Gulf War Veteran to take helm of Montana VA Healthcare System

By the Associated Press

(HELENA – AP) - The VA Montana Healthcare System has announced the appointment of a new director.

Robin Korogi replaces Joe Underkofler, who retired in October after 37 years with the VA.

Korogi is a Desert Storm veteran.

She will oversee the Montana VA and its 1,000 employees. The agency includes 13 outpatient clinics scattered across the state, along with a 30-bed nursing home and a 50-bed hospital.

The Montana VA also plans to break ground on a 24-bed impatient mental-health facility at Fort Harrison next week.

Before her appointment to the VA Montana Healthcare System, Korogi served as associate director at the VA Salt Lake City Health Care System. She has spent 11 years with the Veterans Health Administration.

ATP may increase energy, muscle strength

Adenosine Triphosphate,

the energy of life
by Robert Mason Ph.D

(smart-drugs.net) - Adenosine Triphosphate (pronounced A-den-o-seen Try-foss-fate) or ATP represents the universal energy molecule. In a very real sense ATP is the power behind life. ATP is a nucleotide consisting of adenine, ribose, and a phosphate unit. It is the principal carrier of energy for all forms of life. ATP is estimated to provide 95% for all cellular energy throughout the body.

The Power behind Life

In essence, energy arrives from the Sun, but humans are unable to convert it directly to run metabolic processes. Therefore, we depend on photosynthesis to convert solar energy into chemical storage (in the form of carbohydrate). Through catabolic metabolism, carbohydrate is converted into the energy of ATP.

Nobel Prize

The importance of the role of ATP cannot be overstated. Perhaps that’s one of the reasons why in 1997 the Nobel Prize for chemistry was awarded to; Dr. John Walker of the Laboratory of Molecular Biology, Cambridge, Dr. Paul Boyer of the University of California, Los Angeles and Dr. Jens Skou of the Aarhus University, Denmark for their detailed work on how ATP shuttles energy.

ATP and the Mitochondria

ATP is created inside cells called mitochondria. The mitochondria can be found in every cell of every organ, but they are perhaps “hardest at work” inside the brain. This isn’t a surprise considering that the brain utilizes approximately 20% of the body’s oxygen and 50% of the sugars we ingest in its ever constant demand for energy.

The Dangers of ATP Production Problems

The brain is unable to store ATP and the mitochondria are unable to “share” ATP from other organs mitochondria. It is estimated that the demands for a resting human are 40Kg (88 Lbs.) of ATP per 24-hours! During strenuous activity this demand increases to 500g (1.1 Lbs.) per minute! 

Yet while ATP serves as the energy current for all cells, its quantity is very limited. In fact, only about 70mg of ATP is stored in the body at any one time! Therefore, during strenuous activity, such as sprinting, ATP supplies would last for no more than 5 to 8 seconds! 

It becomes immediately apparent that ATP must be constantly and effectively synthesized to provide a continuous supply of energy. When an interruption of the energy producing substances (such as oxygen or blood carrying nutrients) occurs, (e.g. heart attack or stroke) that as the production of ATP is effected a cascade of free-radical damage begins. 

Recent research indicates that it may be an ATP-imbalance, (the result of damage to the neuronal support [glial] cells, or to the mitochondria themselves under ischemic and hypoxic conditions such as those mentioned above) that leads to increased neuronal cell death. 

However, even “minor” oxygen and blood starvation events, such as those that may not appear serious but may be attributed to an aging condition, could lead directly to temporally lobe epilepsy (a mild form of epilepsy).  

Furthermore, we can consider that such events also have a consequence for the onset of multiple sclerosis itself. 

ATP and Disorders

Around the world ATP supplements have been and are being used in all the following conditions: 

1. Acrocyanosis: (Discoloration of hands and feet due to poor circulation).

2. Acroparaesthesiae: (Tingling in hands and feet).

3. Asthma: (In general).

4. Back Pain: (Particularly mild lower back pain).

5. Cardiology: (Spasms related to the coronary arteries and thrombosis of peripheral vessels. And as a preventative for potential heart attack).

6. Chronic Asthenia: (Accompanied or not by low blood pressure, genital and senile asthenia, stress).

7. Circulatory Alterations: (In general).

8. Convalescence: (Following operations and of seriously ill patients).

9. Dermatology: (Atopic dermatitis, chronic and acute eczema).

10. Diabetes: (As a coadjutant in the treatment of diabetic arteriopathies).

11. Ear Problems: (Ménière's Disease, Tinnitus [ringing in the ears], deafness due to nerves, deafness due to streptomycin).

