this post was submitted on 18 Mar 2024
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“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.

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[–] [email protected] 120 points 5 months ago (5 children)

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

[–] [email protected] 36 points 5 months ago (2 children)

Because we don't want doctors guessing or being creative. They're not the R&D creating engines, they're the mechanics.

[–] [email protected] 52 points 5 months ago (6 children)

"hi my car is making a noise that sounds exactly like a faulty wheel bearing. I think my wheel bearing is broken."

"No, it's not. You can go now."

I don't see how this analogy makes their arrogant dismissals any better.

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[–] [email protected] 15 points 5 months ago (18 children)

They can damn well explain why they disregard some symptoms and why my online diagnosis is unlikely

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[–] [email protected] 7 points 5 months ago (5 children)

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.

[–] Mouselemming 14 points 5 months ago (2 children)

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."

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[–] [email protected] 12 points 5 months ago

That is true. But it sounds like he had decent evidence?

I agree with the fact that doctors shouldn’t just diagnose everything because someone says that’s what they’ve got.

[–] [email protected] 9 points 5 months ago

It's not so much they don't admit they don't know, it's that they tell you nothing is wrong.

[–] [email protected] 6 points 5 months ago (1 children)

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.

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[–] [email protected] 6 points 5 months ago

They get one shithead hypochondriac WebMD scroller and just assume every patient is an idiot.

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[–] [email protected] 94 points 5 months ago (5 children)

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.

[–] [email protected] 41 points 5 months ago (7 children)

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

[–] [email protected] 21 points 5 months ago (7 children)

Usually that tool is that I'm a woman

[–] [email protected] 25 points 5 months ago (1 children)

It could be an embolism, but first let's check to make sure you aren't pregnant...

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[–] [email protected] 10 points 5 months ago (1 children)

That’s how it should be. It’s astonishing to me that some doctors don’t take the chance that the patient might be right

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[–] [email protected] 8 points 5 months ago

Yeah, you're definitely in the minority.

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.

[–] [email protected] 8 points 5 months ago (3 children)

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.

That was a pretty fucked evening...

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[–] [email protected] 6 points 5 months ago

I'm sure you think this and for people with decent insurance it may be true.

Never once have I ever received adequate medical assistance in my entire life.

Hell I was once even sent home with appendicitis AFTER testing confirmed it.

American for-profit medicine is a joke and untold people die from it every year.

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[–] [email protected] 13 points 5 months ago (1 children)

Thank the opioid era for that.

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[–] [email protected] 6 points 5 months ago

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.

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[–] [email protected] 78 points 5 months ago (2 children)

"Your injuries are not service related"

[–] [email protected] 32 points 5 months ago (1 children)

"Best I can do is 50%"

"But that would make me 130% disabled..."

"Best I can do is 90%"

[–] [email protected] 22 points 5 months ago (2 children)

Ah yes, the VA, the only institution that has its very own math. 50+50+30+10=70

[–] [email protected] 10 points 5 months ago

Where 60% is 100%, if you can get it.

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[–] [email protected] 17 points 5 months ago (1 children)

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.

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[–] [email protected] 73 points 5 months ago (1 children)

Jesus Christ 29, repeat explosion based TBIs and being told he's fine. I wish more than anything else we'd take care of our vets.

"The only easy day was yesterday"

[–] [email protected] 14 points 5 months ago (1 children)

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.

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[–] [email protected] 50 points 5 months ago (1 children)
[–] [email protected] 18 points 5 months ago (1 children)

Yeah… it definitely sucks, but explains what was going on and why the guy seemed to lose his mind.

I wonder how much longer we’ll see people playing sports like football or UFC as brain trauma becomes better understood.

[–] [email protected] 10 points 5 months ago (2 children)

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.

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[–] [email protected] 42 points 5 months ago (3 children)

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.

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[–] [email protected] 16 points 5 months ago (1 children)

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...

[–] [email protected] 6 points 5 months ago

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.

[–] [email protected] 6 points 5 months ago* (last edited 5 months ago) (3 children)

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.

[–] [email protected] 17 points 5 months ago

Neuroradiologist here. 👋🏻

The short answer is not necessarily.

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.

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