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Traumatic Brain Injury and the Art of Paddling

Collins enjoys stand-up paddle boarding for how it helps him with TBI. His service dog, Charlie, likes it too. (Courtesy Photo by U.S. Army Special Operations veteran Josh Collins) Collins enjoys stand-up paddle boarding for how it helps him with TBI. His service dog, Charlie, likes it too. (Courtesy Photo by U.S. Army Special Operations veteran Josh Collins)

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I am on a new mission: to raise awareness about treating traumatic brain injury, or TBI, in the most effective way possible. My world on dry land was always moving. But, when I stood on a stand-up paddle board for the first time, the constant moving just stopped. The horizon was steady for me while the water movement under the board reduced the balance and vision challenges I have due to TBI. For me, getting on a paddle board also represents challenges a lot of combat veterans deal with when they return home and are faced with adjusting to daily life or recovering from injuries.

I deployed for operations in Bosnia, Operations Desert Shield, Desert Storm, Enduring Freedom, Iraqi Freedom, and to other places around the world. While serving with Army Special Operations, I experienced four documented TBIs with loss of consciousness from explosive blasts. I sustained two TBIs by parachute landing falls, and one TBI from combat training. After I retired in 2008, I continued to support the military as a contractor. It was in 2013 when I sustained two more TBIs in the same week, which was the proverbial straw that broke the camel’s back. It was devastating.

My symptoms include several physical balance issues; cervical spine compression; vestibular ear damage in both ears from blasts; eye nerve damage and double vision, which I’ve had treated surgically; tremors from early onset of Parkinsonism; cognitive decline; stuttering; severe attention deficit with hyperactivity disorder, or ADHD; and memory loss.

U.S. Army Special Operations veteran Josh Collins sustained several traumatic brain injuries over his career. Collins, shown here with a supporter he met along the way, is on a mission is to raise awareness about TBI and promote resources for nonprofit organizations that help service members and veterans like him. (Courtesy Photo by U.S. Army Special Operations veteran Josh Collins)U.S. Army Special Operations veteran Josh Collins sustained several traumatic brain injuries over his career. Collins, shown here with a supporter he met along the way, is on a mission is to raise awareness about TBI and promote resources for nonprofit organizations that help service members and veterans like him. (Courtesy Photo by U.S. Army Special Operations veteran Josh Collins)

My friends and family saw the changes in my personality. I was caught in an endless cycle of anger. It was so frustrating to drive 60 miles in the wrong direction, or to show up somewhere and not know why I was there – or how I got there. I used prescribed medications and self-medicated with alcohol, which caused me to become reckless. I reached the limits of my ability to function.

Returning to normal life can be difficult when you’re suffering from invisible wounds. Thankfully, I have family and friends who pulled me out of the quicksand, enabling me to receive treatment at the James A. Haley Veterans’ Hospital in Tampa, Florida. My first extreme paddling voyage began soon after those three months of treatment. I dared to live again while skimming along the water, in a way that's bigger than me.

I began my first extreme paddle board journey in 2016 as a way to help others like me. I thought taking on something physically intense and never quitting could turn people’s attention to the topic of TBI. After all, helping others is why many people join the military in the first place.

I started out with a tent and five-day supply of water and food. I ended up traveling 2,632 miles on a 14-foot paddle board. I focused on an estimated 1.7 million paddle strokes – one at a time. I averaged 28 miles a day during 94 days of paddling while my wife, Tonia, drove 10,435 miles along the way. I camped out overnight and restocked supplies every few days. People in boats or on paddle boards came up to me almost daily asking what I needed. I usually needed water, but the connections with hundreds of people may have been more essential.

I made it to the Statue of Liberty and received a water salute from the U.S. Coast Guard. “Operation Phoenix” took me five months – 140 days – to travel from South Texas to New York’s Battery Park. My 20 years in the U.S. Army and several years supporting special operations as a contractor were fulfilling. I’m proud of my service, but equally proud that after this particular journey, I hung my paddle board in the New York Fire Department’s boat house – just blocks from where more than 400 first responders lost their lives on Sept. 11, 2001.

Today, I'm not the same person I was two years ago. I don't stutter or get lost every time I leave a gas station. While everyone’s journey with TBI is unique, we all experience a disruption with normal brain function. My paddle board voyage helped me find myself now that combat is over.

My advice to those who think they might have some brain issues is to listen to the people around you. Observe how your family and friends react. Your mission is recovery. This fight is just as big as the one you fought overseas. Make learning a habit for daily life. Doctors can help you but you have to work every day to heal yourself.

Here are some ideas:

  • Learn to do three-dimensional puzzles that can help you work on spatial intelligence. Practice these once a day. It took me a year to learn one with an instructional DVD. This exercise helps me with how I think and has improved my memory.
  • The motor cortex is a great way to tap into your brain - do things that involve hand-eye coordination. Try switching hands for using chopsticks, writing, and playing a musical instrument.
  • Watch “A Head for the Future” videos about other TBI stories, and access resources to recognize and recover from brain injury. You've got to get help. It's your brain.