12. Endocrinology: (In general).

13. Geriatrics: (Improve well being and energy).

14. Gynecology: (Particularly alterations due to spasms of the uterine muscle).

15. Itching: (In general).

16. Neurology: (As a coadjutant in the treatment of extended sclerosis and other neurological lesions and related to muscular dystrophy’s).

17. Nutrition: (In general).

18. Ophthalmology: (Strained eyesight).

19. Poisoning: (In general).

20. Raynaud's Disease: (Blanching of the fingers and toes).

21. Rheumatism: (In general).

22. Sports Medicine: (Training, physical strain, fatigue of all kinds).

23. Surgery: (Prior to and following surgery to prevent anoxia).

ATP and Aging

The body’s ATP production declines as we age. the size, volume, and number of the mitochondria alter during age. As the mitochondria produce ATP, an abundance of free radicals are generated. Free radicals over a life-time damage cellular components which of course leads to decreased efficiency.

Conclusion

Whilst the authors could find no clinical studies to support ATP supplementation and aging, there is no doubt that ATP is a vital component of life.

It appears to be a logical step that ATP supplementation can aid and assist in improving energy levels and help support conditions such as chronic fatigue, multiple sclerosis and similar disorders where neuronal glial cells and mitochondria are especially at-risk.

We’ve heard from a number of patients and health professionals that sublingual or injectable ATP supplementation can be highly beneficial for those who feel permanently weak, tired, or lack energy (i.e. chronic fatigue).

Dosages, Side Effects and Contraindications

It is noted that patients with either pulmonary hypertension or myocardial infarction should not use ATP if the disease is in its acute phase.

ATP appears to be a very safe and satisfactory supplement

Whilst dosages have to be altered according to the age and condition of the patient and the desired result, it is generally considered that the following dosages are effective in 90% of cases:

By injection: 2-4 c.c. daily by deep intramuscular injection (or by intravenous injection when dissolved in a glucose serum).

By sublingual absorption (under the tongue): 30mg to 90mg per day taken in three divided doses (i.e. 10-30mg three times per day). It is important to ensure that the product is absorbed through the mouth membranes and not swallowed.

References

1. Cotrina ML, Lin JH, Lopez-Garcia JC, Naus CC, Nedergaard M, ATP mediated glial signaling, Journal Neurosci. 2000 Apr. 15;20(8): 2835-44.

2. Kunz WS, Kudin AP, Vielhaber S, Blumcke I, Zuschratter W, Scramm J, Beck H, Elger CE, Mitochondrial complex I deficiency in the epileptic focus of patients with temporal lobe epilepsy, Ann. Neurosci. 2000 Nov; 48(5) 766-73.

3. Verweij BH, Muizelaar JP, Vinas FC, Peterson PL, Xiong Y, Lee CP, Impaired cerebral mitochondrial function after traumatic brain injury in humans, J. Neurosurg. 2000 Nov; 93(5): 815-20.

4. Anderson E, You scratch my back and I will synthesize adenosine triphosphate by means of oxidative phosphorylation.

5. Adenosine Triphosphate, Microsoft Encarta Online Encyclopedia, 2000.
6. Atepodin, manufacturers insert 1999.
7. Chemistry in Britain, November 1999.
8. Database of the Swedish Academy of Sciences, Stockholm.
9. Database of the Oxford University, England.
10. Skou J, Aarhus University, Denmark.

11. Walker J, Laboratory of Molecular Biology, Medical Research Council, Cambridge, England.

12. Boyer P, University of California, Los Angeles, USA.

VCS calls for Real Change at VA for Gulf War, Iraq, Afghanistan Veterans

Prepared Oral Comments, House Committee on Veterans’ Affairs, Hearing on VA’s 2011 Budget

By Paul Sullivan, Executive Director, Veterans for Common Sense

February 4, 2010

Chairman Filner, Ranking Member Buyer, and members of the Committee, thank you for inviting Veterans for Common Sense to testify about the Department of Veterans Affairs’ proposed budget for 2011.

VCS strongly endorses President Obama’s $125 billion VA budget, especially the new $300 million in funding to end homelessness by the end of 2014.

However, we do have some concerns about two cohorts of veterans: first, our Iraq and Afghanistan veterans, and, second, our Gulf War veterans.

VCS urges Congress to require VA to develop more accurate casualty estimates as well as implement a long-range strategic casualty plan.

