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A Time to Heal: Soldiers With Amputations Rebuild Lives at the Center for the Intrepid

Monday October 20, 2008
(Photo by Brian Diggs)
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Army Corporal Shane Parsons and Specialist Adrian Garcia are eagerly waiting for their new legs to arrive at the U.S. military's state-of-the-art rehabilitation center for wounded veterans in San Antonio.

Garcia, 20, and Parsons, 23, each lost both legs above the knee to explosive devices in Iraq. Garcia had been in Iraq for only 20 days when a rocket-propelled grenade ripped through the Humvee in which he was riding. "I knew something bad was happening," he says. "It was the most painful thing I ever felt."

Parsons was a month away from finishing his time in Iraq when his Humvee was demolished by a sophisticated roadside bomb. "[After the explosion] I was trying to put a tourniquet on my leg," he says. "You're supposed to take your boot off, and when I did, everything came with it."

Both men have been at Brooke Army Medical Center and The Center for the Intrepid, a rehabilitation center located on the same campus, for more than a year, Parsons almost two years now, recovering from their physical and psychological wounds. The circumstances of how Garcia and Parsons lost their legs are similar, but different factors have shaped their physical and mental rehabilitation.

Although the explosion that destroyed Garcia's legs would have been sufficient to cause post-traumatic stress disorder, he was not in Iraq long enough to have collected other disturbing memories of combat. He says he has not been diagnosed with the disorder. Parsons already had enough combat memories to trigger PTSD without the physical trauma of losing both legs. In addition, the blast wave from the explosion caused severe traumatic brain injury, from which he would also have to recover. Parsons has been diagnosed with PTSD.

As devastating as the loss of both legs would be for anyone, Parsons and Garcia had some advantages as they began rebuilding their lives. They were young, healthy, and in top physical shape when wounded. They also come from a military culture that demands discipline, hard work, and the setting and achieving of specific goals.

Most importantly, they have been emotionally and psychologically supported by a network of peers, family, and friends and a team of physical and occupational therapists, nurses, physicians, prosthetists, and other specialists required for their recovery.

Servicemembers with amputations are usually taken to either Brooke or Walter Reed Army Medical Center in Washington, D.C., where the military's first and larger rehab center for amputees is situated. Soldiers, Marines, or airmen can arrive at either hospital as early as three days after they are wounded in Afghanistan or Iraq.

Jorge Torres, APRN, BC, is one of the first people to greet servicemembers with amputations when they arrive at Brooke Army Medical Center. Torres is a behavioral medicine clinical nurse specialist and the only RN who works at the Intrepid, as well as the hospital. He also is a retired Army major, which soldiers say makes it easier for them to talk to him about their experiences.

Parsons says when they first met, Torres told him, "You are still a soldier. You're still active Army. You can still fight for your country, but in a different way. He encourages me in ways I can't explain. He knows how to talk to soldiers."

Specialist Lawrence Guerro, 24, whose right leg was amputated in Iraq by a steering wheel during a roadside explosion, says his recovery would have been more difficult without Torres' support. "I think it would be hard to deal with the stress. I was angry about what happened to me. People didn't understand what I had been through; they didn't really get it."

But servicemembers with amputations are no more likely to develop PTSD than those who have no permanent physical disability, Torres says. Hal J. Wain, PhD, chief of the psychiatry consultation liaison service at Walter Reed, agrees. "Just because they have an amputation does not mean they will be more vulnerable to PTSD," he says.

PTSD arises from different aspects of the traumatic experience, not necessarily the event itself, Torres says. Other factors include how many amputations the soldier had, what body part was amputated, and what circumstances surrounded the injury.

In some ways, these soldiers receive more support than those who have no physical wounds but face emotional difficulties when they return from duty in Iraq or Afghanistan, Wain says. Physically disabled soldiers are supported by a network of healthcare providers over an extended period of time.

Physical therapist Matthew Parker says it is his challenge to get every soldier he cares for up and moving, and this requires meeting their emotional, mental, and spiritual needs, as well as physical needs. "I have moments when I have to step back and look at what they are going through and how much strength they show," he says.