Finally, please reach out to another veteran. Connection has been part of the cure and continues to work for me.

Josh Collins is a retired U. S. Army sergeant first class who served with Special Operations Units. Paddle boarding is his current mission for raising TBI awareness and resources to support nonprofit organizations benefiting service members and veterans. This month Collins will try to complete 300 miles on a stand-up paddle board for a second time through the Everglades of Florida. This summer he will begin a 750-mile race to Alaska called “Operation Torrent.”

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Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

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This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

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6/19/2017
Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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Erectile Dysfunction among Male Active Component Service members

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Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. ED can result from a problem with any of the above: •	Hormones •	Emotions •	Nerves •	Muscles •	Blood vessels These factors are required for an erection include. Picture is a brain (left) and a male figure (right) showing the heart and main arteries of the body. The top three most common ED diagnoses are: 1.	Psychosexual dysfunction 2.	Hypoactive sexual desire disorder 3.	Male orgasmic disorder Image shows a couple outside together during sunset. House displays in background. Causes of ED (Shows cut out of male body highlighting areas of the body where causes happen) •	Unrealistic sexual expectations •	Depression/ Anxiety/ Stress or other mental health issues •	High blood pressure •	Diabetes •	Obesity •	Injuries that affect the pelvic area or spinal cord •	Low testosterone •	Aging, Substance Abuse Demographics: •	Incidence rate of erectile dysfunction are higher among black, non-Hispanic servicemen when compared to other race/ethnicity groups. •	Black non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction, including hypertension, obesity and diabetes. •	Separated, divorced and widowed servicemen had a higher incidence rate of ED than servicemen never married. •	Servicemen never deployed had the highest crude incidence rate of erectile dysfunction. Get the facts •	Erectile dysfunction is the most common sexual complaint reported by men to healthcare providers •	Among male service members nearly half of erectile dysfunction cases related predominantly or exclusively to psychological factors. •	Incidence rates of psychogenic erectile dysfunction are greater than organic erectile dysfunction for service members. •	Organic erectile dysfunction can result from physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. •	Highest incidence rates were observed in those aged 60 years or older. •	Those 40 years or older are most commonly diagnosed with erectile dysfunction. Effective against erectile dysfunction •	Regular exercise  ( Shows soldier running) •	Psychological counseling (Shows two soldiers engaging in mental health counseling. They are seating on a couch).  •	Quit smoking ( shows lit cigarette)  •	Stop substance abuse ( Shows to shot glasses filled with alcohol) •	Nutritional supplements ( Shows open pill bottle of supplements) •	Surgical treatment ( Shows surgical instruments) Talk to your partner Although Erectile Dysfunction (ED) is a difficult issue for sex partners to discuss, talking openly can often be the best way to resolve stress and discover underlying causes. If you are experiencing erectile dysfunction, explore treatment options with your doctor. Learn more about ED by reading ‘Erectile Dysfunction Among Male Active Component Service Members, U.S. Armed Forces, 2004 – 2013.’ Medical Surveillance Monthly Report (MSMR) Vol. 21 No. 9 – September 2014 at www.Health.mil/MSMRArchives. Follow us on Twitter at AFHSBPAGE. #MensHealth

Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. This infographic provides details on the ways ED impacts male active component services members of the U.S. Armed Forces.

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Update: Exertional Rhabdomyolysis Active Component, U.S. Armed Forces, 2012 – 2016

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Rhabdomyolysis is characterized by the rapid breakdown of overworked intracellular muscle, skeletal muscle cells and the release of toxic fibers into the bloodstream. It is a significant threat to U.S. military members during physical exertion, particularly under heat stress. This report summarizes numbers, rates, trends, risk factors and locations of occurrences for exertional heat injuries, including exertional rhabdomyolysis for 2012-2016. In 2016, there were 525 incident diagnoses of rhabdomyolysis between 2013 and 2016 rates increased 46.2 percent – 69.7 percent of cases occurred during May through September. Risk factors for exertional rhabdomyolysis include being male, younger than 20 years of age, black, non-Hispanic, low level of physical fitness, prior heat injury and exertion during warmer months. Additional information about the causes and prevention of exertional rhabdomyolysis can be found in the MSMR at www.Health.mil/MSMR

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

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Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

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Update: Exertional Hyponatremia U.S. Armed Forces, 2001-2016

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Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water. There were 1,519 incident diagnoses of exertional hyponatremia among active component service members from 2001 through 2016. 86.8 percent were diagnosed and treated without having to be hospitalized. 2016 represented a decrease of 23.3 percent from 2015. In 2016, there were 85 incident diagnoses of exertional hyponatremia among active component service members and 77.6 percent of exertional hyponatremia cases affected males.  The annual rate was higher among females. Service members age 40 and over were most affected by exertional hyponatremia. High risk service members of exertional hyponatremia were: •	Females •	Service members aged 19 years or younger •	White, non-Hispanic and Asian/ Pacific Islander service members •	Recruit Trainees •	Marine Corps members Learn more at www.Health.mil/MSMR

