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You can hear the compassion in Christine Mac Donald’s voice when she talks about the military men and women she has known for nearly 10 years. She met many of them at some of the most challenging moments of their lives following medical evacuation to Landstuhl, Germany from the battlefields of Iraq and Afghanistan. The bright, lively associate professor in the department of Neurological Surgery counts these 591 service members from 50 states, two territories and 11 countries as patients first and data sets second. She is humbled by what they have given up for this country and laser-focused on unlocking the mysteries of battlefield concussion to help develop better diagnostics and treatments for both acute and long term care. It’s a mission for her.

“The research I am doing focuses on combat concussion and the long-term impact it has on these service men and women and their families,” said Mac Donald.  “These exposures are often referred to invisible wounds of war—just because you can’t see the injury doesn’t make it any less devastating.”

Mac Donald always wanted to serve her country. At 18 she was headed to the naval academy with the hopes of being a nuclear engineer.  A knee injury deterred her plebe experience at Annapolis; instead she completed undergraduate studies at Santa Clara University in California.  But the military kept luring her and she intentionally chose a work study position in the ROTC Bronco Battalion in Santa Clara’s Military Science Program.

As part of her clinical fellowship training following graduate school at Washington University, Mac Donald was asked to direct a study on advanced imaging in acute combat brain injuries.  Because of her prior experiences working with the military, she knew the culture and was able to rapidly integrate into the combat casualty care environment overseas. Living for 5 years, on and off, in Landstuhl, Germany to see medically evacuated casualties of war, she examined new imaging methods and acute screening tools for blast-related traumatic brain injuries with the initial seminal paper published in the New England Journal of Medicine in 2011.  Additionally she teamed up with a Navy Neurologist to conduct the only advanced MRI study and clinical outcome study to date in the combat theatre in 2012.

Dr. Christine Mac Donald with colleagues in Landstuhl, Germany

Photo of Dr. Christine Mac Donald at Landstuhl, Germany

Completing prospective, observational, longitudinal research studies with these service men and women has enabled Mac Donald and her team to connect the dots from acute injury to long term outcome. “When you can literally be at a patient’s bedside, and then personally see them a year later, and then 5 years after that, you can appreciate patient outcome trajectories in ways that are unfortunately missed with cross-sectional studies” says Mac Donald.  This has allowed for an in-depth look at many co-morbid conditions that arise following these exposures.  In a recent JAMA Neurology publication, her team found that the majority of patients exhibited evolution not resolution of symptoms over the first 5 years post-injury; a surprising finding for these seemingly mild injuries.

She calls her current research a ‘grass roots’ effort as she pieces together Department of Defense dollars and NIH RO1 grants to fuel her longitudinal study of combat concussion. Several weekends a month, Mac Donald and her team run a research clinic at UWMC and fly in these military men and women who are part of the study for continued clinical and imaging evaluation.

Unfortunately, some in the study have been lost to suicide. It saddens Mac Donald and makes her even more resolved to serve those who have served this country and sacrificed so much.  “They have made it through the war,” she says, “but in so many ways the battle has just begun.  We hope that the work we are doing contributes in a meaningful way to lessen this long term burden.

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