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For injured veteran, war continues even at home

Chuck Rotenberry can talk about the virtues of others, both man and dog, at length.

The Marines he served with during two deployments, Iraq in 2005 and Afghanistan in 2011. How young they were. How eager.

"To see what these Marines go through ... they were hungry for it every day. Each day, they wake up not knowing if they're coming back, but they do it."

And the dogs - they go first when clearing an area of improvised explosive devices or checking a house during a forced entry. It's something most people back home don't stop to think about: who walks point.

"Everyone is looking at the dog and the dog handler like, 'Whaddaya got?' That's a huge responsibility."

But Chuck, 35, is slower to talk about himself.

Active-duty Marine for 13 years. A staff sergeant, chief trainer of military dogs and kennel master. Now a Marine reservist living in Hampton.

It takes awhile to get to the part about the IED, the shrapnel, the flying body parts, the brain injury.

His wife, Elizabeth, urges him on to March 29, 2011.

That day, he called her on the phone after the explosion. She needed to buy new tires for the truck. And that had been stressful for the mother of three, who was also five months pregnant.

He listened. He comforted. He hung up the phone.

Later, she received a phone call from Marine headquarters.

"Have you talked with your husband today?"

"Yes."

"Are you aware he's been injured?"

____

Chuck earned a Purple Heart on that rugged landscape, and he also injured his brain.

You'd never know it to look at the lean, 6-foot-1 veteran with the easy smile and gentle manner. There's no visible evidence, no scar - just an injury inside that's derailed the tranquility of a family that looks picture-postcard-perfect.

People with post-traumatic stress disorder and traumatic brain injury often land in the news when violence erupts, but the reality is, thousands struggle quietly in day-to-day battles that never cross the public's radar screen.

According to the Armed Forces Health Surveillance Center data, Chuck's was one of more than 250,000 cases of traumatic brain injury in the military between 2000 and 2012. An estimated 14 percent of American veterans of the Iraq and Afghanistan wars suffer from PTSD.

Such injuries go back centuries. What's new is the recognition, screening, treatment and exploration of the role that the alphabet soup of TBI and PTSD plays in substance abuse, sleep problems and suicide.

The injuries are difficult to treat. Counseling, medication and rest have been mainstays, but the varied results and side effects drive many veterans to search for alternatives.

Dr. David Cifu is executive director of Virginia Commonwealth University's Center for Rehabilitation Science and Engineering. He has spent years and millions in federal money researching the issue and is now principal investigator of a $62 million project, launched in August, to study brain injuries in military service members and veterans.

Cifu cautions against a simple solution to a condition that's hard to see, measure and monitor.

"If I knew the answer, I'd be making a billion dollars," says Cifu, one of 30 brain injury scientists and doctors who make up the Military and Veterans Injury Recovery and Rehabilitation Network. "I am willing to say that in five years of this study, we are going to have better management of the effects. I am not going to cure it. If I did say that, I'd be giving false hope. We haven't cured cancer in 50 years. But many more patients who have it don't die from it. And people are more hopeful."

____

Hope is what Chuck and Elizabeth are looking for.

They met in high school in Wilmington, Del. Chuck joined the Marines in 1999 at 21. He went through basic training for the military police and was selected to go to canine handling school, where he trained dogs and their handlers.

The couple married in 2002. Chuck's service and training took them across the country: Albany, Ga.; San Antonio; Yuma, Ariz.; Camp Lejeune in Jacksonville, N.C.

In 2005, he was deployed to Iraq, where he found that some things can be learned only in war zones:

How to be a first responder in a medical emergency.

How to balance on-duty stress with off-duty recovery.

How to prove to others the legitimacy of the dog teams.

"Sometimes an engineer would have gone through with a metal detector and found nothing, but the dog indicated something was there. Once it was a couple of hundred pounds of explosives and weapons, buried so deep the metal detectors weren't picking up on it."

In November 2010, Chuck deployed to Afghanistan. He was a chief trainer and staff sergeant over dog teams that served 27 units.

By this time, he and his wife had three children: Kristopher, 6, and 3-year-old twin daughters Anna and Sara. Elizabeth was also pregnant.

The stress and intensity ratcheted up from Chuck's prior deployment.

"Of the 29 dog handlers, only four had ever been deployed before," he says. "They didn't know what they were getting into."

Shain Nickerson, a Marine sergeant, was one of the dog handlers. He, too, had served in Iraq, but the explosives in Afghanistan were more sophisticated: "IEDs going off right and left. Every other day, something was happening like someone losing a leg. It was crazy."

He says Chuck was the kind of guy you could go to about anything - your dog, something personal, a Marine issue: "He was on top of everything."

Chuck would fill in on patrols, go behind the dog team, be the handler's second set of eyes and ears.

"There was a tremendous amount of pride, a sense that I am helping them do their job," Chuck says. "Moving them through an environment to support the unit and the mission."

There was not much down time to recover. They'd come back, clean weapons, take care of the dogs. And even then, explosions were a constant backdrop.

"Constantly, 'Boom, boom, boom,' " Chuck says. "The final straw was being within 3 feet of an IED detonation. That was rough. That scrambled my eggs."

