What the VA faces with Iraqi Freedom/Enduring Freedom Vets
Speakers: Psychologist Eric Proescher, also a veteran; Mark Galben, clinical social worker, Ken Khuane, physician; Valerie Creedon, social worker. All work at the Jesse Brown VA hospital in Chicago. The Jesse Brown program was founded by Mike Konkoly, who is now at the North Chicago VA Medical Center. Mary Martini led AHCJ members on a tour of one of the wards in the newly green-certified addition to the hospital after the presentations.
Proescher and Galben talked about the changing demographics for the VA. The newest veterans are a mix of career army and activated reservists and National Guard. So the VA needed points of contact for the Gulf War and the New Gulf War vets. A father who was a veteran of Desert Storm found Proescher's name on a website and contacted him. He said, "Something's happening to my son."
The old VA was all male and a 50-50 split between black and white. Now increasingly, veterans are Latino as well as female so the VA had to change to be more proactive. Some 3,000 National Guard reservists went to Iraq and Afghanistan from the Chicagoland area. Those vets were younger, busier and more reluctant help seekers. So the VA implemented a case management system to screen and identify needs and help them with navigating the VA. There are two people at Jesse Brown doing full-time outreach. The VA also developed post-deployment clinics. Half of the reservists have no military base to go to. Those on active duty have Department of Defense (DOD) health care.
The post-deployment clinics are not like the Vietnam-era Vet Centers, which were community-based mental health clinics and had a different chain of command than the VA.
So what issues is this population facing? Proescher noticed changes since he started in 2005. The vets wanted to get back to their lives and they were not disability-focused. With the down economy, Proescher is seeing the same guys who are more depressed and need more help. They have many psychosocial issues.
With Vietnam, the process was slower and many vets might not have survived injuries vets are living with today. There's been an increase in amputations and traumatic brain injuries since Vietnam and Desert Storm.
How does the case management system work now? Say a vet has post-traumatic stress disorder (PTSD) and substance abuse issues. What do we treat first? Well, the new directive is to treat both simultaneously. The traditional masculine values of self-reliance, self-control and strength can make a good soldier, but they can interfere with readjustment. A vet's homeostasis is reset by prolonged stress. Galben has blended yoga, reiki and other mind-body interventions and called it “Battle Body Retraining,” which de-emphasizes the New Age, touchy-feely aspects. Proescher saw one vet with PTSD psychosis come into Battle Body and hunched and withdrawn. After a movement exercise of walking in circles and following the leader to music, the vet was giving the thumbs up and standing tall. Vets also garden at the center.
The VA is reaching out to vets through a national call center. This is an extension of EF/IF partnering with DOD for the first time. National Guard and reservists now have access to screening. They have same care as vets if honorably discharged.
Seventeen percent of active duty vets are women. Eleven percent of those women have seen combat. Every VA has special needs for women. Women can want to be with the men since they had same training. However, April is Military Sexual Trauma Awareness Month. On active duty, one of five women experience sexual trauma. The figure is higher for the VA population.
According to Khuane, the DSM keeps changing criteria for PTSD. Now it points to a life-threatening traumatic experience. If three months or more after the experience, you suffer intrusive recollection of trauma, physiological reactions and avoid anything that reminds you of the trauma, you have it. It has a significant impact on social and personal lives. Ten to 18 percent of returning vets have PTSD. It's estimated that 30 percent of returning veterans have other mental health issues.
There are a lot of suicides in active duty. They are harder to track with civilian integration. The VA has partnered with the National Suicide Hotline. They have suicide prevention teams throughout VA hospital. Suicidal issues are noted in records so all providers are aware and do follow-up.
The women's unit at Jesse Brown has female doctors plus changing tables in restrooms and child- friendly waiting areas. Twenty percent of people enlisting are women. The unit is separated from where the men are treated.
VA medical records are electronically up to date with their Computerized Patient Records System, which uses software developed by the VA which is available for $60. All of the VA medical centers and clinics can communicate with each other and the data is backed throughout the VA system so even if there’s a major power outage or other catastrophe, the records will still be available. This was a huge help with veterans who were displaced in Katrina. The system is intuitive and makes it easy to talk to other VA hospitals and clinics. It's not as easy to talk to DOD. With younger, more mobile veterans, it's much easier to help with treatment with CPRS.
Limbs and Veins: New Work with Prosthetics and Nitric Oxide
Israel "Izzy" Rubinstein VA researcher introduced fellow researcher Richard Weir, who talked about prosthetics and how the body talks to them. Lower limb amputations outnumber upper limbs by 10 to 1 among vets. Myoelectric control, in which electrical impulses from muscles drive the limb, is best control for now. Weir says better hands are being designed, but noted that adding complexity loses robustness. He also noted that the French man who underwent a hand transplant opted to amputate the transplant after the surgery. They have received some funding from Advanced Research Projects Agency (ARPA), whose research computer network was the forerunner to the Internet.
Six percent of casualties from IF/EF result in a major limb amputation.
The DEKA arm (featured on "60 Minutes" some months back with its developer Dean Kamen) is now in clinical trials. The old arms do not have a powered shoulder joint. Weir had a prosthetic arm available for writers to examine. It weighs about seven pounds, which is close to the weight of a real arm.
Melina Kibbe, a vascular surgeon, noted that cardiovascular disease is leading cause of death and disease in US. You have to catch it early to prevent it. Some interventions include angioplasty, stenting, endoarctectomy and grafting. Because of neointimal hyperplasia (Irregular growth), those are only temporary fixes.
However, nitric oxide, produced by endobilial cells, can prevent the return of plaque in laboratory settings. Kibbe is testing the substance on veins and has reached some preliminary conclusions. There is a gender-based difference in effectiveness and it works better in diabetics if insulin is present. There's a lot more to come.
