Tagged: PTSD

PTSD + Agent Orange = extra risk of Dementia

Exposure to Agent Orange during the Vietnam War doesn’t seem to increase the risk of dementia on its own, but it may exacerbate the effects of other risk factors like PTSD…

In an analysis of Veterans Affairs data, having been exposed to Agent Orange and having PTSD together was associated with a significantly increased risk of dementia according to Deborah Barnes, PhD, MPH, of the University of California San Francisco and the San Francisco VA Medical Center.

They reported their findings at the Alzheimer’s Association International Conference…

Some 8% of veterans were exposed to Agent Orange during the Vietnam War, where it was used as an herbicide to clear dense areas of forest…

Many other studies have looked at the health effects of Agent Orange exposure, and there have been mixed results regarding its neurological effects. Some studies found no adverse neurologic effects, while several recent studies have found worse cognitive function with greater exposure. Other studies have shown that verbal memory is the most affected neurocognitive region among Vietnam veterans.

Yet there haven’t been any studies specifically looking at the relationship between Agent Orange and the risk of dementia among these veterans, Barnes said.

Consequently, she and colleagues accessed VA electronic medical record data on 46,737 Vietnam veterans over age 55 who had at least one baseline visit and one follow-up visit, and who did not have dementia at baseline.

They looked at Agent Orange exposure alone and in combination with PTSD…

Barnes noted that there was a significant difference between the exposed and unexposed populations at baseline. Veterans exposed to Agent Orange were younger and had more comorbidities including diabetes, hypertension, cerebrovascular disease, depression, and PTSD…

When they looked at PTSD and dementia risk, however, they did find a significant association — and having both Agent Orange exposure and PTSD together was associated with a larger increase in risk of dementia…

“Agent Orange alone doesn’t appear to increase the risk of dementia,” Barnes said, “but it may exacerbate the effects of other risk factors such as PTSD.”

She cautioned that the findings were limited because the researchers weren’t able to measure the actual exposure to Agent Orange; they had to rely on patients’ own reports of exposure…

Soldiers on the line ain’t about to forget exposure to Agent Orange. Until they get Alzheimer’s, anyway.

And, no, that wasn’t meant to be a joke.

Vietnam War vets still suffering from PTSD

A small, but significant, portion of Vietnam War veterans still experience symptoms of post-traumatic stress disorder (PTSD) even 40 years after the war ended, according to the results of a survey-based study.

When examining veterans over the course of a 25-year period, 10.8%, or about 271,000, of male “theater veterans” – those who served in the Vietnam theater of operations – reported experiencing current clinical and subthreshold war-zone PTSD symptoms based on CAPS-5 criteria, said Charles Marmar, MD, of New York University’s Langone Medical Center…

More than a third (36.7%) of all veterans with PTSD directly related to the war also experienced comorbid major depression. In addition, 30.9% met the criteria for current major depressive disorder…

Marmar told MedPage Today that he was surprised at the persistence of symptoms for veterans over the course of time.

“We did know that PTSD symptoms could persist in a minority of war fighters, or civilians for that matter, but it was surprising to find that 11% of those who served in the Vietnam theater had either PTSD or significant symptoms of PTSD that interfered with their functioning,” he said. “So the persistence was an important finding…”

Marmar said he did the study not only to honor the Vietnam generation and answer some questions for them, but to see what the road ahead may look like for veterans of the Iraq and Afghanistan wars.

“Nobody has known before this study what the true lifetime effects of military service are on psychological health in an epidemiologically drawn, representative sample,” he said. “People have done studies of longer term effects of war, but not in a proper sampling frame where you’re getting a picture of every man and every woman from all branches of the services in all levels of combat…”

While not involved with the study, Gary J. Kennedy, MD…told MedPage Today…that the results demonstrated the majority of veterans did not suffer from PTSD or depression. However, he pointed out that for those who were impacted, there may be inadequate resources to offer assistance.

“The optimistic finding of rather remarkable resilience is contrasted by the complicated needs of those who do not recover,” he said. “Just as in the post Vietnam era, the VA is not adequately funded to meet the mental health needs of returning service personnel…”

He concluded that similar to World War II veterans, Vietnam war veterans also deserve quality care for their physical and mental well-being, both from clinicians and from the nation itself.