As of June 2009, VA reported 480,000 veteran patients and 442,000 disability claims from the Iraq and Afghanistan wars.  This is far above any worst case scenario for casualties. 
VA treats nearly 9,000 new patients per month from the two wars.  For VA’s 2012 budget, VA estimated less than 500,000 patients.  A more realistic estimate for 2012, based on VA data, is as high as 800,000 new patients and claims from Iraq and Afghanistan veterans.

One factor that may increase healthcare use and claims activity is multiple deployments, as Stanford University researchers estimated 35 percent of new war veterans may return with post traumatic stress disorder - PTSD.

VA’s failure to accurately forecast demand is serious because one-in-four patients wait more than one month to see a doctor.  According to the Veterans Benefits Administration, more than one million veterans are now waiting 161 days for an initial answer for a disability claim.

We are alarmed VA’s 2011 budget request shows VBA taking a staggering 190 days to process an initial claim.  That’s one more month of waiting for our veterans.

While we support hiring additional VBA staff to process the one-million claim backlog, VBA must also work smarter.  VCS urges Congress to fund development of a one-page claim form plus new, simpler regulations VBA staff can learn in six months, not the two-to-three years currently required.  VCS urges Congress to fund a specific program to implement the proposed lifetime electronic record to end the epidemic of lost and difficult-to-find military service and military medical records.

VCS supports the Veterans’ Benefits Improvement Act of 2008 as a strong move by Congress to improve quality at VBA.  We urge Congress to hold accountable those VBA leaders who openly flaunted the law by failing to provide several reports and implement sections of the new law designed to overhaul VBA’s broken claims system.

Specifically, VBA has not created temporary disability rating systems or reports required under Title II, Modernization of VA’s Disability Compensation System, Subtitle A, Benefits Matters, Section 211.

VCS remains deeply concerned that funding for the Board of Veterans Appeals only increased three percent when there is a backlog of 200,000 unprocessed appeals, and where veterans wait four years for a decision.

VCS also urges Congress to fund full-time, permanent VBA claims staff at every military discharge location plus every VHA medical center and clinic.

Here are some VCS budget recommendations for our Gulf War veterans.

First, VCS urges Congress to create and fund a robust Gulf War veteran advocacy committee to provide advice directly to VA Secretary Shinseki on Gulf War illness, treatments, and benefits.

Second, VCS urges Congress to fully fund the Congressionally Directed Medical Research Program, that identifies “off the shelf” treatments.

Third, VCS encourages VA to restore funding for Dr. Robert Haley’s research at the University of Texas Southwestern Medical Center.  VA’s IG confirms that VA Central Office employees “impeded the ability of the contracting officers . . . to effectively administer the contract.”  In our view, a few VA staff sabotaged Dr. Haley’s research.

Finally, Mr. Chairman, you are correct that VBA’s Veterans Benefits Management System is nothing more than a new name for several existing broken VBA computer systems.

Disney has Pixar studios, and James Cameron has his movie Avatar that thought outside the box.  VCS urges Congress to fund a high-priority task force to overhaul VBA immediately, from application to payment and access to healthcare. 

Essentially, if the VBA claims process can be described as a bridge, then the current one-lane obsolete wooden structure lacks the capacity to handle the millions of veterans now using it.  There are traffic jams trying to cross, and veterans constantly fall over the side or through the cracks and plunge into the icy waters below.

An entirely new concrete and steel high-capacity bridge needs to be built as a replacement.  The more time spent adding timber, changing the name, and applying paint to the wooden bridge only means more delays for our veterans seeking healthcare and benefits.

Thank you.  I will be glad to answer your questions.

VVA Calls for More VA Focus on Gulf War Veterans

Vietnam Veterans of America (www.VVA.org), whose motto is “Never again shall one generation of veterans abandon another,” joined the call at this week’s HVAC (House Veterans’ Affairs Committee) hearing on Obama Administration’s proposed budget for the U.S. Department of Veterans Affairs.

Testimony by Rick Weidman, VVA’s Government Relations Director, called for more research into health conditions affecting Vietnam War and post-Vietnam war veterans, including those of the 1991 Gulf War:

Research

VVA calls for an increased outlay for Research and Development.  Traumatic Brain Injuries, or TBI, needs to be better understood for treatment to be more effective.  Other mental health issues, too, that are afflicting too many of our returning troops, need to be better understood.  Research, for which VA scientists and epidemiologists can be justifiably proud, benefit not only troops who are forever changed by their experiences in combat but the general populace as well. VVVA believes that we must become more serious about research at the VA, given that the National Institutes of Health (NIH) continues to totally ignore veterans and the long term health effects of military service. Other than one head injury study, we know of no other NIH research project that even tangentially asks about military service and uses that as a variable (and possible confounder). VVA recommends that Research & Development be provided at least $ 750 million for FY 2010 and commensurately large increases in the out years, so that over five years this activity is funded at least at the $1 Billion level.

