Why our “Take a Motrin” approach could be hurting our troops: Part I of II

2015-03-19T13:47:33-04:00

All of us have experienced – or at least heard about – this type of situation unfolding overseas: a troop suffers a potential head injury, is hastily evaluated (despite best intentions), and is put back into the fight too early. “Take a Motrin,” the adage goes, where unit-level medics give troops a few Motrin, ask them to recite the alphabet backwards, and tell them to shake it off. Added to this is that military personnel have a tough mentality; they too often avoid admitting they’re hurt or in pain until it becomes unbearable. But by then, it could be too late, and tragedy becomes almost inevitable.

The unit-level “screening” tests conducted in the military actually do not tell us much about the true brain injury that may have occurred. For example, we don’t know whether taking a Motrin helps or actually HURTS a troop with a serious head injury. In a literal sense, this means a troop could have a TBI, and the military’s protocols could actually be hurting him/her. It’s true, as much as I wish it wasn’t.

What we need is a test that tells us whether this troop is truly injured, how bad the injury is, and how we may be able to best treat him. Magnetic Resonance Spectroscopy (MRS) is such a test. It’s a unique version of an MRI that measures the chemicals in the brain – a completely harmless procedure that can tell if chemicals in the brain have changed. A renowned Harvard brain scientist, Dr. Alex Lin, is spearheading an ambitious study to bring this test to the DoD – a change that would save the lives of countless members from among our military community.

Currently, we can look at MRS studies in mice to see how their brain chemicals change after head trauma from a blast. We can also look at MRS studies from NFL players and professional soccer players, and make predictions about what chemicals might change in military troops due to a blast. However, scientists don’t know exactly how the brain responds to an IED blast versus a high-impact football tackle. This requires us to further investigate how an IED blast specifically affects troops’ brains.

Through Dr. Lin’s MRS study, it will be possible to not only determine what chemicals in the brain change due to an IED blast, but also start the process of developing new treatments that could improve – and ultimately save – troops’ lives on the battlefield and years later at home, after they have taken off the uniform.

Perhaps most groundbreaking for readiness across the DoD today, these MRS studies will also allow doctors to easily identify troops at risk for PERMANENT damage if they are hit by another blast – thus preventing troops from returning to the fight before they are ready.

-- How you can do your part to save troops’ lives –

While these studies are sometimes enigmatic, they are critical in that they enable us to learn what we don’t know. The success of Dr. Lin’s study ultimately requires active troops and veterans to volunteer a few hours of their time to be scanned. Being that I am a veteran who is no longer serving, the decision to take three hours to get my brain scanned was easy – the whole time I was thinking, “I am doing my part to save the lives of my brothers and sisters in arms.” The medical community is working to equip line medics with better diagnostic tests and tools to protect troops suffering from a TBI, and as individuals we can all play a role in pushing this process forward.

Dr. Lin in Boston, MA is conducting this study. If you are in the New England area, or are willing to travel to do your part just like I did, please say so by posting a response in this thread, or by clicking this link: http://bit.ly/bwh_study

In my Part II follow-up in this series, I will share my own experience going through this study with Dr. Lin. Coming soon!

Response by MAJ Private RallyPoint Member made Mar 19 at 2015 1:49 PM

2015-03-19T13:49:29-04:00

This is a leading cause of the VA backlog. This is partially the cause of my issues post-deployment; I however share in the blame because I bought into the Army mindset that as a Commander, I had to suck it up and lead by example for the sake of my Soldiers and my mission. The Motrin/quarters/RTD tread-mill is an antiquated model by any medical standard; but it seems to me it was only reinforced with the introduction of Combat Stress personnel in Theater who were quick to introduce sleep medications that often masked the lingering effects of a TBI.

Response by SGM Erik Marquez made Mar 19 at 2015 1:52 PM

2015-03-19T13:52:18-04:00

Wish was closer ....Id happily give up the time required.

Response by SFC Dan Sorrow, M.S. made Mar 19 at 2015 1:52 PM

2015-03-19T13:52:19-04:00

They're still throwing Vitamin M at everything, I see. I was on that and then Celebrex the last 5 years of my career and the first 3 years after I retired. It was later determined NSAIDS cause numerous side effects including gastrointestinal and hypertension. After a lengthy fight with the VA and an appearance before a VA judge under appeal, my hypertension became service connected. The GERD was service connected under their initial finding.