My closest friend till his death was a WW2 vet who still had occasional bouts with PTSD – and little substantive help from the VA. Fortunately, one of his main areas of study – courtesy of the GI Bill – was in psychology and he did a pretty good job of managing things on his own. Still, I’ll never forget a couple of times when he was roused unexpectedly from a sound sleep and thought he was back in Bastogne.

The American military in a chickenhawk nation

The Atlantic magazine has unveiled a new cover story bluntly titled “The Tragedy of the American Military.” Written by James Fallows, it explores the problems and culture of the U.S. military after more than 13 years of war, and what it might take to fix them.

In particular, Fallows targets the “chickenhawk nation” that has sent its troops into combat without clear strategies, weapons acquisition programs that are expensive and politically connected, and an American public that is largely disconnected from the wars. Fallows also reports on the findings of a commission that President Obama requested in 2011 to examine how the Pentagon could best be reformed.

The commission, headed by former Sen. Gary Hart (D.-Colo.), made a series of recommendations that will be familiar to those following defense policy in Washington. It sought the creation of another panel to assess the lessons learned in Iraq and Afghanistan, a separate effort to determine how the decision-making process for the use of military force should work in the future, and for the president himself to help bridge the gap between those who have served and the rest of American society…

The piece has created buzz on social media, in part because of the senior officials and famous academics quoted in it. But it’s the latest in a long line of journalism this year that grapples with how the military should reassess and reinvent itself following wars that have cost billions of dollars and thousands of American lives, without many clear victories…

Earlier this year, The Washington Post also published a series of stories titled “After the Wars.” Relying in part on a poll conducted along with the Kaiser Family Foundation, it found that 87 percent of the 2.6 million Iraq and Afghanistan veterans feel proud of what they did during the wars, although more than half struggle with physical or mental issues and feel disconnected from civilians.

I wonder if our government, the Pentagon or even the Washington Post considered surveying the Iraqis, the Afghans, the civilian populations killed and maimed a hundred times more than our invading military?

All of these pieces expose the same basic issues: There will be no easy fixes for the military adjusting to life after a generation of intense sacrifice. The military is now shrinking and coping with budget cuts that would have been unheard of five or 10 years ago, increasing anxiety for many who want to serve at least 20 years and retire from the military honorably.

People write these articles as if they – and we – don’t discern any difference between war with an honorable task – fighting back against Fascist Imperialism, freeing nations from occupying foreign legions out to steal land and resources for a master race.

Sorry to hurt a few folks’ feelings; but, our military history since 1946 seems more and more like role reversal every decade since.

Suicide rate among veterans may be more than “official” 22 a day

Every day, 22 veterans take their own lives. That’s a suicide every 65 minutes. As shocking as the number is, it may actually be higher.

The figure, released by the Department of Veterans Affairs in February, is based on the agency’s own data and numbers reported by 21 states from 1999 through 2011. Those states represent about 40% of the U.S. population. The other states, including the two largest (California and Texas) and the fifth-largest (Illinois), did not make data available.

Who wasn’t counted?

People like Levi Derby, who hanged himself in his grandfather’s garage in Illinois on April 5, 2007. He was haunted, says his mother, Judy Casper, by an Afghan child’s death. He had handed the girl a bottle of water, and when she came forward to take it, she stepped on a land mine…

Derby was not in the VA system, and Illinois did not send in data on veteran suicides to the VA…

Combat stress is just one reason why veterans attempt suicide. Military sexual assaults are another. Psychologist Craig Bryan says his research is finding that military victims of violent assault or rape are six times more likely to attempt suicide than military non-victims.

More than 69% of all veteran suicides were among those 50 and older. Mental-health professionals said one reason could be that these men give up on life after their children are out of the house or a longtime marriage falls apart. They are also likely to be Vietnam veterans, who returned from war to a hostile public and an unresponsive VA. Combat stress was chalked up to being crazy, and many Vietnam veterans lived with ghosts in their heads without seeking help…

Then, Ronald Reagan issued an executive order denying unemployment compensation to VietNam-era vets “who decided not re-enlist”.