For the first time in many years, VVA has NOT signed on to the Friends of VA Health Care & Medical Research (FOVA) although we strongly believe that there needs to be a significant increase in R&D funding. VVA did not sign on to FOVA because of a required pledge not to push for any earmarks in Research & Development funds. It would be irresponsible of VVA to sign this pledge and not seek ear marks given that we have been unable to discover ANY research programs into the long term health effects of Agent Orange and other toxins, despite repeated inquiries to the current Undersecretary for Health and the current occupant of the office of Director of Research & Development, as well as the previous two occupants of the office of Secretary of Veterans Affairs.

Obviously we need ear marks for research into the environmental wounds of Vietnam, as well as into the deleterious health effects of service in other periods of time and theaters of operation, such as the first Gulf War. It would be a betrayal of our members and their families if we did not urgently seek ear marks for further research into the terrible health long term effects of exposure to the herbicides and other toxins (including pesticides, PCBs, etc.) used in Vietnam during the war.

VVA’s public testimony also called for longitudinal studies  for Vietnam War and post-Vietnam war cohorts.  Longitudinal studies are intended to monitor and measure health over a long period of time for the emergence of similar health conditions, which then might be able to be diagnosed and treated with enough time to make a difference.

This lack of such research projects is compounded by VHA’s adamant refusal to obey the law and complete the replication of the “National Vietnam Veterans Readjustment Study” (NVVRS) as a robust mortality and morbidity study from the only existing statistically valid random sample of Vietnam veterans in existence. Frankly, this study in needed not only to document the long term course of post traumatic stress disorder, but also to document physiological problems in this population (which we know to be many). Their refusal says a great deal about their bias and determinedly continued willful ignorance.

Mr. Chairman, VVA thanks this Committee and the Appropriations Committee for using the power of the purse in the FY 2008 and FY2009 Appropriations act to compel VA to obey the law (Public Law 106-419) and conduct the long-delayed National Vietnam Veterans Longitudinal Study. VVA asks that you schedule a hearing and/or a Members briefing for the second half of March for VA to outline their plan as to how they are going to complete this much needed study for delivery of the final results to the Congress by April 1, 2010, as a comprehensive mortality and morbidity study of Vietnam veterans, the last large cohort of combat veterans prior to those now serving in OIF/OEF.

VVA is concerned that previous leadership at VA felt they were above the law and ignored this mandate, and were unapologetic about being scofflaws. We hope this provision will again be included in the Appropriations act and that General Shinseki will see to it that VA obeys the law and gets this done on his watch.

Further, VVA strongly urges the Congress to mandate and fund longitudinal studies to begin virtually immediately, using the exact same methodology as the NVVRS, for the following cohorts: a) Gulf War of 1991; b) Operation Iraqi Freedom; and, c) Operation Enduring Freedom.

Please take action now so that these young veterans are not placed into the same predicament Vietnam veterans find themselves today.

VCS’s Common Sense Congressional Advocacy for Gulf War Veterans

Statement About Gulf War Illnesses by Veterans for Common Sense

Paul Sullivan, Executive Director

November 4, 2009

Veterans for Common Sense (www.VCS.org) thanks Subcommittee Chairman Mitchell, Ranking Member Roe, and members of the Subcommittee for inviting us to testify about improving government policies involving Gulf War veterans.

Founded by Gulf War veterans in 2002, VCS is a non-profit 501(c)3. VCS and our members provide advocacy and publicity about policies related to veterans’ healthcare, veterans’ disability benefits, national security, and civil liberties.

Nearly 700,000 Gulf War veterans deployed to Southwest Asia in 1990 and 1991. The human and financial costs of our war continue rising. The Department of Veterans Affairs (VA) reports 300,000 of us sought medical care and a similar number filed disability claims. VA spends $4.3 billion per year for our medical care and benefits.

VA and VA's Research Advisory Committee on Gulf War Veterans’ Illness (RAC) agree as many as 210,000 Gulf War veterans suffer from multi-symptom illness. VA’s RAC and the Institute of Medicine (IOM) both agree the exposures and illnesses are real.

