Monday, July 19, 2004 - Sgt. 1st Class Alec Giess clenched his eyes shut as he struggled to recall how his fellow Oregon National Guardsmen found him after a truck, swerving to avoid a suspected land mine, ejected him onto an Iraqi roadway -- then rolled on top of him.

"If my boots weren't sticking out from under the truck, they probably wouldn't have found me. It was like the Wicked Witch of the East in ... " He paused, his face a mask of concentration. "What is that? Oh, yeah, 'The Wizard of Oz.' "

That effort to recall a film known and beloved by nearly every American is one Giess must bring to all his activities now, from remembering to eat lunch to arriving on time at his daughter's middle-school graduation.

Giess has more or less healed from many of the injuries he suffered when the transport truck landed on his body and gave him cracked vertebrae, a broken collarbone and shoulder and bruises where his life-saving body armor pressed into his skin.

But he still suffers from traumatic brain injury, or TBI, a wound that has proved unusually common in the Iraq conflict, in which new body armor saves soldiers from injuries that would have killed them in the past but can't keep their brains from banging against the walls of their skulls.

Giess, who reaches his 45th birthday this month, is being treated at the Veterans Hospital in Palo Alto, Calif., home to one of just seven centers in the nation dedicated to researching and treating traumatic brain injury in veterans.

While experts say that perhaps 20 percent of injured veterans of past wars suffered from TBI, early estimates from screening at Walter Reed Army Medical Center in Washington of injured troops returning from Iraq deemed at high risk for TBI suggest that, whatever their other wounds, as many as two-thirds also had brain injuries.

The numbers are still being studied, but several factors may be contributing to the increase, researchers say. They say better medical technology and awareness may be leading doctors to look more carefully for signs of TBI. Researchers also blame modern warfare and the unique nature of the Iraq conflict.

Modern armor is strong enough to let a soldier shrug off a direct hit from a rifle round, and cutting-edge battlefield medicine is keeping more casualties from becoming fatalities. But the standard-issue helmet doesn't guarantee protection against impacts that cause brain injury, and battlefield medics can do little to treat it.

And the weapons preferred by those attacking U.S. troops in Iraq -- land mines, improvised explosives, mortars -- deliver exactly the kind of concussive blast that can cause TBI, even if soldiers suffer no obvious external injury, researchers say.

The results can easily be overlooked, even by sophisticated medical tests. Soldiers have checked out of hospitals without knowing they had a brain injury.

"They were just sent home, and we found out only retrospectively that there were many, many problems," said Henry Lew, medical director of the Palo Alto VA's Comprehensive Rehabilitation Center.

The symptoms of traumatic brain injury -- irritability, poor memory, disinhibition, anxiety and depression -- can make day-to-day life a struggle. In severe cases, it can lead to inexplicable, violent confrontations with strangers or family members.

But unlike amputation, paralysis, burns or other physically disfiguring wounds of war, TBI's scars and symptoms are subtle and all too easily dismissed as personality quirks or moodiness that seem natural after combat.

"TBI is a silent handicap," Lew said. "If you met (a patient) on the street or in a bar or anywhere, you would never notice they had TBI."

Take Army Spc. Rigoberto Oceguera, a 23-year-old Chico, Calif., native now convalescing with Giess in Palo Alto. Without close inspection, little on his body betrays the fact that he barely survived, plummeting hundreds of feet from the sky, when his Chinook helicopter was shot down by a missile outside Fallujah in November.

The attack killed 16 soldiers and injured 26, including Oceguera. Today, his lungs are free of blood, his broken pelvis is healing, his eye is back in its socket, and healing scars hide where his spleen was removed. On the outside, he looks much like the young man who joined the Army with dreams of making its tae kwon do team, maybe turning military service into a career, with time out to compete in the Olympics.

"I can still kick," he said proudly during a recent interview. "Yesterday was my first day to run. I ran around the hospital."

But some problems haven't gotten better. Oceguera, never a strong student, once harbored hopes for college. Now, he has even more trouble learning. And inside his head, he has other scars, other losses.

The last memory he has of his time in Iraq is watching the movie "Resident Evil" with some buddies sometime around Halloween.

His next memory is of coming to his senses in a bed at Walter Reed.

"It felt like I fell asleep in Iraq, and I woke up in the States," he said. "I didn't know what had happened to me."

Oceguera can't recall the accident, which killed one of his Army buddies. He couldn't recall the man's name until he saw his face on a memorial Web site. He can't remember the first time his family visited him at Walter Reed, when, his mother says, he seemed to think he was still in the war, maybe imprisoned. He can't recall "President whatshisname ... Bush" visiting Walter Reed in mid-December.

And he can't recall re-enlisting, an event that occurred sometime between "Resident Evil" and the crash, but which Oceguera only discovered when he noticed that his identification card -- with a photo of him in a coma -- had a separation date three years later than the one he remembered.

"Weird" is the only word he can think of to explain how he feels.

Most symptoms of TBI are so subtle that it is often a family member who first detects a problem, Lew said.

Giess' wife, Shana, noticed after his return that the easygoing, relaxed dad who went to Iraq had become a quick-tempered man who couldn't remember the family's daily schedule, jumped up screaming when the family cat landed on his bed and couldn't tolerate crowds.

The world inside his head, Giess said, was even stranger: He felt bewildered, with no sense of time other than "daytime" and "nighttime." He also felt cut off from his emotions.

"When my kids come and hug me, I don't feel a thing," he said.

In retrospect, Shana Giess said, much of her husband's behavior reminded her of the special-needs children she works with as an educational assistant.

"When they finally diagnosed him, it all made sense," she said.

After some errors he made filling out a standard military form brought him to the attention of a neurophysiologist, Giess was transferred to Palo Alto, where he has been trying to reconstruct his old self through a program that uses intensive scheduling and repetition to try to retrain the damaged mind.

"You teach yourself something, then the next day you've got to teach it again. And again. And again." Giess said. "Remembering how to remember."


INJURY SYMPTOMS

These are some of the common symptoms experienced after a brain injury. Veterans or their family members with questions about TBI can contact their local Veterans Affairs hospital or the Defense and Veterans Brain Injury Center at 800-870-9244 or www.dvbic.org.


Persistent headaches

Difficulty remembering

Trouble concentrating

Feeling unusually tired

Changes in sleep

Mood changes

Ringing in the ears

Confusion

Irritability
Source: Veterans Affairs Palo Alto, Calif., Health Care System



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