There’s probably a tidal wave of suicides coming,” says Brian Kinsella, an Iraq war veteran who started Stop Soldier Suicide, a nonprofit group that works to raise awareness of suicide. Between October 2006 and June 2013, the Veterans Crisis Line received more than 890,000 calls. That number does not include chats and texts.

Though there is a tradition among conservatives to consider all war as patriotic, there is no matching correlation with the cost of war. This is especially true of the Neo-Cons with “con” standing for both conservative and confederate. They love sending folks off to war – without the least consideration for the cost of war.

At best, they count the cost of war in dollar$ and cent$ for hardware. At worst – more typical – they consider the cost in human lives as collateral damage when it comes to the “other side” and some kind of inherent weakness outside of combat casualties on “our side”. Sit down and have a couple of beers with Dick Cheney and you’ll see what I mean. Metaphorically or otherwise.

So, Bush and Cheney sent our military off to foreign lands with bigger and better hardware. Many came back with bigger and much worse cases of PTSD than the VietNam vets sent off by Johnson and Nixon. Neither group of stinking politicians included plans to pay for the cost of their wars. Neither group considered the damage done to our military men and women as part of that cost – anyway.

RTFA to add another jot of sadness to your day. Beaucoup examples of the overlooked and forgotten.

Thanks, Mike

Feds finally roll over for a study of cannabis as PTSD treatment

medical marijuana

The U.S. government has signed off on a long-delayed study looking at marijuana as a treatment for military veterans with post-traumatic stress disorder, a development that drug researchers are hailing as a major shift in U.S. policy.

The Department of Health and Human Services’ decision surprised marijuana advocates who have struggled for decades to secure federal approval for research into the drug’s medical uses.

The proposal from the University of Arizona was long ago cleared by the Food and Drug Administration, but researchers had been unable to purchase marijuana from the National Institute on Drug Abuse. The agency’s Mississippi research farm is the only federally-sanctioned source of the drug.

In a letter last week, HHS cleared the purchase of medical marijuana by the studies’ chief financial backer, the Multidisciplinary Association for Psychedelic Studies, which supports medical research and legalization of marijuana and other drugs.

MAPS has been working for over 22 years to start marijuana drug development research, and this is the first time we’ve been granted permission to purchase marijuana from NIDA,” the Boston-based group said in a statement…

Which serves to reinforce the fact that it doesn’t matter whether we have a conservative or liberal government in Washington, DC. Both are constituted of cowards who fear science almost as much as they fear the ignorance of voters who assure their power and petty lordships. They follow, ignoring every opportunity to lead.

Political times change and that’s what changes policies and protocols. The brave men and women who rejected the jive War on Drugs and fought for real change for decades have moved the public far enough to allow opportunist politicians to join the struggle for a sane drugs policy. Or at least put their pedicured toes into the water.

While more than 1 million Americans take medical marijuana — usually for chronic pain — rigorous medical research into the drug’s effects has been limited, in part due to federal restrictions.

Marijuana remains a Schedule I substance under the federal government’s Controlled Substance Act. That means the drug is considered a high-risk for abuse with no accepted medical applications.

Most politicians know better. Most bureaucrats know better. The folks who deserve the credit for this tiny advance are the doctors and stoners, scientists and honest advocates who built a successful political movement strong enough to overcome the two gangs of political hacks we are allowed to vote for.

Drone pilots found to get same PTSD as combat pilots do

In the first study of its kind, researchers with the Defense Department have found that pilots of drone aircraft experience mental health problems like depression, anxiety and post-traumatic stress at the same rate as pilots of manned aircraft who are deployed to Iraq or Afghanistan.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones…

…Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible…”

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators…

Well, then, we’re all OK, right?

You don’t need to be fired on in a foreign country to get P.T.S.D.