According to VA’s Gulf War Veterans Information System (GWVIS), 13,000 veterans filed claims seeking disability compensation and healthcare for one or more Undiagnosed (UDX) condition. According to VA’s Gulf War Review, 3,400 received disability compensation for UDX. Unfortunately, there are no effective treatments.

Veterans for Common Sense is encouraged by VA’s comments during the May 19, 2009, hearing, “… Secretary [Eric Shinseki] has charged us to transform VA’s process for determination of presumptive service connection into one that is based on good science, is substantially faster and makes VA an advocate for our Veterans.” Seeking to build on this forward momentum, VCS provided VA with a six-point plan to address our needs on August 2, 2009. Today, VCS provides the Subcommittee with seven urgently needed changes to policy, research, treatment, and benefits for our Gulf War veterans.

The first government policy that must change is Presidential Review Directive 5, adopted in August 1998, with a goal of “minimizing or preventing of future post-conflict health concerns.” The best policy solution would be for President Barack Obama to order a revision of PRD-5, with input from Gulf War veterans, so the official U.S. policy declares Gulf War illness is serious public health issue and a long-term cost of war.

Second, VA must improve its culture. Last month, panelists on VA’s Advisory Committee on Gulf War Veterans wrote, “The VA system itself presents an impediment to care and services.” Improving VA culture starts when VA consolidates Gulf War related activities within VA into a single office so Gulf War illness remains a high-profile and high-priority issue. Similarly, the Department of Defense (DoD) must improve, too.

During a recent military health conference in Kansas City, Kelley Brix, representing DoD’s Health Affairs, dismissed Gulf War illness as stress-related. The best policy would be for DoD to work with Congress and fully fund DoD’s Congressionally Directed Medical Research Program (CDMRP). The CDMRP is a highly effective approach to identifying effective “off the shelf” treatments for our ailing Gulf War veterans.

Third, VA must listen to independent experts and veterans’ advocates. VA must review and respond to the November 2008 report issued by the RAC with an eye toward granting disability benefits for conditions associated with Gulf War deployment and exposure, as allowed by the “Persian Gulf Veterans Act of 1998” (PL 105-277 and PL 105-368). Similarly, VCS supports the recommendations made in September 2009 by VA’s Advisory Committee on Gulf War Veterans – with the exception that Gulf War veterans’ needs should be addressed separately from veterans of other conflicts.

Congress should restore our access to Priority Group 6 medical care that expired in 2002. Congress should also remove the expiration date for our UDX disability benefits. Since the Advisory Committee on Gulf War Veterans has expired, Congress should charter a successor committee to provide advocacy on behalf of Gulf War veterans, with authority to review VA’s handling of disability claims, including UDX claims.

Fourth, VA must launch an aggressive outreach effort to educate our veterans and their families about healthcare and benefits. VA should resume publishing the “Gulf War Review” and add Gulf War veterans to the review process. VA should contact all the Gulf War veterans denied benefits under the 1994 UDX benefits law (PL 103-446) who may now be eligible under the expanded 2001 UDX benefits law (PL 107-103).

Fifth, the largest obstacle reported by every panel investigating Gulf War illness remains the lack of objective and consistent data collection and research by VA and DoD. The lack of information about toxic exposures hampers our access to treatment and benefits. In order to obtain more salient exposure and research data, Congress and VA should support research at the University of Texas Southwestern Medical Center by converting the current contract into a grant in order to preserve already completed research. VA and DoD should start more research into the adverse health consequences of toxic exposures, especially depleted uranium.

Sixth, on April 2, 2009, VA published a statement in the Federal Register that VA intends to publish regulations linking nine diseases with deployment to the Gulf War. VCS urges VA to promulgate those regulations as soon as possible.

Seventh, VA should resume publishing and distributing GWVIS reports, as required by a 1992 law (PL 102-585). GWVIS should be expanded to include expenditures for all VA healthcare and benefit programs. VA should report information about the combined degree of disability for service-connected veterans as well as lists of the most frequent medical diagnoses and disabilities, and VA should provide more robust information about UDX claims, such as the grant and denial rate for each condition, including the percentage rating, sorted by each VBA office. GWVIS reports and data sets are essential tools for monitoring the post-war activity of Gulf War veterans.

