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'I've been suffering for 10 years': Why are brain injuries still going undiagnosed in veterans?
Ian Huxley was fun and confident until he finished four tours in the Middle East. The ten years that have followed have seen him passed from "pillar to post," ITV News Correspondent Geraint Vincent reports
To military medics, Ian Huxley's symptoms must have seemed all too familiar.
After two tours of Iraq and two of Afghanistan, he had trouble sleeping, was drinking heavily and was quick to anger. He felt depressed and reported intrusive thoughts and emotions.
The diagnosis was Post Traumatic Stress Disorder (PTSD), a psychiatric condition that can occur in response to distressing or threatening experiences and affects 9% of veterans of the "War on Terror".
But when Ian did not respond to normal treatments, he was discharged from the army into the care of the NHS.
Still, his PTSD diagnosis stuck.
Life since has been tough.
Ian has tried to work but lost several jobs due to his symptoms. He has separated from his wife, been sectioned and attempted suicide.
"I get panic attacks, I freeze and get hot and cold sweats.
"Even doing something like going to the shops, I need to see the exit all the time... if I can't see it, I start flapping and freaking out and then the anxiety goes up and you get to the point like I'd rather not eat than do the shop," he said.
"I get headaches, blurred vision, really severe headaches. I had one the other night and it wiped me out for five hours.
"I just had to be in a dark room on my own. Really, really intense and painful... I'm always ill as well, from lack of sleep, always ill."
"I've been suffering now for ten plus years.
"I've been through the NHS, passed from pillar to post. I've been on a number of medications and nothing ever works. I still feel just as angry, just as got to the point like this feels normal to me now," he added.
Over the last decade, Ian has seen 29 doctors and scores of other healthcare professionals; his medical records run to over 700 pages.
But it was friends, not doctors, who suggested he might have blast-related mild Traumatic Brain Injury (mTBI), a condition where repeated exposure to blast causes cumulative damage to the brain, resulting in severe neurological problems.
Explosions create a wave of 'overpressure', a spike in the surrounding air pressure above normal atmospheric levels caused by a blast wave.
Pound per square inch (PSI) is the unit of measurement used to quantify the amount of overpressure in a specific area.
1 PSI would be enough to cause window glass to shatter, whilst a PSI of 20 would likely cause a concrete building to collapse.
Nato allies widely assume that any overpressure above 4 PSI can damage the brain.
Several weapon systems used by the British Army appear to breach that threshold, meaning the soldiers who fire them are particularly at risk.
Ian was never visibly injured in combat, but he was exposed to blasts throughout his service, particularly in Afghanistan.
Symptoms of blast-related TBI overlap with those of PTSD, but there are other signs too, many of which Ian displayed: severe headaches, visual disturbances, sensitivity to noise and light, short-term memory loss and a sense of personality change.
"Who I am today and who I was then are two completely different people.
"Back then, I was fun, outgoing, I loved sport, loved running, I was just fun, young, confident, cocky, a typical squaddie, I suppose.
"It upsets me because of who I was for my older ones, they remember daddy being fun, outgoing, quirky, laughing and joking all the time, full of energy.
"My younger children... see an angry man at times, they feel 'why is daddy getting upset' or 'why can't he take me to the park today, it's not like he's doing anything' and you just, the lack of motivation, you are just constantly mentally exhausted and physically exhausted and the thoughts that go through your head, the constant self-doubt of am I good enough? "
Ian contacted ITV News after seeing our previous reports on blast TBI and offered to undergo a brain scan to see if his PTSD diagnosis was responsible for his symptoms or whether there was something else his doctors had missed.
The damage caused by repeated blasts is widespread, but so small that it does not show up on normal head scans.
However, an innovative medical software company has now developed an algorithm that compares MRI scans to a database of thousands of "normal" brains, highlighting previously undetectable areas of damage.
Innovision IP CEO, Peter Schwabach, told us: "A lot of the symptoms of psychological damage like PTSD are very similar to the ones of brain injury, and what tends to happen is in the absence of images which show damage, all patients are put into the psychological basket.
"Some of them may have PTSD, but many people will have an organic injury... so this could really help doctors make an accurate diagnosis."
When Ian's results came back, they were stark.
His scan showed clear signs of physical trauma: damage to several of the brain's network connections, consistent with injury.
Parts of his cortex were visibly thinned and many neurons had lost their vital insulation - changes that signal a loss of mental function.
All this in a man just 39 years old, with no recorded head injury.
To neurologist Dr Steven Allder, however, the scans tell a depressing but familiar story. Ian is the latest of several veterans he has seen with these patterns of damage.
He described seeing each person as like "picking up the same set of notes every time" and said "there is a real problem."
"They're all veterans, they've all been deployed in the same place, and now they've got this very consistent constellation of symptoms which is sufficiently complicated that someone needs to take ownership of it.
"And until we do that, the patient and the families are going to just feel like they do, which is that they just get passed from pillar to post with no explanation.
"A little bit of intervention here, potentially a drug there, but it doesn't make any difference really."
The scale of the issue is hard to pin down, but Dr Allder said the people he works with are worried about hundreds of people.
The Ministry of Defence has provided funding for research into the diagnosis and prognosis of blast-related TBI, and a variety of cutting-edge scientific studies are underway.
It says it recognises the urgent clinical need to address the complexities of diagnosis arising from the overlapping symptoms of TBI and PTSD.
Campaigners say all research is welcome, but there is already sufficient scientific knowledge to justify urgent action to help veterans who are suffering now and they also call for the government and NHS to do more.