Response by Sgt Aaron Kennedy, MS made Mar 19 at 2015 2:04 PM

2015-03-19T14:04:16-04:00

My doctor calls it Vitamin M, and just shakes his head.

Ibuprofen (Motrin) as a nonsteroidal anti-inflammatory drug (NSAID) is over prescribed.

When I started running (marathons), one of the first things I discovered was that I wasn't supposed to take it when doing Endurance Sports.

Chesty Puller's Ghost!?!

I used to have BAGS of these. Not 200mg, not 400mg, but the 1600mg pills. We popped them like tick tacs. For everything. We used to take a couple before Battalion Hikes to help alleviate the pain.

Here's a direct quote:

"NSAIDs may cause an increased risk of sudden kidney failure and even progressive kidney damage."

The hell. Now, I was young, stupid, didn't know better, and we even joked about finding out that Vitamin M would be discovered to cause Cancer later in life.

Excluding bullet wounds, Docs would normally tell you to 1) drink water, 2) change your socks, 3) have some motrin....

Response by Cpl Jerry Millar made Mar 19 at 2015 2:27 PM

2015-03-19T14:27:34-04:00

Cpt Kletzing,

I could not agree more with this! Add to football and futbol (soccer) the sport of hockey. I played hockey growing up and played Junior A (single-A or AA-equivalent to baseball) in my teenage and early 20's. It is another sport that has a deep rooted "tough guy" culture where most concussions are treated with ibuprofen, admitting injury is seen as a sign of weakness, and can ultimately cost you your spot on the roster. As I still live with the fears and effects of multiple concussions (my last season I had three within five months) I continue to do a lot of research to help explain what happened and what is next for me...

I came across a two-part article in National Geographic a few months back that talks about the effects of TBI (traumatic brain injuries) and concussion specifically for service members.

**Here is a link to the story; it does contain some IMAGES OF INJURIES so please use caution if you are sensitive to that.

http://www.nationalgeographic.com/healing-soldiers/index.html

Healing Soldiers

Using Art to Reveal the Trauma of War

Response by SFC Charles S. made Mar 19 at 2015 2:28 PM

2015-03-19T14:28:14-04:00

During my 20 years, the TMCs would have standard "Ranger Candy Packs"... bottles of 60 ea, 800 Mg Motrin for general dispersal. Granted we were 82nd Airborne Division and We ate them and Liked it. But Thinking back on it... probably not the best thing for us.

Response by LTJG Robert M. made Mar 19 at 2015 3:44 PM

2015-03-19T15:44:20-04:00

Drug companies have never healed anyone or cured any disease, they just create new customers.

Response by SGT(P) Michael H. made Mar 19 at 2015 4:01 PM

2015-03-19T16:01:43-04:00

As a seasoned Army Combat Medic, who has been fortunate enough to cut my teeth under the direct supervision of the Associate Dean of JSOMTC back from 2002-2005, as well as numerous other DR.s, PA's, 18Ds, and a few very well versed 68Ws, I can say that it should be mandatory for every 68W to be taught and maintain the skill set of performing a full Flight/Dive neurological exam. If this were the case, many of the injuries slipping through the cracks downrange would be caught in plenty of time to treat the patient properly.
The "bare minimum" "you will get OJT at your next assignment" mentality needs to stop. It is killing many of our soldiers and lowering their standard of life for the long term.
Also, this Motrin mentality needs to stop! And I can say from experience...be a man and step up and stand up for yourself and do the right thing...get the medical treatment you need and deserve! 20 years down the road YOU are the only one who is going to remember how "hard" of a soldier you were, and your chronic injury issues will be talking to you and keeping you company everyday for the rest of your life.
I am a huge advocate of TBI studies and treatment. I hope all goes well for you and the others who take part.

Regards,

Doc Harris

Response by Sgt Richard Martin made Mar 19 at 2015 4:43 PM

2015-03-19T16:43:51-04:00

Great article and I would be interested to see how many former vets can benefit from this research!!!