In conclusion, Veterans for Common Sense commends this Subcommittee for your strong and sustained interest in the needs and concerns of our Gulf War veterans. VCS hopes to continue working with Congress, VA, and DoD to make sure our Gulf War veterans receive access to prompt and high-quality healthcare and disability benefits.

Longtime Gulf War Health activist honored for service

Jeffrey Allen, OneWorld US

People of 2009: Paul Sullivan, for exposing the disgraceful treatment of soldiers returning home from Iraq and Afghanistan and for his work to protect civil liberties for all Americans

WASHINGTON, Feb 3 (OneWorld.net) - Gulf War veteran Paul Sullivan has dedicated the last few years of his life to making sure Iraq and Afghanistan war veterans get the care they deserve, while also exposing the true financial and human costs of the current conflicts.

In 2009, Sullivan not only worked quietly behind the scenes to help numerous journalists break stories about the epidemic of suicides and other mental health disorders facing returned veterans, but his organization fought the Department of Veterans Affairs (VA) publicly to force the release of documents demonstrating the reality of longterm health issues faced by U.S. veterans.

The Freedom of Information Act request executed by Sullivan's Veterans for Common Sense revealed that nearly 300 veterans filed new disability claims every single day in 2008. Sullivan's group posted all the documents it received from that request on its Web site for journalists and others to use to uncover the extent of damage done to U.S. soldiers in today's wars.

Paul Sullivan

With Sullivan's aid, Nobel Prize winning economist Joseph Stiglitz was able to calculate the financial cost of the war, concluding that an unprecedented $3 trillion will ultimately be spent, when the expenses incurred helping veterans cope with the traumatic stresses of war are fully counted.

Sullivan has testified before Congress seven times throughout his crusade to make the U.S. government fulfill its responsibilities to the men and women it sends into combat. In testimony in March, Sullivan noted that the VA takes six months to process each claim of Post-Traumatic Stress Disorder (PTSD) and requires onerous documentation of the cause of stress before agreeing to pay for a veteran's medical care.

As the tide of PTSD-related violence rises across the United States, institutional stigmatization of the disease remains intense, causing untold veterans to suffer in silence, Sullivan explained in a letter to new VA Secretary Erik Shinseki last January. The toll is paid in broken families, unemployment, crime, drug and alcohol abuse, homelessness, and suicide, Sullivan noted.

"The long-term human and social consequences from these two wars remain enormous, and much more work still needs to be done so our veterans stop falling through the cracks at VA and experiencing long delays to access healthcare and disability benefits," Sullivan wrote on the Veterans for Common Sense Web site in September. "Both wars continue undermining our domestic economic recovery and further increasing the Federal budget deficit. VA reports reveal the crisis goes far beyond the military, as the wars are impacting millions of veterans, their families, and local communities." 

* This story profiles one of OneWorld.net's People of 2009. Meet all the honorees and tell us about the people who inspire you.

NGWRC Releases 2010 Legislative Agenda for 1991 Gulf War veterans

The following is a letter from the NGWRC (www.ngwrc.org) to House Veterans’ Affairs Committee chair, Rep. Bob Filner, regarding the NGWRC’s legislative agenda for veterans of the 1991 Gulf War.

==================================

Dear Chairman Filner and Members of the House Committee on Veterans’ Affairs,

The National Gulf War Resource Center (NGWRC) appreciates the opportunity to submit a written statement for the record regarding our priorities for the second session of the 111th Congress.

The NGWRC is a non-profit organization based in Topeka, Kansas, focusing on issues related to Gulf War illnesses. We have testified regularly before the House Veterans’ Affairs Committee since 1995, when we were first formed in Washington, DC.

The NGWRC leads the battle in identifying problems facing Gulf War veterans and their families and finding practical solutions. Using the Freedom of Information Act, NGWRC forced the Department of Defense to confirm hundreds of thousands of our fellow veterans who were exposed to toxins during Desert Shield / Desert Storm, including oil well fire pollution, depleted uranium, chemical warfare agents, anthrax vaccines, pyridostigmine bromide pills, pesticides, and others.

NGWRC also led the legislative efforts to fund medical research at the Department of Veterans Affairs, to provide service-connected disability benefits for undiagnosed illnesses, and the creation of VA’s Research Advisory Committee on Gulf War Illnesses.

Our statement for the record is limited to our top four best ways Congress can assist our Nation’s 700,000 Desert Storm veterans from 1991 and those who entered Southwest Asia since 1991.

