Michael E. DeBakey VA Medical Center - Houston, Texas

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Teaming Up to Heal the Troops

March 11, 2007

http://www.chron.com/disp/story.mpl/headline/metro/4619393.html

March 11, 2007, 11:27AM
By ROSANNA RUIZ
Houston Chronicle

Cpl. Robert Engelbrecht doesn't appear self-conscious of his twisted, almost useless hand or his blind right eye. He gently chides his mother to allow him to tell his story without interruption, then crosses his right leg underneath his amputated left one.

"I didn't know I was this bad," he continues, recalling his thoughts after the bomb blast in Iraq last summer that mangled his body.

It could have been worse. Engelbrecht almost bled to death from a severe shrapnel wound, but he survived because he received critical care not far from the battlefield and then was whisked away to a military hospital. Dramatic improvements in protective gear and medical procedures mean more soldiers like him are surviving the wars in Iraq and Afghanistan with lost vision, missing limbs and brain injuries.

Today, the 23-year-old Tomball man has the distinction of being the first patient treated at the Michael E. DeBakey Veterans Affairs Medical Center by a team of physicians dedicated to Iraq and Afghanistan veterans with catastrophic wounds, including traumatic brain injuries.

One-stop setting
The approach is referred to as "polytrauma" care, referring to the complex injuries — attributed to the use of car and roadside bombs — these veterans have that require expertise in multiple fields. VA centers now concentrate medical specialists, therapists and counselors for each polytrauma patient in a sort of one-stop-care setting.

"He is actually on the better end of the spectrum," compared with other veterans with traumatic brain injuries treated at the Houston VA hospital, said Dr. Stephanie Sneed, one of Engelbrecht's doctors.

The VA designated four sites as polytrauma centers in 2005 and expanded the services to Houston and 16 other cities last year. Houston's VA was chosen because of the number of experts on its staff, but the polytrauma team was not fully in place until this year. The team includes experts in brain and spinal cord injuries, blindness and rehabilitation. The number of physicians assigned to one patient varies by the extent of the veteran's injuries.

"I feel that the VA has been very instrumental in taking people who are going to be dedicated to treating our veterans who are coming back with more injuries from those in the Vietnam War or even before that," said Sneed, who oversees the local polytrauma unit.

Twenty-two other war veterans, 10 with brain injuries, were treated at Houston's VA Hospital before the team was officially in place, Sneed said. Brain injuries are considered among the more serious injuries soldiers now face. Explosions can rattle the brain and cause symptoms that include headaches, irritability, sleep disorders, memory loss and depression.

Focused attention
The VA's objective is to provide critical care at the primary sites, then move the patient to regional hospitals for treatment that's closer to home, said Dr. Sally Ann Holmes, the Houston VA's spinal-cord-unit chief.

Medical care for wounded veterans was the focus of congressional hearings last week after a series of articles in the Washington Post exposed poor living conditions and other problems at Walter Reed Army Medical Center.

The care issue was also the primary focus of a recent documentary by ABC News anchorman Bob Woodruff. Woodruff, who suffered a brain injury during an explosion 13 months ago while reporting in Iraq, also questioned whether the military and VA hospitals were up to the task of caring for critically wounded veterans. The program included an interview with a veteran who was left to linger without treatment from his local VA.

Some physicians at Houston's VA responded last week that the documentary was referring to smaller regional centers, where experts typically aren't as available as they are here. VA physicians receive immediate notices whenever veterans from the current wars have waited 30 days or more to see a doctor. Iraq and Afghanistan veterans are granted preferential treatment and are moved ahead of all other veterans.

'Nothing but compliments'
Complaints among some veterans here generally are about what they consider an overburdened staff and lengthy waits to see physicians. But all of them said they are more than pleased with the quality of medical treatment they receive.

"Once you're in the system, the care is very good," said retired Army Sgt. Dale Myers of New Caney, who served in Korea and Vietnam. "I have nothing but compliments for them once you're in the system."

Engelbrecht, too, raves about the care he received at Walter Reed and at the VA's Polytrauma Center in Palo Alto, Calif., where he was treated for four months before being transferred to Houston on March 4.

The Humvee driver was severely wounded in a bomb blast July 31.

Engelbrecht did not see an improvised explosive device along a road in Al Hilla, but he was told later it was hidden under a pile of rocks. Unable to stop the vehicle after shrapnel tore through his leg, Engelbrecht instead killed the engine and headed for a nearby creek. The vehicle crashed into the creek and came to rest in about five feet of water. No one else was as severely wounded.

He was ultimately flown to an aid station. His last memory of Iraq was the ceiling of the helicopter.

Physicians at Walter Reed tried to save Engelbrecht's left leg but had to amputate above the knee Aug. 10. Engelbrecht regained consciousness the next day and asked his mother, Raylene Watts of Houston, "What am I going to do without a foot?" She told him it was much worse than that. A tear rolled down his face, and he fell back to sleep.

"I was mad, but I can live with it," he said.

Tally of wounded
So far, the war has produced 760 amputees. That includes 500 men and women who lost a limb, hand or foot and 260 more who lost fingers or toes, according to the Defense Department.

Engelbrecht also has some short-term memory loss; he is blind in his right eye and has some vision loss in the other. His right arm and wrist were also badly injured. Surgical scars and shrapnel wounds can be found on his arms, chest, back and legs.

He explained his chipper attitude through the bumper-sticker philosophy that "stuff happens." (He prefers the saltier version.) He frequently falls back on his robust sense of humor, telling others that the 75 pounds he has lost was "all leg."

"He's a character," his mother said. "If he wasn't so easygoing and laid-back, I think this war would've messed up his mind. But he's my old son."

His father, Robert W. Engelbrecht, agreed that the only changes he suffered were physical. But it was difficult for a father to see his son so mutilated. After he's released, the younger Engelbrecht will return to live with his father and stepmother, Paula, in Magnolia.

Until then, Engelbrecht will continue to receive routine therapy sessions, which include practice sessions with his new prosthetic leg.

"I don't have any regrets," he said. "It was a life experience."