balance after standing up for about two minutes," Riga says. "I'd have to grab onto something or lean against something to be able to stand for that amount of time."
Riga served several tours in Afghanistan from 2001 to 2014, eventually commanding all U.S. special forces there. During his 29 years in the Army's 82nd Airborne, Rangers and 3rd and 7th Special Forces groups, he also served in Africa and Iraq.
"We were always either preparing for combat or deployed in combat," Riga says. "Blasts and exposures were a daily incident. So I've always been interested in what effect that has on your brain, your body, and everything else."
After the invasion of Iraq, the VA and Department of Defense were confronted between 2004 and 2005 with a large number of traumatic brain injuries (TBI) and concussions from IEDs. In previous wars, people died from other injuries. Their survival rate from those injuries had improved.
Veterans Administration researchers in Boston were tasked with understanding the long-term effects of TBI. They decided to cast a wide net to look at variety of symptoms, such as post-traumatic stress disorder (PTSD), alcohol abuse and sleep problems.
It's now the most comprehensive study to date of blast injuries on post-9/11 veterans. A record number of veterans from around the country have enrolled in the study to find out what blast exposure has done to them.
"We don't only look at the military service period," says Regina McGlinchey, one the study's co-directors. "We look at what happened to these people when they were younger, before they were in the military, so we capture things like rock wars and sledding incidences when they were growing up--"
"Sports injuries and bar fights, and the whole gamut," interjects Bill Milberg, the study's other co-director.
"The whole nine yards," says McGlinchey, laughing.
McGlinchey, Milberg and other researchers at the Boston VA found exposure to blasts also resulted in changes to brain function and brain structure.
McGlinchey says they are not trying to understand just PTSD, or just TBI.
"It's like: What does war do to an entire person?" McGlinchey says.
"It's like: What does war do to an entire person?"Regina McGlinchey, one the study's co-directors
The researchers have learned concussions were not necessarily causing other symptoms veterans encountered. It was rare to find veterans with concussions and nothing else.
One of the researchers at the Boston VA, Laura Grande, decided to look at the impact of close blast exposure independent of concussion. She found the effects are the same whether or not a person had symptoms of concussion at the time of the blast. So she wanted to find out if blast exposure caused changes in behavior.
"And we found that these folks do have changes in their memory for verbal information," Grande says. "We had a large enough sample that we could really look at so many patients, and we could realize that it's not the PTSD that's driving this memory deficit. It's not the sleep deprivation. It's not the substance abuse. And I think what this study demonstrates is that's not all that there is, that there is something about blast exposure that is also associated with memory impairment."
At 54, Riga — the veteran who has served multiple tours in Afghanistan and works at the VA in Northampton — has had many concussions. He has traumatic brain injury. He has problems with short-term memory.
Riga says he is always looking for studies. He lives in Westfield, in the western part of the state, and works as a patient advocate at his local VA in Northampton. Once he learned about the Boston study, he volunteered. By participating in the VA research, he's learned new ways to cope with his memory loss.
"I go through a lot of stickies," Riga says. "My wallet is full of them. It's a tool. Rather than not only forgetting something and adding the stress of worrying about forgetting something, you can just simply write it down and knock out both the stress and the cause and effect of TBI ... ."
By working with some 800 veterans, including Riga, McGlinchey hopes the VA team can identify combinations of conditions that seem to predict poor outcome.
"So that we can target who it is that [is] going to need a lot of care, bring them in while they're still relatively young, and see if we can somehow thwart their trajectory, intervene early enough where we can have an effect and have an impact on the rest of their lives rather than letting the horse keep running out of the barn," McGlinchey says. "But first we have to know who to find, how to target.
"You can't just bring three million people who've been deployed in for help."
Veterans interested in participating in the study can contact study recruiter Wall Musto at 617-799-8617.
This segment aired on March 4, 2019.
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