The initial approach to treating severely wounded servicemembers is to help them quickly normalize their traumatic experiences by reinforcing that the sleeplessness, nightmares, hallucinations, and anger are normal reactions to traumatic events, say Wain and Torres.

They also need to have their innate resiliency reinforced by pointing out the sacrifices they made while serving their country, something not everyone can do, and explaining that they can still live normal lives and contribute to society.

Torres and Wain use a variety of treatment approaches, including cognitive behavioral therapy, exposure therapy, and individual and group therapy. Torres can prescribe psychotropic medications as necessary. Most commonly he prescribes medications for sleep, anxiety, and depression; but he doesn't force anyone to take them. He also helps servicemembers recognize when they are ready to stop taking pain medications.

One of the first things for which soldiers are assessed is whether they are getting enough sleep. A good night's rest can be elusive for soldiers. While in Iraq or Afghanistan, they remain hypervigilant, always anticipating mortar, IEDs, or other types of attacks that can come out of nowhere. Lowering that heightened sense of alertness can be difficult, Torres says.

Servicemembers also return with jet lag and are coping with pain from their wounds. Without adequate sleep, soldiers will not be able to maximize their rehabilitation. Wounded servicemembers also need emotional support from healthcare personnel, family, friends, and perhaps most importantly their peers — other military men and women who have similar amputations, Torres says. He connects new amputees with other soldiers who are further along in their rehabilitation and can provide peer support.

Part of treating a soldier includes treating the family as well, Wain says. The stress on the family can be overwhelming. Torres says he keeps the family informed and educated about their loved one's treatment and can refer them to therapy when needed, including child therapy.

Torres also runs a support group for family members at the Intrepid. Parsons' mother, Cindy, says she has not had time to attend the support groups. She and her son live in housing on the grounds of the medical center. As her son's primary caregiver, she has few hours in the day for herself. An RN, Cindy left her home and her job at Fostoria Community Hospital's ED in Ohio two years ago to help care for her son.

When she first saw her son after he was wounded Sept. 30, 2006, "the hardest part for me was looking at his limbs," she says. "I couldn't do it for several days, even though I've seen bad wounds. Finally I talked myself into dealing with it, and then I was ready to care for him."

Parsons' recovery from his wounds and physical rehabilitation have been slow and painstaking. Because of the TBI, he has had to relearn how to read and write. But he has been making progress, especially in the past six months. "If it weren't for my mom being here with me, I wouldn't be progressing as well as I am," he says.

Torres and the other members of the medical and rehabilitation team encourage servicemembers to set new goals for themselves. Parsons has reached out to the community as a spokesperson for different organizations. He also volunteers at an animal shelter in San Antonio. His goals are to work with organizations that help other wounded soldiers, continue playing with the sled hockey team, and attend college.

Guerro's recovery has been complicated by infection, constant pain, and abnormal bone growth in the tissues of his residual limb. His goals are to leave the Army, go to college, and find a job so he can support his wife and children.

Garcia plans on leaving the Army and going to college and eventually becoming a screenwriter. "My injuries help me see life, the good and bad," he says. "They have definitely helped me mature a lot. When I'm down, I see there's always someone worse off."

Garcia and Parsons are waiting for computerized prosthetic legs — the best that medicine and technology can offer. As double amputees, they know that even with the most advanced prosthetics, they will probably never be able to walk for long periods of time. But the C-legs, combined with what they have learned at the Intrepid, will help them regain their independence, return home, and reach their new goals.

Rates of Amputation and Traumatic Brain Injury

"As of February 2008, the Department of Defense reported 1,031 individuals who have suffered major limb amputations [while serving in Iraq or Afghanistan]," according to a report by the Congressional Research Service for the U.S. Congress.

"As of January 2008, the Department of Defense reported a total of 5,503 soldiers suffering from traumatic brain injuries," according to the report.

"These injuries may overlap, that is, a single soldier may experience both a TBI and an amputation," the report states. "Amputation and TBI statistics are provided to CRS by the Office of the Army Surgeon General."



Janet Boivin, RN, is editorial director for national features and the New England edition. To comment, e-mail editorNTL@gannetthg.com.