As a single mom and combat-wounded Navy corpsman, Holly Crabtree has too much on her mind to stress about the next time she might black out. She'd rather think about her daughter's busy schedule packed with things such as dance classes and Girl Scouts.
But Crabtree's been getting seizures every week or two since she was shot in the head while serving on a Special Operations mission in western Iraq three years ago. The bullet led to two strokes, partial paralysis and epilepsy.
She doesn't feel the seizures coming and she can't prepare for them.
"They surprise me," said Crabtree, 33.
Epilepsy is a common side effect veterans experience after suffering head trauma at war. It's debilitating for parents such as Crabtree who worry about passing out in front of their children, and damaging for other veterans who can't drive or hold down jobs because of their occasional seizures.
"The financial issue is big," said Judy Ozuna, a nurse practitioner who spends several days a week caring for epilepsy patients at the federal Department of Veterans Affairs hospital in Seattle. "Families don't know how to make ends meet."
The link between combat-related head trauma and recurring seizures is so well-known that Congress created special epilepsy centers within the VA six years ago. They care for troops coming home from Iraq and Afghanistan, where insurgents wielded homemade explosives as their primary weapons against American military service members.
The centers, including one in Seattle, are leading the VA's treatment for the 66,000 epilepsy patients it sees every year. Crabtree is one of the Seattle patients.
Doctors there helped her bring down the frequency of her seizures from three a week to one or fewer by using medication. That's important for her because experiencing a seizure can make Crabtree feel like she's regressing amid all the work she's doing to reclaim her health.
"If you take two steps forward, then all of a sudden you have to take three steps back," she said.
Medicine works for her, but other options for patients include surgery and procedures that regulate the brain's electrical impulses.
"The good news is most people will never have a seizure again after the first medicine we give them," said Christopher Ransom, a neurologist at the VA hospital.
An even larger number of veterans are getting care for seizures that are not necessarily related to epilepsy. The Veterans Health Administration estimates about 100,000 former military service members are seeking treatment for seizures every year, up from 70,000 in 2000.
The rising numbers stem from the traumatic brain injuries that an estimated 20 percent of Iraq and Afghanistan veterans experienced during the wars. Survivors of battlefield explosions often had their heads rattled, fell unconscious and sometimes experienced lasting changes to their memory and moods.
In many cases, the explosions would have been fatal if not for advances in-battlefield medical care and body armor.
"The body armor has allowed people to survive, but they're still exposed to a blast injury," said Dr. William Spain, chief of the epilepsy program at the Seattle VA.
Studies show about half of people who suffer penetrating head wounds or severe traumatic brain injuries -- injuries similar to Crabtree's -- will develop epilepsy over time.
The ratio for people who experience mild or moderate traumatic brain injuries is lower, but the VA nonetheless is preparing for as many 170,000 post-traumatic epilepsy patients from the wars in Iraq and Afghanistan.
Patients are steered to the epilepsy center in Seattle by way of referrals from primary-care doctors.
In some cases, the neurologists adjust treatment plans to give patients more precise care. In others, they start fresh by monitoring new patients with an electroencephalograph (EEG) test around the clock for a week. They can monitor two patients at a time, and usually administer weeklong tests for up to 40 new patients a year.
Crabtree's injuries are complex by any standard. She visits the VA a couple times a month for a series of physical therapy, mental health and other regular appointments.
"I just take it one day at a time," she said. "You never know what you're going to get."
Her days begin at her uncle's home in Sequim, where she and her daughter live. Crabtree gets her girl ready for school and then unusually makes her way to an aquatics gym where she enjoys working out with other veterans. In the evenings, she often goes to one of daughter Leah's events: Three dance classes, Girl Scouts or Bible study.
Leah "will never be alone," her mom said.
Crabtree played three sports in high school and still wants to get outdoors as much as she can. She has been to Alaska twice on expeditions with the nonprofit Combat Wounded Veteran Challenge. The cane she uses when she walks is fitted like a ski pole, taking her back to the days she has spent hiking on glaciers with wounded veterans.
She also is working on a new degree and studies daily. She now realizes the brain is like a muscle. She has to use it or risk forgetting how to do basic tasks, like reading.
Crabtree joined the Navy as soon as she graduated from high school to see the world. She rose through the ranks quickly to become a chief petty officer, supervising the less experienced medics who care for sailors and Marines.
She pursued one of the most dangerous jobs available to female sailors in 2009 when she completed training to serve on the cultural support teams that assist Green Berets, Rangers and SEALs on combat operations. She was a valuable addition to her Special Operations team in Iraq when she deployed late that year as a corpsman with some skills speaking the Arabic language.
Crabtree and another female military service member on her team were charged with interacting with Iraqi women on missions -- a task difficult for male special operators because of cultural and religious considerations in Muslim countries.
Crabtree loved the work.
"I wasn't afraid to go outside the wire," she said.
She was shot on a mission on April 15, 2010, near the end of her deployment. The bullet pierced her helmet, fractured her skull and settled behind her eye. She was not expected to live.
She says she can't remember her first seizures, which started while she was in the hospital just after the shooting. Crabtree grew more worried about them when she had a seizure in front of Leah. Her uncle notices the episodes begin, sometimes with a jerking motion that the former sailor misses.
Her mind is different since the shooting and the strokes in ways other than her occasional seizures. She tends to read her college coursework twice now to make sure she absorbs the material. Sometimes, she'll sing a song to her daughter but the words will come out in a foreign language.
Leah laughs with her and asks her to keep singing, but in a new language.
"Every day is a work in progress," Crabtree said. "People can make huge strides in a matter of time. As long as someone is there to support them and encourage them, it's going to go faster."
-- For more information, go to epilepsy.va.gov/