Every night before he sleeps, Philip Meyer looks at a laminated list pinned to the wall next to his bed.
At night, the list tells him to take his medicine, lay out his clothes for the next day, find his keys, wash face, brush teeth.
In the morning, the same list gives him another set of tasks to start the day. As he completes each, he drags a black erasable marker in a line across the words, tracking what's done and what's not.
Before his 2006 tour in Iraq, and the eight separate bomb blasts that he experienced, the college graduate and U.S. Army military police officer didn't need such reminders.
But without structure, the traumatic brain injury and post-traumatic stress disorder that Meyer sustained in those 11 months cause him to lose all sense of time. He'll forget to eat if not reminded.
Meyer said he began experiencing some symptoms immediately after the blasts, but they seemed minor at first.
"I didn't notice right away. I started getting really bad headaches right away, but everyone told me that was normal," the 29-year-old said.
Then his sense of balance began to fail, and he began to fall as often as four times a day. He lost patience easily and became short-tempered.
Meyer is among an increasing number of U.S. troops who have experienced traumatic brain injuries as a result of the widespread use of improvised explosive devices by enemy forces in Iraq and Afghanistan. From 2000 to 2009, the number of such injuries recorded annually nearly tripled, topping 29,000 last year.
TBI has been called a "signature wound" of the current wars, and critics say the military was slow to diagnose and treat the injury in the early years of the wars.
After nearly two years of treatment, Meyer manages most of the symptoms with lots of tools.
His service dog, Lahaina, a Labrador retriever/hound mix, calms him and blocks strangers who approach in public. A handheld PDA stores phone numbers and sounds alarms to tell him when to take medicine or go to an appointment. A wooden cane is always within grasp.
His wife and two children have learned to speak slowly and one at a time, so as not to confuse Dad.
The New Paltz, N.Y., native moved to Chattanooga after he left the service to be closer to his brother.
But there's only so much family can do, only so much they can understand.
Which is why Meyer went to a meeting last month to connect with others who have faced these problems.
The Chattanooga Area Brain Injury Association and local Department of Veterans Affairs office partnered to start the group, which held its first meeting Nov. 18 with five attendees.
Part of the difficulty of having meetings is the nature of the injury, said Chris Atkins, combat case manager at the Chattanooga VA office.
"That's part of the struggle," he said. "You're working with a condition where short-term memory and long-term memory are compromised."
But the meeting was good not just for those suffering from brain injuries, but also for their families. Spouses connected, sharing similar experiences, Atkins said. Spouses and families often become the primary caregivers and can motivate loved ones to continue with activities such as the group.
The group plans to meet again for a Christmas party Tuesday at Siskin Hospital, where the Chattanooga Area Brain Injury Association is based.
DEALING WITH INJURY
The local VA office screens all post-deployment troops with a checklist for traumatic brain injury symptoms. A service member who shows signs of such injury is referred to the polytrauma VA hospital in Murfreesboro, Tenn., Atkins said.
Last year, Atkins referred 139 people who screened positive for traumatic brain injury to the Murfreesboro office.
Traumatic brain injury is defined as "a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain," according to the Defense Department.
The injury doesn't have to come from combat or military service. Head injuries in sports, car wrecks or other scenarios also can cause it.
The Centers for Disease Control and Prevention estimates 1.7 million Americans sustain some form of traumatic brain injury each year and that 52,000 die from the injury.
But IEDs used by enemy forces in Iraq and Afghanistan have caused a greater number of such injuries among U.S. troops since the wars began.
In 2000, the Department of Defense reported 10,963 traumatic brain injury cases among military service members. Last year, the department confirmed 29,184 cases.
HIT AGAIN AND AGAIN
Military brain injuries by year
Source: Defense Medical Surveillance System and Theater Medical Data Store
Meyer remembers that the first blast was the worst, but he and the other soldiers shook it off.
During the third month of his first combat deployment, Meyer was standing in his truck's machine-gun turret when an improvised explosive device rocked the vehicle. Shrapnel sprayed toward him and slivers embedded themselves in his face guard.
He remembers being told that "everyone in the truck lost consciousness, at least for a little while."
Through the next nine months, he would be hit seven more times.
When he returned to Fort Bliss, Texas, with the U.S. Army's 987th Military Police Company, he ignored the headaches, dizziness, loss of balance and irritability.
Meyer loved his time in the Army and his fellow soldiers. He relished the challenges and was proud to wear the uniform. He feared that admitting something was wrong could end any chance of a budding military career.
It was nearly two years later, when he had transferred to Schofield Barracks in Hawaii, that the symptoms got so bad he had to seek help.
"My arm movements became so bad that I wasn't able to hide them anymore at work and I couldn't keep balance at home," he said. "I kept falling and hitting my head."
As a result of his brain injury, Meyer has a condition called hemiballismus, which causes violent muscle spasms on the right side of his body.
During a 45-minute interview, his right arm twice spasmed suddenly above his head, locking into place for a few seconds, seemingly out of his control.
Dr. Bhaskar Mukherji, a Nashville VA physician who specializes in brain injury, said reluctance to seek help is common among many veterans. On the battlefield, the most serious injuries are treated first and seemingly minor wounds are bandaged quickly to send the troops back into the fight.
That may be all the treatment a veteran expects to get from the VA as well, Mukherji said. However, soldiers out of the battle have a range of hospital staff, physical and mental health counselors at their disposal, he said.
"I think support groups can be hugely beneficial," he said.
Veterans may return to civilian life feeling estranged. If they also suffer from TBI and PTSD, the isolation can worsen.
LOCAL GROUP FORMS
Danielle Hooper is the service coordinator for the Chattanooga Area Brain Injury Association, which was founded in 1986 to help patients, families and area medical professionals educate the public on brain injury prevention and resources.
She and Atkins began work on the support group six months ago and started reaching out to veterans with traumatic brain injury to attend.
Hooper said participants wanted to keep the events social and active, which she agreed helped jump-start conversations.
Meyer said the first meeting was helpful and simply swapping stories about his six years in the Army was comforting. He encouraged others to look to the group as a way to network and share coping strategies.
"It was nice being able to meet some of the other guys who have some of the same problems I have and who have also been where I've been," he said. "I'm definitely going to keep going."
Contact staff writer Todd South at tsouth@timesfree press.com or 423-757-6347.