We got back from Fort Drum last Friday night,and the week went well. On Tues Rick had Behavioral Health,and Part 1 and Part 2 of his physical. Behavioral Health is a fancy term for "we are going check to see if you really have PTSD." When we went to check in,we were told that the Dr was not in that week,but they would see when they could schedule us,and would we please have a seat? I was sputtering," If they can't do this appointment this week,I am going to be very very angry," among a few other choice phrases. Rick kept telling me to keep my voice down." Let's not get upset yet," he told me."They wouldn't have had us come here if someone wasn't going to see us." I was amazed that he could seem so calm. "Oh,I'm not, "he told me,"but I am trying very hard to hold it together."
About 20 minutes later, a soft spoken woman came over to us. "Specialist Shaw,the Dr you were suppose to see is not here this week,but we have arranged for you to see another Dr via teleconference from Walter Reed Hospital.Please follow me." We both breathed a collective sigh of relief and followed her to another part of the building.They brought us into the teleconference room,and I must admit it was pretty neat.The Dr was there on a big flat screen TV. He went over the report that the Dr had made in March,and asked us questions. I told him that Rick had a NeuroPsych evaluation in May,and did he have access to that report? He said that while he could pull up a few VA reports,he was not able to pull up that one. I told him I had it,and could we fax it to him. He said that would be great,so I went out to the reception area and gave the soft spoken lady the report for her to fax.
He read the report,then asked,"How old is the Dr that administered this test?" Right away our warning flags went up. " He is older, maybe late 60's or early 70's," I told him."That would explain it," he said. "This test is an old testing method. It really doesn't tell me much. Testing for TBI has changed two or three times." Rick and I groaned. Great. However...." Rick is scheduled for another Neuro Psych eval this week," I told him. " Well,it couldn't hurt,"he said. His initial diagnosis was Cognitive Disorder NOS.Because some of the symptoms of PTSD and TBI are the same,there is no way of telling what is what. Apparently this is a new term they use for patients with PTSD and TBI.
Next was Rick's Part 1 Physical,which consisted of blood work,a hearing test,an eye test,a chest xray,and and EKG. Then we went to Part 2,where his medical history is gone over. When we went in March, Part 2 took over 3 hours. We had to fill out all of Rick's medical history. They then go over everything with him and type up their comments. Since most of the work was done,this time they just went over what was written up in the report before,and added any changes.They want Rick to have an EMG done on his right foot-electronic impulse testing-to see if he has any nerve damage,which we are doing through the VA. Rick now walks on the outside of his right foot because of his knee pain,and it is causing blisters and calluses.He also now sort of swings his right foot out to the side in a sort of semi circle when he walks. They also made note of his knees,his sleep apnea,hypopituitaryism,and his hypothyroidism.
Wednesday was Range of Motion,which was for his knees. I hate when they test his knees, because I know how much pain he is in,and I always get tears in my eyes. I can't help it.He told Rick that each knee should bend to 140 degrees,and his only bend to 90 on one and 85 on the other. He said to Rick," Your knees are messed up." They are waiting for a report from the Orthopedic Surgeon at the Boston VA,whom we saw today to see if Rick will have surgery. I will have to post about that appointment separately.
Thursday was a really big test: the NeuroPsych evaluation. This test determines if Rick has TBI,and at what level. The test he had in May said he had TBI,but it was not a very thou rough report. It didn't say at what level it was,and it was a page and a half. The military wanted something more specific,with a longer report. We went to another town to see a civilian PhD,who the military uses. He was very nice,and conducted a medical and mental health record review,clinical interview,and NAB ( Neuropsychological Assessment Battery).He asked about several symptoms,and out of the 30,Rick had 27. He then gave him testing in the following areas:Attention,Language,Memory,Spatial,and Executive Functioning. The tests took 5 hours. Rick thought it had only been 30-60 minutes. He also thought that he was going quickly on the tests,when in actuality he was going rather slowly.
When Rick was done, the Dr said he could give us a preliminary diagnosis based on the test scoring and his impressions. Here is what the test results showed. 100 is considered average.
Attention: 49 Severely impaired
Language:73 Mildly to moderately impaired
Memory:68 Moderately impaired
Spatial:75 Mildly to moderately impaired
Executive Functions: 83 Mildly impaired
The bottom line is his brain injury is considered moderate.
We were surprised. Moderate? Not mild? We had been told he had a mild injury because he didn't lose consciousness when the explosion happened. We told the Dr this,and he said, "Who told you that? Excuse my language,but that is bullshit." The blast affected his brain globally.Rick was depressed after this appointment,but we were glad that finally,we have a proper diagnosis.
Once the military has all the information,they will finalize the NARSUM ( Narrative Summary),send it to us,then send it to Walter Reed Hospital,where it will be reviewed by doctors who will determine if Rick can be retired,or temporarily retired ( if they think some of his problems might be able to get better). We should know after the holidays.