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Routine Screening for HIV Antibodies Among Male Civilian Applicants

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3/24/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both male civilian applicants for U.S. military service and male service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 368,369 males out of 463,132 civilian applicants for U.S. military service were tested for antibodies to HIV. Out of 124 civilian applicants that were HIV positive, 114 were male. Throughout the period, seroprevalences were much higher among males than females.  As for U.S. Armed Forces active component, 467,011 male service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 117 were male. Annual seroprevalences for male active component Army members greatly exceed those of females. During the 2015, on average, one new HIV infection was detected among active duty army soldiers per 5,265 screening tests.  HIV-1 is the cause of Acquired Immune Deficiency Syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. Of 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in the military. Get tested and learn more by reading the Medical Surveillance Monthly Report at Health.Mil/MSMR.

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What is Rhabdomyolysis?

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3/21/2017
Although regular exercise is good for the body, too much physical activity can do more harm than good. Rhabdomyolysis is the rapid breakdown of overworked muscle cells, following the release of toxic fibers into the bloodstream, causing many complications during physical exertion. This infographic provides information about the symptoms of Rhabdomyolysis, prevention and treatment.  How to avoid: •	Thoughtfully plan out your exercise routines •	Drink adequate amounts of fluid •	Minimize your workout time in extreme heat conditions How to treat: •	IV fluids/ fluid replacement •	Urinary Alkalization •	Blood transfusion  Symptoms of Rhabdomyolysis •	Difficulty in arm motion / trouble lifting objects •	Muscle weakness, muscle swelling and leg fatigue •	Fever, confusion, loss of consciousness •	Nausea and vomiting •	Dark colored urine or lack of urine  Learn more at Health.mil/MSMR

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An abdominal hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. This infographic provides information on incident diagnoses of the five types of abdominal hernia that were documented in health records of 72,404 active component service members from 1 January 2005 through 31 December 2014.  A total of 87,480 incident diagnoses of the five types of abdominal hernia were documented in health records of 72,404 active component service members. Here are highlights of the findings from this study: •	The give types of abdominal hernia categories used in this analysis were: inguinal, umbilical ventral/ incisional, femoral and “other.” •	 During the 10-year interval, incidence rates for most of the five types of hernia trended downward but increased for umbilical hernias in both males and females and ventral/ incisional hernias among females. •	Overall incidence rate of inguinal hernias among males was six times the rate among females. •	Incidence rates of femoral, ventral/ incisional and umbilical hernias were higher among females than males. •	For most types of hernia incidence rates tend to be higher among older age groups.  Abdominal hernias are diagnosed most frequently in the inguinal, umbilical, and femoral regions, but another category of relatively common hernias of the anterior abdominal wall includes ventral and incisional hernias. Health records contained documentation for 35,624 surgical procedures whose description corresponded to the types of hernia diagnoses in U.S. military service members. Learn more about the findings of the study at Health.mil/MSMR

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Signs of Mental Health Distress

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Cardiovascular disease comprises disorders of the heart and circulatory system including coronary heart disease and cerebrovascular disease. This infographic provides data on the risk factors for cardiovascular disease among military members base on diagnostic codes in the electronic health records of service members during a 10-year surveillance period.

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The HPV Vaccine Saves Lives

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The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4). This graphic highlights information the benefits of the HPV vaccine. The vaccine is most effective among fully vaccinated individuals.   Cancer Prevention Facts •	HPV is the most common sexually  transmitted infection (STI) •	There are more than 40 HPV types that can infect the genital areas •	Some HPV types give warts •	Some HPV types develop cancer  Effective Against STI Transmission •	The HPV vaccine is a safe and effective way to protect yourself from the virus •	The HPV vaccine provides nearly 100% protection from HPV types 6,11,16 and 18 •	HPV vaccine shows early signs of success in reducing HPV infections and related illnesses •	Protection is expected to be long-lasting  Safety Tips •	Getting your HPV vaccine and practicing safe sex such as wearing a condom may lower the risk of HPV •	Limiting the number of lifetime sex partners can also lower the risk of HPV •	When given the HPV vaccine, the body makes antibodies in response to the protection to clear it from the body  Get the Facts •	2,091 female service members aged 17-26 years received 1-3 HPV4 doses during 2006-2012, stratified by number of doses (1, 2, or 3).  Get the HPV Vaccine •	Only 22.5% of eligible service members initiated the series •	Of those, only 39.1% completed the full three-dose series as of June 2011.  Even though the 3 dose regiment provides nearly complete protection against HPV16 and HPV18, in the U.S., only 12% and 19% of female adolescents among commercial and Medicaid plans respectively complete the series.  Read HPV Facts from the CDC: https://www.ok.gov/health2/documents/IMM_Teens_HPV_Facts.pdf  Read the STI issue of the Medical Surveillance Monthly Report at Health.Mil/MSMR   Get the conversation started. Ask your healthcare provider about the HPV vaccine today. Follow us on Twitter @AFHSBPAGE and use hashtag #VaccinesWork.

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Practice Healthy Living Habits

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1/19/2016
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