The NGWRC asks the House Veterans’ Affairs Committee to work closely with the House Armed Services Committee and the House Appropriations Committee to budget and then appropriate $30,000,000 for the purpose of funding treatments for the estimated 200,000 Gulf War veterans suffering from chronic multi-symptom illnesses.

We would like $10,000,000 of the funding to go to Dr. Haley’s research being done in Texas. The Congress approved $75,000,000 for his research at UTSWMC over a five year time frame. With the VA now redirecting the funding to different studies, the last of Dr Haley’s studies needing to be completed, this money is needed now. To see the importance of the finding, we also ask that you do a joint hearing to hear from Dr. Haley on what his research has found and how it will help the veterans.

NGWRC supports the program because the DoD Congressionally Directed Medical Research Program is an innovative, open, peer reviewed program focused on identifying effective treatments, with first priority for pilot studies of treatments already approved for other diseases, so they could be put to use immediately. Nearly 20 years since the start of the war, one-third to one-fourth Gulf War veterans continue to suffer from chronic multi-symptom illness according to the November 2008 report on Gulf War Illness, and there are still no effective treatments.

Congress approved $8 million in 2010, and the first phase of the program resulted in over 100 applications for treatment studies, of which five were approved.

 The bottom line for Gulf War veterans since their return home from combat, is to find ways to improve their health.

NGWRC second request is that Congress remove the presumptive deadlines in the CFR 38 section 1117. By removing the deadline for gulf war illness, you would be doing what was done for the veterans of Vietnam and their exposure to Agent Orange.

NGWRC’s third request is that Congress enacts legislation granting a presumption of service connection for our Gulf War veterans who deployed to the war zone and who are diagnosed with auto-immune diseases, such as multiple sclerosis (MS), Parkinson’s disease and auto-immune diseases that act like MS but can not be diagnosed as MS yet.

VA has granted service connection based on the Secretary’s authority under existing regulations. These grants should be made permanent for existing and future veterans so that these very sick and highly vulnerable veterans aren’t needlessly forced to fight diligently when the science is so clear.

The VA November 2008 report does show the three leading causes for the chronic multi-symptom illnesses are chemicals. We are just now starting to understand how these chemicals cause these different auto-immune disorders. While strong evidence linked ALS and brain cancer to Gulf War deployment, we believe the research on auto-immune disorders similar to ALS shows the same results.

NGWRC’s fourth request is that Congress enacts legislation that would add to the CFR title 38 a set way for all raters to be trained and tested on undiagnosed illness and Post Traumatic Stress claims.

We have worked with veterans and their service officers all over the country whose claims were denied because the rater do not know or will not follow the law regarding these claims. I have seen claims turned down for the following presumptive illnesses:  (1) Chronic fatigue syndrome; (2) Fibromyalgia; (3) Irritable bowel syndrome
Being a presumptive for their service in the gulf, the veteran only needs to show they served in the gulf and that they have the illness on or before 31 December 2011. In the last 2 months we have worked with over 200 veterans where the regional office has denied the claim stating that it did not start in service. This is one example of many more claim we have worked around our country.

We need a mandatory training program set up for all adjudicators and their supervisor to attend. By making it mandatory we will take care of a large problem of many adjudicators not going to any training after they get their job. As a part of this training, there needs to be a closed book test on the classes. Everyone that fails the test will need to redo the class and take the test until they pass.  Once an adjudicator is certified to work an undiagnosed, TBI or PTSD claim, then that adjudicator will be allowed to rate those types of claims.

There should also be a quality control system so that as an adjudicator’s claim comes back either as a notice of disagreement or as a remand, the adjudicator must be trained in that area again and retested. As before he will need to pass the test before he can rate claims in that area.

In conclusion, the NGWRC would like to thank you for their continued interest in this important subject. We regret we are not able to appear in person.

We look forward to working with you on these critical issues identified here as well as on other issues impacting our Gulf War, Iraq War, and Afghanistan War veterans and their immediate access to VA’s high-quality healthcare and the prompt receipt of disability compensation benefits.

James A. Bunker, NGWRC

Initial Clinical Trial data suggest that lower-dose Savella improves chronic pain, physical function

Written By Charles Bankhead, Staff Writer, MedPage Today; Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

Action Points 

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• Explain to patients that a fibromyalgia drug proved superior to a placebo throughout two large clinical trials.
• Note that the drug affected several outcomes and demonstrated efficacy at two different doses.
• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

(MedPageToday.com - SAN ANTONIO) -- The fibromyalgia drug milnacipran (Savella) achieved clinically meaningful reductions in pain throughout almost four months of randomized therapy, a post-hoc analysis of daily pain control showed.