____

It was March 29, 2011. A large company was clearing an area, cruising along an elevated patch of rough terrain. The group engineer went first, then the dog team, then Chuck.

The engineer of another unit was behind him.

For some reason, the engineer behind Chuck stepped out of the path the dog had cleared. His left foot was in Chuck's right footprint.

The difference was the width of his shoulders.

An IED exploded.

Chuck got up and saw the legs of the engineer, blown off by the bomb, lying on the ground.

He helped stabilize the Marine and applied tourniquets.

He noticed blood dripping on the engineer. It was the first clue that Chuck himself was injured.

Chuck and other Marines carried the engineer to medical evacuation, then continued the mission.

Six more hours.

When Chuck returned, medics assessed his injuries: shrapnel in the neck, face and eardrum.

They gave him a concussion test, telling him to put his feet together, tilt his head back, put his arms out.

He fell down.

They read him a story and asked him questions about it. How did he do?

Not good.

He was nauseated. Dizzy. Muscles felt like they were on fire, as if he were sitting on something hot.

During the conversation with his wife that day, he was thinking: "I'm alive. I hear my wife. I have a family." He didn't want to tell her what happened because he didn't want her to worry.

Then came the Marine headquarters phone call to Elizabeth:

"We have to let you know he sustained an injury to the neck, face and eardrum."

____

The signs of another invisible injury arose in phone calls during the next few weeks.

Elizabeth heard fear in his voice: "Like he was injured and didn't want to believe he was."

He'd forget things. He'd get frustrated because he couldn't follow a conversation. He needed medicine to sleep. An administrative task, such as filling out account logs, would take him twice as long to complete as before. He'd go somewhere and not know why. Another Marine would step in to fill the gap in his memory.

He fit the criteria for concussion and was retested in the days and weeks after the explosion. In April, he was moved to desk work for the remaining three months of his deployment, easing his stress to avoid reinjuring the brain. But the move was also frustrating.

"I wanted to be out in the dirt with them and doing what we'd been successful doing."

Still, he sensed something wrong.

"I felt like everyone was staring at me. It was like being in a fog. It was like when you have a bad day and you lock your keys in the car. Only that was all the time, every day."

He returned with his unit in July to North Carolina.

For a while, things were good. His fourth child, Charlie, was born July 19.

Chuck also adopted Shandi, a dog in the unit that had to leave service because of PTSD. Some dogs can recover from the syndrome with training and down time, but others cower from noises and hang back from what they were trained to do.

Baby and dog came home on the same day.

"We don't do anything halfway," Chuck says with a wry smile. "It's always the full count."

Two weeks into a 30-day leave, Chuck started having headaches. He had them in Afghanistan but wrote them off to the stresses of deployment.

Elizabeth noticed other changes: He was pulling away from her emotionally. His patience was short. Noises, the baby crying, kids running around, got to him in ways they never had before.

The children would roughhouse, and he'd ask them to stop, and they'd keep on.

"Then I'd get worked up and ruin everything. And the fun goes away."

Says Elizabeth: "I wouldn't be able to find him in the house. He'd be in a separate room having a breakdown."

Shandi, a Belgian Malinois, knows when something is wrong, like when Chuck feels a migraine settling in. She won't leave his side and will circle around him. Loud noises, like thunder, cause her to whine and seek cover. She'll lie at Chuck's feet or jump in bed with him.

Chuck agrees with Elizabeth's observation: They comfort each other in a zone all their own.

"We're like peas in a pod."

____

Military doctors diagnosed Chuck with mild to moderate traumatic brain injury and severe PTSD, qualifying him for a 16-week brain injury clinic at Camp Lejeune in November 2011.

The clinic included vestibular therapy rehab to improve his sense of balance and ease dizziness. Cognitive therapy to help with his frayed executive-order skills - prioritizing tasks and managing time and attention. Appointments with psychologists and neurologists.

Chuck learned to keep his life on track by using a notepad with lists, alerts on his cellphone and tricks such as always putting things in the same place.

"I have to micromanage myself. That's helpful, but it doesn't fix anything. It helps me get by."

Chuck felt as if he was moving toward medical retirement. He didn't want that. He wanted to support his family.

In early 2012, he decided not to re-enlist in active duty. That July, he became a Marine reservist and accepted a job training dogs with the Department of Homeland Security in Norfolk. The family moved to Hampton.

But the brain injury dogged him, even after more treatment at the VA Medical Center in Hampton. And the side effects of medication for sleep, depression and headaches were daunting.

"He's 35, and he has a pill box," Elizabeth says. "Ten to 12 pills a day."

Fifteen minutes after he took one medication, "his face would hang," Elizabeth says.

Other side effects were seizures - and suicidal thoughts.

"There were some black moments when he was ready to..."

She stops and gathers herself, then picks up again.

"... when he said he thought we'd be better off if he wasn't here. I said, 'No, not an option.' "

They both agreed he needed a different treatment.

"I started at 100 percent in Afghanistan," Chuck says. "I came back at 50 percent. Then I reached 65 percent. That was an increase, I can't deny that, but it's nowhere near 90 percent, nowhere near what was me."