The emotional toll of a heart attack can be so severe that an estimated 1 in 8 patients who survive the experience develop post-traumatic stress disorder, a condition that doubles the risk of dying of a second heart attack…

While it has long been known that a heart attack affects both physical and mental health, most doctors and patients are not aware that the emotional stress of a life-threatening heart event can develop into full-blown post-traumatic stress disorder, or P.T.S.D. The disorder, which more typically affects combat veterans and victims of violent crime, can be particularly insidious in heart patients, who live with constant trepidation about their own bodies, frequently paying anxious attention to each heartbeat or twinge of chest discomfort.

…In the new report, researchers from Columbia University Medical Center combined the results of 24 studies that had documented post-traumatic stress in a total of 2,383 heart patients. Their analysis…found not only that P.T.S.D. after a heart attack was far more common than previously believed, but also that the disorder doubled the risk of dying of a second event over the next one to three years, compared with those who did not have P.T.S.D…

“I think that the broader cardiology community and medical community haven’t really paid attention to this issue,” said Donald Edmondson, assistant professor of behavioral medicine at Columbia and the study’s lead author. “When you think of P.T.S.D. due to combat or a traumatic event, the patient experiences intrusive memories reliving an external event. But this type of trauma is something that is internal…”

In the Columbia study, the severity of the heart event was not a factor in a patient’s risk of developing P.T.S.D. Instead, the research found that patients who were relatively young when they experienced their first heart event, and those who subjectively felt that their lives were in danger and that they had lost control, were at greatest risk for the disorder…

Post-traumatic stress disorder is typically treated with behavioral therapy and antidepressants. Dr. Edmondson said he hopes that future research will focus on ways to minimize the trauma for patients at the time of the heart attack to prevent patients from developing P.T.S.D. symptoms later.

Wow. Think about this. Especially in cases of younger heart attack victims or folks who’ve rarely been near a hospital environment – going through the extremes of a screeching ride in an emergency vehicle, crashing through ER doors into immediate intensive care certainly could be as intimidating as the heart attack itself. Scary stuff.

Maybe the best way to forget a war – is to bring part of it back home?

Playing with dogs at Nowzad

Spot made the clandestine journey from the Afghan Taliban stronghold of Helmand to the capital Kabul, where he is undergoing medical treatment before moving to the United States to live with the family of the Marine who rescued him.

His ears clipped and tail severed from his days as a fighting dog, the surprisingly docile ginger and white mutt is one of hundreds being adopted in increasing numbers by foreign soldiers, who pay vast sums to take their new pets home.

“Dogs have been proven to help post-traumatic stress and the soldiers who adopt them are addressing this,” said Pen Farthing, founder of British charity Nowzad, an animal shelter on the outskirts of Kabul.

A former Royal Marine, Farthing adopted his dog Nowzad, named after a Helmand district, during his tour there in 2006. He then set up the charity, where dogs and some cats are neutered and vaccinated against rabies before their journeys abroad…

We’re seeing more soldier rescues than ever before. When you’re being shot at by the Taliban every day, dogs give you that little bit of normality,” Farthing said by a row of outdoor pens holding black and yellow puppies.

Nearby stood Dshka, an affectionate grey hound rescued by a U.S. Marine sergeant in Kajaki in Helmand, where British forces handed security to the U.S. in 2010 as part of the American troop surge. His neighbor, Poppy, a small black dog from Kandahar, will soon go to a British soldier’s home…

Workers at Nowzad are now hoping that Afghans will begin to adopt dogs, banking on a changing attitude to owning pets. Poverty prevents many Afghans from having dogs and cats at home, and some Muslims believe dogs are unclean and therefore unfit for keeping. Kabul is home to thousands of stray dogs, and many are shot and killed…

Afghan families are beginning to adopt dogs from Nowzad, they said, giving promise to the charity’s goal to become Afghan-led in the future.

One can only hope. And help when you can afford it.

In many ways this is a global battle worth fighting for. And it doesn’t require billions of dollars for bombs and bullets, rockets and rifles.

Army hospital commander removed during PTSD probe

Medical aid in the snow — does it matter which war?

The Army has removed the head of the Madigan Army Medical Center in Washington state during an investigation into whether soldiers had diagnoses of post-traumatic stress disorder reversed to reduce medical costs.