Response by SPC David Shaffer made Mar 20 at 2015 9:06 AM

2015-03-20T09:06:59-04:00

CPT Aaron Kletzing very good post Sir. Since I was injured with my STBI, I have been on a mission to learn everything about the brain and brain injury. Scientist have worked hard to understand the brain, but there is still so much they do not know. I know for a fact (I have a severe brain injury) that there are many variables that go into the healing process. When I came out of my coma, I could not function at all. I did not know my wife or child, my name, who I was, what happened, could not walk, eat on my own, or complete any of the functions of daily life. They told my wife that if I would come out of my coma that I would be like a child for the rest of my life. I obviously knew different! I have recently joined the "Golden Key Honor Society" for my high grade point average (4.0). I have also become a FreeMason, and business owner. The "Take a Motrin" approach is going to hurt more people that it will help. The biggest problem the SM will face is the fact that every single brain injury is different and each individual will heal/recover in their own way.

David Shaffer

Response by MSgt Marvin Kinderknecht made Jul 31 at 2015 8:52 PM

2015-07-31T20:52:51-04:00

Best of luck. Sounds mighty good to me. we must advance in all fields--not just military.

Response by SSgt Terry P. made Aug 1 at 2015 11:05 AM

2015-08-01T11:05:03-04:00

my son (in the Army for the last 15 years) always has a big bottle of Motrin when he is home

Response by PO3 Steven Sherrill made Aug 3 at 2015 12:20 PM

2015-08-03T12:20:28-04:00

A concussion is not something you can just shake off. No matter how much you try, when the head is traumatized, the only thing you can do immediately is remove the person from the situation. In combat, when is that possible? Never. So you end up with a soldier who has a headache, nausea, dizziness, and is not in full control of their mental faculties in the fight. Despite best intentions, they are going to be a detriment not only to themselves, but to their team.
There is also a social issue with these things. As MAJ Private RallyPoint Member mentioned the mentality of lead by example. Nobody wants to be accused of being cowardly. Nobody wants to appear weak in front of their comrades at arms, or worse still the enemy. The problem is when you have a head trauma, you are weak. Your body is reacting to a trauma, and everything else falls by the wayside. In these situations, the best thing that can be done is to properly evaluate that soldier.
I am glad that this study is being conducted. I hope that it does lead to changes in the way head trauma is diagnosed and treated. I hope that it leads to the saving of lives.

Response by Sgt William Biggs made Aug 3 at 2015 12:39 PM

2015-08-03T12:39:15-04:00

I had a kidney stone in country. The HM1 decided that all I needed was motrin. Once I started screaming and writhing in agony, he decided to go to a larger dose of aspirin. Surprise, surprise, this didn't work and I ended up at Charlie Med getting Dilautin shots until it could pass. I have minimal respect for the "Motrin Cures All" mentality.

Response by SA Harold Hansmann made Aug 3 at 2015 12:49 PM

2015-08-03T12:49:08-04:00

Let's think about this a moment.
My questions are: How cumbersome is this machine?
How delicate?
Can it be transported on the trailer of a tactical semi?
Does the trailer need a special suspension to avoid damaging the equipment?
How many pieces of this equipment can be sent to the various bases?
How soon can we send them?
How accurate are they?
How many troops can be sent through per hour prior to going on patrol to get a base reading of every troop to know how their brain chemicals are before and after getting hit with an explosion?
I could probably come up with a dozen more questions to ask, but, the one question that I think is the most important.
Why aren't these machines in place by now?

Response by MSgt Private RallyPoint Member made Aug 3 at 2015 1:08 PM

2015-08-03T13:08:09-04:00

Good article....and if that is really all your unit level medical does you need to replace them. There are many field tests that can be done to help rule-in and rule-out head injuries that are much more precise that the "copish" test of counting backwards, saying abc(s), or walking a straight line. A neuro exam is not a difficult thing to learn....it just needs to be added to the Army curriculum ....it's aleardy in the AF's ....but there medics are required to be at least EMT B certified....anyway as I started with get a new medic if that's all they are doing....they are hurting you in more ways than one I assure you.