____

In October, Chuck and Elizabeth saw a WVEC-TV story about Dr. Paul Harch, a New Orleans physician who came to Virginia Beach to talk about hyperbaric oxygen treatments he developed for people with traumatic brain injury and PTSD.

The patients lie in a chamber where atmospheric pressure is raised higher than normal. That leads them to breathe in more oxygen, which is dissolved in the blood to reach damaged tissues and promote healing. The FDA has approved the treatment for carbon monoxide poisoning, chronic tissue wounds such as ulcers, and decompression illness in divers.

In the late 1980s, Harch began using protocols he developed for "off label" use, including brain injuries in veterans and cerebral palsy in children. His study of patients, which included brain scans, showed improved blood flow to the brain and easing of symptoms.

Chuck and Elizabeth decided to check it out.

They reached out to Harch and learned they would need $20,000 to cover eight weeks of treatments and living expenses in New Orleans. Mercy Medical Airlift, a Virginia Beach-based charity that helps patients with transportation for diagnosis and treatment, agreed to pay for Chuck's transportation and helped set up a fundraising effort at www.gofundme.com/walking-point.

In a phone interview, Harch said he has treated 700 people with brain damage ranging from war injuries to birth defects to dementia. He has treated more than 100 veterans and said he's seen consistent improvements.

The Rotenberrys read about National Football League players using hyperbaric oxygen treatment for concussions at Harch's clinic and others like it scattered around the country. They're frustrated that the military won't do the same for its people.

But the departments of Defense and Veterans Affairs have conducted studies that have not found the medical evidence to support the technology's use for traumatic brain injury and PTSD.

Cifu was one of the researchers who conducted a number of studies at different sites. The most recent, published in September, involved 60 service members with a combat-related brain injury. The study was a double-blind, randomized, sham-controlled trial at Pensacola Naval Air Station.

The 40 treatments over a 10-week period didn't produce any more improvement than the sham treatments.

"For my money, I would not do it," Cifu says.

Harch contends that the DOD studies failed to include a true control group, and that the higher doses used in the military study were not the most conducive for healing the brain.

"The higher range they were using can be toxic," said Harch, whose study has been published in the Journal of Neurotrauma. "There's a lower range where it's most effective."

Cifu says the majority of people who suffer concussions recover within a year. But the rate of symptoms lingering longer than that are higher among veterans than civilians. He said the team studying brain injuries is throwing the door open to a wide array of treatments:

"A complex organ like the brain needs a combination of things. We've spent 20 years looking for the next big thing. I don't jump to conclusions. I would rather find nothing if there is nothing to find, instead of giving false hope."

____

The price of a treatment that's not scientifically proven includes this: You have to go public to get money because insurance won't cover it.

Chuck was reluctant at first. Once people know you have those conditions, they look at you differently. It's not like a physical wound. Not like a missing limb.

"It's like, 'Uh-oh, is he going to go off? Is he nuts? Will he flip out?' "

But for Chuck, settling for less than his full potential isn't enough. He believes there has to be more than medicine and counseling.

By late December, more than $20,000 had come in through the website, and Chuck leaves Thursday for New Orleans to begin the treatment.

The couple could have backed off being so open about Chuck's injury, but they didn't because they had realized going public served another purpose.

They heard from others who suffered traumatic brain injury and PTSD in the military and were afraid to tell anyone because of the stigma. One worried about going to the VA to seek treatment. Another wrote about her husband, a Marine who committed suicide when treatment couldn't ease his PTSD.

Nickerson knew that Chuck had been forgetting things toward the end of their deployment, but he didn't know the extent until he saw a clip of a TV interview with Chuck on Facebook.

"I saw it, and I started tearing up," says Nickerson, who trains dogs for a security company in the D.C. area. "I broke down pretty good. I never knew how much he was dealing with. It pushed me to the next level. Now I'm seeking counseling, and I'm not the only one. Chuck opened our eyes. It made us realize we're all flesh and bone, not big bad warriors. It took guts for him to do that."

People thanked Chuck for "Walking Point," the name of the website (tinyurl.com/o5sv5sj) the Rotenberrys update with video diaries of his experience. Like the dog teams going into uncharted territory, he doesn't know what he will find.

Maybe the treatment will help only a little, or not at all. But maybe his experience will help someone else.

An interesting aspect of the most recent study involving service members and hyperbaric oxygen: Even those in the sham groups showed improvement.

Maybe, Chuck says, it's like finding a $20 bill and going to the movies. It doesn't cure you, but it helps you go down the road a little bit further, until the next bit of hope comes along.

"Some people will do anything to make it go away: seek treatment or take their life," Chuck says. "I'll do whatever it takes to get better, within reason. If it doesn't work, or even if helps just a small percentage, we gave it a shot."

Elizabeth Simpson, 757-222-5003, elizabeth.simpson@pilotonline.com

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©2014 The Virginian-Pilot (Norfolk, Va.)

Visit The Virginian-Pilot (Norfolk, Va.) at pilotonline.com

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