“We’re really at an infant stage in terms of our clinical ability to assess traumatic brain injury,” a medical expert said.
“We’re really at an infant stage in terms of our clinical ability to assess traumatic brain injury,” a medical expert said.
Before he ended his life, Ryan Larkin made his family promise to donate his brain to science.
The 29-year-old Navy SEAL was convinced years of exposure to blasts had badly damaged his brain, despite doctors telling him otherwise. He had downloaded dozens of research papers on traumatic brain injury out of frustration that no one was taking him seriously, his father said.
“He knew,” Frank Larkin said. “I’ve grown to understand that he was out to prove that he was hurt, and he wasn’t crazy.”
In 2017, a postmortem study found that Ryan Larkin, a combat medic and instructor who taught SEALs how to breach buildings with explosives, had a pattern of brain scarring unique to service members who’ve endured repeated explosions.
Why is it so hard for doctors to take people seriously sometimes? I guess probably because of crazy people insisting there are worms in their skin, but it’s still unfortunate
Because they're arrogant bastards, no more intelligent than your average person, but convinced of their inherent superiority by education and surroundings.
I find that medical doctors and engineers both commonly suffer from huge superiority complexes and/or narcissistic tendencies (and I say that as someone with an engineering degree). I think a huge part of it is that everyone is constantly fawning over them and telling them how smart they must be to have made it through the schooling that they begin to believe it (combined with the fact that many people conflate academic success with intelligence).
As a chemistry major, I went to undergrad with tons of pre-meds that went on to become medical doctors and then I went to grad school in an engineering department. Believe me, plenty of idiots hold a degree (even an advanced degree) in these areas. Most medical doctors are just mechanics that specialize in troubleshooting one particularly poorly designed device, and many engineers are convinced that because they know how to fix or optimize one problem, they can spend a few days/weeks to learn more than experts in unrelated fields.
As an IT admin that has worked in hospitals, nearly all of the docs I had to deal with couldn't comprehend simple things like capslock making their password not work and the fact that turning off the monitor doesn't shut down the PC.
And I'm reminded of the joke: "What do you call a doctor that graduated at the bottom of their class?"
This is my experience with IBD and drs. I have to explain the disease to them for them to understand so they can make decisions. I don't know why my consultant doesn't just make the decisions instead when he's the expert.
It reminds me of this video. The biotech girl with a PhD in cancer biology was so sure she was the smartest person in the room until she took an IQ test and ranked behind the military guy everyone picked for last.
Would you be more likely to visit a doctor who could confidently diagnose everything, or was willing to admit they aren't 100% sure? Most people want answers, and would change doctors if they don't get an answer, or an answer they want.
A doctor who can confidently diagnose everything wrong is the worst kind of doctor. Even one who confidently diagnoses a smaller portion of things wrong is dangerous, because they will ignore evidence to the contrary. I'd much rather have one who says, "I think this is what you've got but we're going to test to be sure."
I really appreciate that my doctor will regularly admit they aren't 100% sure, and often sends me to specialists and for labwork to eliminate worst case scenarios and run things down.
I'd be more concerned if they just wrote off my concerns and symptoms because they couldn't immediately connect it to anything other than say, stress and lack of sleep.
That said, my relationship with my doctor is probably not the norm due to some lifelong health stuff that keeps me going in every 3 months or so, and I've had the same provider for a good number of years. We've had enough time together for them to know how I approach my symptoms and health.
I'm also privileged that I have decent enough insurance, salary, and job that allows me to go and actually do all that. Most people don't.
Back to the point though:
I totally understand the "just fix it!" mindset, but I feel like anyone who has had to spend a decent amount of time troubleshooting anything should realize that isn't always possible. Especially with things regarding the human body.
How many different things can go wrong with a car, a computer, or a business process, that from the outside all look like the same issue? None of these are realistically comparable to the complexity of a person. You're going to expect someone to just listen to a few minutes of your whining, pat you on the back, and send you off with an 100% reliable solution for an issue with something as mind bogglingly complex as a human body?
You can't just drop your body off at the shop, have a crew of people take their time diagnosing and fixing it, and get it back when they're done. You're going to have to hual that death trap junk heap from place to place yourself to get it in front of the right people first. They might have to call in a guy who's familiar with your specific make and model, or a guy that's experienced with electrical systems.
I dunno, the idea of some sort of "quick result" doctor visit that solves your exact issues and doesn't tell you things you don't want to hear just seems incredibly naive.
I was once almost killed by a doctor who wouldn't believe me when I said I thought I had pulmonary embolism and sent me home without treatment, saying to "not use Google to diagnose myself".
I'd be dead today had I not returned to see another doctor the next day.
I think if you name a suspected medical condition at the admission they are far less likely to believe you.
I know I’m a minority but as someone who works in emergency medicine I think the opposite.