Response by LCDR Rabbah Rona Matlow made Aug 3 at 2015 1:21 PM

2015-08-03T13:21:36-04:00

Of course MRS/MRI can't be administered in the field, so you have to rely on emergency field procedures for patient assessment. I think a part of the problem, from what I've seen working with disabled vets, is the old "huah, huah, three bags full" mentality. I can't tell you how many vets reported TBI to me, but when I ask about medical records, they say they never sought help. Far too many are very highly motivated and don't want to be seen as weak by saying they got hurt. DOD needs much better TBI awareness training among ALCON to address this.

The other side of the coin is how common it was in my day, that no matter the injury, they handed you "Vitamin M" and did little else except for RICE (Rest, Ice, Compression, Elevation). They did very little in the way of diagnostics, and far too often serious injuries to joints could slip through the cracks. I had a Meniscus tear on a ship in the North Arabian Sea, that was treated in that fashion. This knee has been a problem for me for 30 years now...

Response by MAJ Matthew Arnold made Aug 3 at 2015 6:53 PM

2015-08-03T18:53:52-04:00

One of the advantages (I guess) of being an aviator is I was very obedient to the command, "no self medication", which kept me from overdoing it on anything. And, the fact that aviators get (or use to get) excellent medical care and availability of care providers made it so that not self medicating was not really a problem. This comment is not meant as a brag, I was in the infantry (airborne) for 5 years before I went to flight school and am very familiar with the aches and pains of being a grunt. That's why I went to flight school.

Response by SFC Mark Merino made Aug 3 at 2015 8:26 PM

2015-08-03T20:26:23-04:00

Rub some dirt and drive on is only a great mentality in combat. Your career WILL end one day. ONLY you will remember how "hard core" you were and your body will pay the price. I am paying the price now post-Army. Now that I can enjoy life without that 24/7 sense of urgency, I am unable to do a great deal of things physically. You want to be able to have a good quality of life post service so PLEASE take care of yourself. Also, no one knows your body better than you. If you are told you are ok (or in the aviation troubleshooting world.....'could not duplicate, MOC'd OK') get a 2nd opinion. I spent 15 months with severe nerve impingement and was threatened with a MEB at 14 years because the same jackhole couldn't read an xray and now my hands are paying for it and my left arm is essentially for show. You can keep the 100% disability and the pension. You will want your body back, believe you me.

Response by SGT Hector Rojas, AIGA, SHA made Aug 3 at 2015 8:51 PM

2015-08-03T20:51:40-04:00

I'm a case study for this.

Early in 2012, a SF Assessment reject came back to the unit and he was put in charge of PT. (PT stud should know everything about PT right?)

2 days after he took over PT, I was injured while conducting a downhill buddy carry sprint. My right knee basically bottomed out compressing and tearing my meniscus.

PT stud SF Reject didn't believe in the severity of the injury so he had me finish PT and I couldn't go to the Aid Station until the next morning. (Because that's what we do, we schedule injured soldiers medical care instead of sending them ASAP)

Long story short, after multiple visits to the Aid Station, several temp profiles and Motrins later, I still had not been seen by a specialist, or at least an X-Ray taken.

This continued until deployment in April 2013, finished my deployment with a horrendous knee pain and more Motrin and basically "Take it easy on the knee".

Came back from deployment and only upon RSRC, when asked about any joint pain, I mentioned the knee history and treatment (or maltreatment) and I was immediately referred to a Knee specialist, who ordered X-Rays and MRI.
Shortly after I was then referred to the actual Chief of Medicine (also a knee specialist) for a more specific MRI and eventually Surgery.

Bottom line is, my Meniscus was torn, bone had been shaved, there was a fragment of both bone and cartilage stuck behind my knee cap which was the reason for the cracking, popping and grinding.

So as a result of all this, now I have an Arthritic Knee, courtesy of both the SF Reject PT Stud and a series of PAs that can only prescribe Motrin.

Rant mode off.

