Monday, March 31, 2008

Untreated Post Concussion Syndrome in an Aging Vietnam Vet

Thanks to Christine Finer.

this is about McCain. A friend who suffers from traumatic brain injury shared this with me

Untreated Post Concussion Syndrome in an Aging Vietnam Vet

My last blog related to lack of concern in Washington and within the VA about Vietnam era brain injury survivors. I would like to give an example of such a person, albeit a person who is hardly homeless. It has come to my attention that a Vietnam era vet has been reported to have wild temper swings and increasing difficulty remembering things. He seems to forget having met people, can show increasing difficulty remembering people and seems to be having trouble with the fluency of his speech.

I confess my own bias. I find a brain injury explanation for almost any pathology, but usually my suspicions are based in fact. One of the developments we have seen in brain injury research in the last decade is research into the relationship between early onset dementia/Alzheimer's disease in those with a history of brain damage. See for example the abstract Prog Brain Res. 2007;161:303-16. Traumatic brain injury and Alzheimer's disease: a here.

This individual is 71. In college, he was a boxer, who was known for his reluctance to backup. Of course, there is long documented research on early dementia in boxers. See for example research on dementia pugilistica. For one article, click here.

After college, he first suffered a significant concussion when in a fighter jet accident, where he was knocked out when his jet crashed into a bay; he was fortunate to awaken before he drowned. Then, a year or two later, he was on an aircraft carrier when he was knocked to the ground and dazed and confused by an explosion that killed more than 100 people.

Then, in the most serious of incidents, his jet was shot down and, in the process of ejecting from the burning jet, he was knocked out. He also suffered serious orthopedic injuries in the ejection. After barely surviving this crash, he was then subjected to repeated torture and-- perhaps most seriously-- he was nearly starved to death.

Starvation can cause a condition called demand hypoxia, which can cause very serious long term brain damage, because the brain cells do not get enough nutrients to maintain health. See Neuropsychol Rev. 2001 Sep;11(3):131-41. Neuropsychological issues in the assessment of refugees and victims of mass violence and also articles on hypoglycemia and brain damage.

In looking at this history, we have a history of boxing, three serious concussions (one of which may have been a severe brain injury) and then starvation. Overlaid on this organic history, he was undoubtedly exposed to extreme emotional distress and beatings, which would be expected to result in Post Traumatic Stress Disorder.

Is this person homeless? No. Is he in a VA rehab center? No. He has had a great recovery, one of those miracles that I often talk about. Yet, now with concerns about his emotional lability and perplexing memory issues, should the questions now be asked about approaching senility?

The man is seventy-two. Why would this be such a concern? Well, he is being considered for a high pressure job, the kind of job where he must function under the most extreme stress imaginable, at least until he is 76. He is applying for the job where he has to diplomatically deal with the world's crisis at 3 a.m. Those who have been following politics have by now recognized him. He wants to become the president of the United States. This history is of Senator John McCain.

The current news media controversy is swirling around whether McCain's history of melanoma could affect his fitness for this office. Not to dismiss that concern, but shouldn't we be more concerned about whether this man is now showing signs of the type of early dementia that his history would predict?

For a documented discussion of his biography and his medical trauma history, see
See also the MSNBC documentary on his life, including actual video footage of the Forestal disaster. Also of more than passing interest in McCain's biography is where he graduated in his Naval Academy class: 894 out of 899.

For a discussion of McCain's temper issues, see
htm See also Ron Kessler's detailed treatment of his temper in Newsmax (and possible relationship to his POW time) at

What these stories miss is his history of concussion even before his POW time.

Further, what we know about brain injury is that if a person has a tendency to have an emotional issue, brain damage will invariably make that worse. I will write at greater length on this issue on another day.

The last seven years of the Presidency has raised the issue: Should we not subject our presidential candidates to at least the intelligence testing that a NFL draftee would undergo? The Wonderlic IQ test. In the case of John McCain, I do not personally feel comfortable that this man can do the most difficult job in the world, until we see the results of detailed neuropsychological testing. The President of the United States is not a job for a man who has pathological problems with his temper, stress and memory. Not to decry or devalue his years of service to this country and the admiration for his survival of his years as a POW. But this job isn't a reward for past heroism. The fate of the world may lie in whom we choose.


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