If you come in thinking you have something there’s probably good reason, and I damn well better be sure you don’t have it if I’m going to send you home. You know your body better than me. It may not mean we test for it, but I need solid clinical decision making tools to support not testing for it
It's a shame too. A lot of this occurs due to the egos of medical professionals, rather than genuine concern that the patient might be going off the basis of misinformation.
Was also sadly my experience. Got a cut because of a collapse, told them that I have heart failure since a kid and this felt strange, but they never did any tests, just wanted to send me to the psych unit.
#notanexpert . my understanding that ER/ED basically only have moderate responsibility to judge that you will not die and sue them in the next ~24h after an event. they tell you to seek further primary care when discharged.
I was 25 when I was diagnosed with Ulcerative Colitis (IBD) I went down to A and E because I had bad swelling on my feet and I couldn't walk at all, the doc told me it was muscular and have epsom salt baths. Next day swelling was worse so I made an emergency appointment with my GP who did tests and sent me to A and E for further tests. Basically after being admitted to hospital they realised that I had an infection from my ibd and I had lost a lot of blood that they gave me a transfusion. If I listened to the first Dr at A and E I could be dead now.
I guess it's just very difficult for the doctor if their interpretation of the evidence says that you are ok. They must choose whether to believe their patient, or to trust in their own knowledge and training. In your case, the doctor made the wrong decision and it almost cost you your life. And in other cases people definitely do die due to mistakes made by doctors. ... or at least, the people would not have died if the mistake wasn't make - that doesn't always mean it was the doctor's fault though. People are imperfect - especially when under pressure; and sometimes the strategies that save lives are the same strategies that let other people down.
I'm reminded of a TV series that I enjoyed, called "This is going to hurt".
I want to rewrite that scene from Liar Liar when Jim Carey yells at the impound driver to fit the VA claims process.
Oh yeah!
“What are you gonna do…”
NOTHING! Because you will just lose my paperwork and make me resubmit for years! Then you will send me to a doctor that is 105 years old and hates that the sun came up. Your board will look at my gunshot wound and say it’s not service related. So I am going to piss and moan like an implant jerk.
we are at the point where they aren't even taking care of the underclass that fights their wars for them. there's almost no benefit to play the game anymore.
That’s a good question as sports are ingrained and you can’t take away people’s tribal entertainment without consequences. Panem et circenses and all that.
It's really interesting reading all the information coming out of rugby right now. It's changed so much over time.
From my memory it went.
Concussion can kill you but if you get up with no symptoms you're fine. If you have symptoms wait until they go away then you're fine.
If you get a concussion and get up and you are fine but have another concussion shortly after you can die. You just need rest and then you are fine.
If you don't get knocked out you might still have concussion.
Repeated concussions can cause permanent damage and that damage can stack and make you more prone to new ones.
You can get brain damage from non knocked out big hits. This can manifest itself years later
Then when shit really hit the fan. Basic bog standard training sessions where you have no negative symptoms can cause brain damage if you do them too often. This is where we are now. Maximum contact training is in place. Players are getting g force sensors in their gum shield.
I can see this going futher to having longer breaks in games with recovery periods. They have changed the rules a about as much as they can. Head guards will probably be mandatory soon.
Finally the game might even die. But I expect the risk of brain damage when managed is less than the pros that come partaking in the sport.
There is no reason to doubt that concussive force concusses the brain. I imagine getting insurance assholes and the military brass to give more of a shit about it is nigh impossible though...
This is not justifying the shitty treatment of vets by the VA or by insurance companies.
The problem is that medicine has long focused on severe acute traumatic injuries. The kind sustained by military individual are mild repeated concussive injuries without an immediate onset of symptoms. We have only very recent learned about the additive effects of long term repeated trauma to the brain like those suffered by American football players, boxers and military individuals.
i didnt read the article or all the comments.
but my impression is a good MRI would be more than enough. no?
maybe the interpretation of the results were not done carefully.
#notanexpert
pretty obvious that DAI is certainly a recognized thing.
maybe DAI is less studied than open head injuries in humans.
I think the main reason for this difficulty on the imaging side is that the brain is such a highly tuned, precise instrument that doing small areas of microscopic damage (below the threshold of medical imaging to detect) can still result in noticeable dysfunction (so a brain can look normal on MRI but have damage too small to see). Secondly, the MRI appearance of chronic trauma overlaps hugely with other, more common conditions.
In a research/university setting there is improved ability to detect some of these cases using advanced or experimental techniques that aren’t common out in the community setting, but even so I would wager that there are a significant number of cases that fall into the “looks normal” category.
What the VA told me was that blast injury is like CTE in a football player's brain. They aren't detectable before death because the damage is widespread at the microscopic levels. Basically trillions of brain cells connections that didn't heal right each time you get a concussion. It's not one big thing that shows up on imaging. They have to put slices of brain on a microscope to see the damage.
And no that did not make me feel good about getting older...