“This is a common practice during ongoing investigations and nothing more,” Maj. Gen. Phillip Volpe, who heads the Western Region Medical Command, said Monday about the removal of Col. Dallas Homas.

Homas is a West Point graduate whose career has included deployments to Afghanistan and Iraq, where he served as command surgeon. His military honors include two Bronze Stars…

The focus of the Army Medical Command investigation is a Madigan forensic psychiatric team that has the lead role in screening soldiers being considered for medical retirement due to PTSD, a condition that results from experiencing or seeing a traumatic event, such as a battlefield casualty.

Symptoms can include recurrent nightmares, flashbacks, irritability and feeling distant from other people. Soldiers diagnosed with PTSD gain at least a 50 percent rating of disability, and qualify for pensions, family health insurance and other financial benefits.

In 2011, an ombudsman investigated complaints from soldiers who said the forensic psychiatric team had reversed earlier diagnoses of PTSD and tagged some of them as possible malingerers.

The ombudsman also wrote a memo about a lecture in which a member of the forensic psychiatric team talked about the need to be good stewards of taxpayer dollars and not rubber stamp PTSD diagnoses that could result in a soldier earning $1.5 million in benefits over a lifetime…

I didn’t know there was a specific field of psychiatric study dedicated to oversight by beancounters.

The ombudsman investigation resulted in more than a dozen soldiers getting a chance for a second PTSD screening by doctors from Walter Reed National Military Medical Center outside Washington, D.C.

Fourteen of those soldiers will have the results of their Walter Reed reviews detailed in individual meetings at Madigan with Col. Rebecca Porter, chief of behavioral health, Office of the U.S. Army Surgeon General.

One would hope the analysis reverts to psychiatric concerns rather than saving the budget.

I’ve mentioned my closest friend being the most decorated WW2 veteran from our home state and the months he spent in hospital after the war. That helped his physical wounds. There wasn’t any broad definition of PTSD available for those vets. So, he received nothing – either for what he suffered in battle – or what he saw and felt at the liberation of Hitler’s Death Camps.

But, I shall never forget the times he woke in the middle of the night and rolled under his bed because he thought there was incoming artillery fire – and that he was back in Bastogne in the winter of 1944-45.

Combat veterans may be helped by talking about killing

The act of killing is as fundamental to war as oxygen is to fire. Yet it is also the one thing many combat veterans avoid discussing when they return home, whether out of shame, guilt or a deep fear of being misunderstood.

But a new study of Iraq war veterans by researchers in San Francisco suggests that more discussion of killing may help veterans cope with an array of mental health problems stemming from war.

The study, published in The Journal of Traumatic Stress, found that soldiers who reported having killed in combat, or who gave orders that led to killing, were more likely to report the symptoms of post-traumatic stress disorder, alcohol abuse, anger and relationship problems…

Shira Maguen…the principal investigator on the study, said the results suggested that mental health professionals need to incorporate killing more explicitly into their assessments and treatment plans for veterans. That would include finding ways to discuss the impact of killing, in public forums and in private treatment, to reduce the stigma and shame, she argued…

Mental health experts said the new study confirmed findings from research on Vietnam veterans and did not break much new ground. But they said it underscored that treating stress disorder among veterans is often very different from treating it in people who, say, have been raped or have been in car accidents.

People don’t understand the moral ambiguity of combat and why it is so hard to get over it,” said Rachel Yehuda, a professor of psychiatry at Mount Sinai School of Medicine in New York. “What makes combat veterans ill is not always about being a victim, but, in some instances, feeling very much both a perpetrator and a victim at the same time…”

Some experts said military law had also complicated therapy by having unclear rules about when a soldier’s conversations with a therapist are protected from legal action. The mere threat that those conversations could be used in war crimes prosecutions discourages many troops and veterans from seeking counseling, those experts say.

My closest friend was our home state’s most decorated soldier in WW2.

He was in parachutes reconnaissance – dropped behind enemy lines to work his way back and record everything of military importance. Still, the toughest memory he tried to excise from those missions was crawling through a field up to a German sentry apparently sleeping against a tree – plunging a knife into his chest to kill him – and discovering that he already was dead from a bullet wound.

Something we revisited time and again.