Response by SPC Private RallyPoint Member made Aug 3 at 2015 9:19 PM

2015-08-03T21:19:06-04:00

I can say I have the new helmet with the sensor in it but it's dead new unit doesn't have the program to read the helmets feedout

Response by CPL(P) Private RallyPoint Member made Aug 3 at 2015 9:39 PM

2015-08-03T21:39:34-04:00

Army medical through ATTRS has a pretty good course on TBI and Omega-3 run through Walter Reed and some docs around the country. The problem is real out there, but the bigger problem is that when a soldier reports an injury in the contemporary climate of the military they are at risk for being bounced out rather than helped. I personally know this fight. Hell they even try to PEB you instead of MEB. With so many cases like that going on, the "take a knee and drink water" approach is how we do it. It's how we have to do it if we don't want our careers on the line. Watching a DS in basic smoke us until one girl dislocated her arm after 4.5 hours was ridiculous, I ended up with an LOD from that nonsense snapping something in my shoulder too because I didn't officially report it until later under direct orders from a drill sgt. She was processed out for her reporting, and I was not. The system is a double edged sword, and one edge is serrated. Until we fix that, and make sure soldiers know they will be able to continue to serve and that their health is truly important, we won't have reporting of injuries on the levels that they should be.

Response by SGM Steve Wettstein made Aug 4 at 2015 5:42 AM

2015-08-04T05:42:14-04:00

CPT Aaron Kletzing -- How you can do your part to save troops’ lives – I didn't save their lives but I made a couple of LTCs go though the concussion testing after they were at an Afghan Police compound that was attacked with a few suicide bombers and a lot of explosives. They didn't want to do it. I think they thought they were to important to the mission. But you could tell by their eyes that they were jacked up. I escorted them to the BAS to get tested. Afterwords they thanked me for making them go. They failed miserably and they thought they were OK. I did this because when I got hit by an IED, no one really did anything for me. I was all jacked up and they made me go out on combat patrols the next day. I had a 1SG who took me aside when I was pushing it to hard right after coming back from a back operation. She told me the Army doesn't care about me (or anyone). There is always someone to replace you, so you have to take care of yourself. I told the two LTCs my little story. That is how I got them to the BAS.

Response by LTJG Robert M. made Aug 4 at 2015 12:58 PM

2015-08-04T12:58:07-04:00

Recent study and warning by the FDA that the use of NSAID's, in higher-level prescription medications (800mg of Motrin) increased the risk of cardiac arrest by about 50 percent

Advil, Aleve, Motrin, more can cause heart attack or stroke: FDA

An Emory professor is among a group of medical experts echoing the government’s warningthat certain non-aspirin painkillers, including ibuprofen, can actually increase the risk of heart attack and stroke, even in low doses.

Response by LTC Stephen F. made Aug 4 at 2015 2:09 PM

2015-08-04T14:09:46-04:00

CPT Aaron Kletzing this discussion about Motrin reminds me of the over-prescribing of small doses of amphetamines in the early 1990's to primarily young boys who were "over-active" - ADD and ADHD seemed to be the diagnosis of the day for many parents of young boys in those days. Some children had ADD or ADHD but many didn't and the over-use of amphetamines on young children caused some issues at the time and I expect other issues will surface as those former-children age.
I had a concussion with amnesia when I was child and my prescription was bed-rest with fluids for one week.
Prior to going through mitral valve repair surgery at Walter Reed in 2003, I found Ibuprofen and Naproxin very useful for situations where pain was due primarily to inflammation.
Since Ibuprofen and Naproxin have blood-thinning properties I can no longer use them without express orders from my physicians.
I had been through more than enough opioid-based pain medications with all of their side effects to be thankful for anything that did not cause severe itching like Dilaudid (hydromorphone) and constipation including Oxycodone, percoset, etc.
The over-the-counter non-steroidal pain medications are wonderful when proscribed properly - aspirin, acetaminophen, ibuprofen all have there places. Hopefully ibuprofin will not be over-proscribed. [I am using over-proscribed versus over-prescribed because ibuprofin is available over-the-counter and four 200 mg tablets is equivalent to one 800 mg prescription tablet of ibuprofin :-)]
LTC Stephen C., SPC Private RallyPoint Member, SGT Forrest Stewart, SSG James J. Palmer IV aka "JP4", TSgt Hunter Logan, SGT Private RallyPoint Member

Response by MAJ Ken Landgren made Aug 4 at 2015 2:32 PM

2015-08-04T14:32:25-04:00

I knew of a young soldier die because they did not diagnose he needed and appendectomy. They gave him Moltrin and told him to suck it up.

Response by SSG Warren Swan made Aug 4 at 2015 3:13 PM

2015-08-04T15:13:28-04:00

The mentality has to change, but it has to be TOP driven. Until the CoS and SMA start bringing the pain down to the lower levels in regards to troop care and accountability, this will continue, and more troops will suffer the consequences. Also knowing the answers to questions upon redeployment screening, doesn't help with identifying those with issues until it's too late. Everyone wants to be in the game; problem is leaders need to ID quickly and substitute those that cannot be in the game, and give them time to heal. How much of this current mentality of "suck it up" is costing troops lives? The Army needs to be hard, but there's a THIN line between HOOAH and Stupidity. Both will get you messed up pretty quick.

Response by MSG David Johnson made Aug 4 at 2015 3:30 PM

2015-08-04T15:30:47-04:00

There was a study going on at Saint Louis university, they were studying the difference between 4 groups, Military with/without TBI, and civilians with/without TBI. I don't know all the info of the study, but it was hard, it went too fast to proccess for me.

Response by SFC Private RallyPoint Member made Aug 4 at 2015 9:30 PM

2015-08-04T21:30:57-04:00

You know, I came into the military at a late age. The Drills always said, "DO NOT JUMP OFF THE TANK. Slide down the front of the tank." Yeah yeah yeah....Now, I have named my left knee Snap and my right knee crackle. My back has arthritis and my neck has bulging disks. I have a P2 profile because when I would do situps it sounded like my back was snapping everytime I did one. At first the profile said no running, I made them change it to run at own pace and I could do the 2 mile run. I run the run in about 15 minutes (I have 1842 to complete the run) I usually cannot move real well for about 3 days after. I have a TBI (my leadership never put me in for a PH for), my wife and daughter remind me of things we have done when I tell them "we should go to this place!" "Dad we went there when we first moved here." "Ohh, did we like it?" Yeah we did. There are days I am clear, I remember things, a lot of times they are painful things like in Iraq, then there are some good things like friends or family. My body now has a pin in my thumb where I broke it in two places and torn the ligaments. My leg was broke in OSUT, but I never went to get seen until it was too late and healing and so they gave me a profile and I motrin and I was able to graduate with my class. My aorta was torn in an explosion and it healed, they never found that until I went in for an emergency appendectomy and they did some scan and found the scar tissue. There are parts of me that I have not had checked out that I KNOW are wrong with me.
Would I say that the mindset will hurt me? Yeah, it is going to kill me I know. If it doesn't then I need to ensure that I have it all documented before I retire so my wife and daughter get paid for it when it finally does. When you are older, and trained to "rub dirt in it" or drink water, drive on" or "take motrin" it is hard to remember to get things fixed when the time comes.
It is even HARDER to make sure that your new privates want to get EVERYTHING looked at. I do encourage them to do so though. (Another reason I am so glad to be in recruiting now, no privates). The mindset is just so hard to overcome, I am just so one tracked. Maybe someday I can think normal again.

Response by SN Victoria Glover made Aug 4 at 2015 11:22 PM

2015-08-04T23:22:02-04:00

Motrin and Ibuprofen are the quick cure all for them and has always been that way. When I had any type of health issue no matter what it was, Motrin was prescribed. I eventually had 2 bouts with Pneumonia and found out I was allergic to coral. They couldn't figure out why my system was reacting the way it was. It didn't matter if there was pain, fever or whatever.

Response by SCPO Morris Ramsey made Nov 22 at 2018 12:31 PM

2018-11-22T12:31:53-05:00

Outstanding

Response by SCPO Morris Ramsey made Nov 22 at 2018 12:33 PM

2018-11-22T12:33:16-05:00

In my day they were called APC’s

Response by PVT Mark Zehner made Nov 22 at 2018 12:34 PM

2018-11-22T12:34:35-05:00

Motrin and super glue!

Response by MAJ Ken Landgren made Nov 22 at 2018 2:58 PM

2018-11-22T14:58:21-05:00

I knew of soldier who was given moltrin instead of truly fixing him.