Half of patients treated with the serotonin/norepinephrine reuptake inhibitor had at least a 30% improvement in pain scores at 15 weeks, and 35% to 40% had at least a 50% improvement, according to analyses reported here at the American Academy of Pain Medicine meeting.

Two different doses of milnacipran led to at least 30% improvement in pain on almost half of the days during the randomized trial. Patients treated with milnacipran had at least 50% improvement during 30% of the days.

"A 30% improvement in pain is clinically significant, and half the patients treated with milnacipran attained that level of pain relief," Aroon Datta, MD, of Forest Laboratories in Jersey City, N.J., said in an interview. "Even when the more stringent criteria of 50% improvement were applied, significantly more patients in the milnacipran groups achieved that threshold compared with placebo."

"By any measure, it is fair to say that patients treated with milnacipran had significantly better pain control," he added.

Milnacipran is chemically similar to the antidepressant venlafaxine (Effexor). However, milnacipran has three times the power to inhibit norepinephrine reuptake. The drug was approved in 2009 for treatment of fibromyalgia.

Datta reported results of a post-hoc analysis of data from two randomized, placebo-controlled clinical trials. One lasted 27 weeks, and the other had a 15-week follow-up.

In the 27-week trial, approximately 900 patients were randomized 1:1:2 to placebo, milnacipran 100 mg/d (50 mg BID), or milnacipran 200 mg/d (100 mg BID). In the 15-week trial, 1,200 patients were randomized in equal proportion to placebo and the two doses of milnacipran.

Patients recorded their pain level several times a day by means of an electronic diary. They rated their pain according to a visual analog scale (VAS) with a range of 0 to 100.

The post-hoc analysis centered on outcomes at 15 weeks in both trials. The primary outcomes were change from baseline in weekly 24-hour VAS pain score, the proportion of patients who achieved ≥30% and ≥50% improvement in the VAS pain score, and the proportion of days with ≥30% and ≥50% improvement in pain.

In the longer trial, the change in the weekly average of 24-hour recall of VAS scores differed significantly in both milnacipran groups within two weeks, and the difference was maintained through 15 weeks (P<0.05 to P<0.001).

Significant differences emerged within the first week in the second trial and persisted through week 15 (P<0.05 to P<0.001).

In both trials, 52% of patients assigned to 100 mg of milnacipran and 56% of those assigned to 200 mg had ≥30% improvement in pain scores, compared with 40% to 42% of placebo-treated patients (P<0.05 to P<0.001).

When the more stringent criterion of ≥50% improvement was used, 31% to 35% of the 100-mg milnacipran patients achieved that goal, as did 36% to 37% of patients treated with 200 mg.

About 25% of placebo patients had ≥50% improvement. Only the 200-mg dose differed significantly from placebo (P<0.05 to P<0.01).

A similar pattern emerged in evaluation of the proportion of days with threshold pain reductions. Milnacipran-treated patients had ≥30% improvement on 44% to 47% of days in the trial and ≥50% improvement on 25% to 30% of days.

For both thresholds, milnacipran was significantly better than placebo, whose patients had ≥30% pain improvement on about a third of days and ≥50% improvement on fewer than 20% of days (P<0.01 to P<0.001).

Datta also reported findings from a randomized, placebo-controlled clinical trial evaluating the pain relief afforded by the 100-mg daily dose of milnacipran. The study involved 1,025 patients with fibromyalgia randomized to placebo or active therapy.

The trial had two principal 12-week efficacy outcomes: the composite of ≥30% improvement in pain and the Patient Global Impression of Change (PGIC), and the composite of the same two outcomes plus improvement ≥6 points on the physical function component of the SF-36 health assessment survey.

The principal efficacy analysis used baseline observation carried forward (BOCF) for patients with missing data. By that statistical method, 29% of milnacipran patients were responders compared with 18% of the placebo group (P<0.001).

An analysis that employed last observation carried forward (LOCF) showed response rates of 33% with milnacipran and 19% with placebo (P<0.001).

An analysis of observed cases resulted in response rates of 42% versus 26% (P<0.001).

Similar results emerged from analyses of the three-measure outcome. Milnacipran led to significantly higher (P<0.001) response rates by BOCF (20% versus 11%), by LOCF (28% versus 12%), and by observed cases (30% versus 16%).

Milnacipran therapy also led to significantly higher (P<0.001) response rates for each component of the composite outcomes: ≥30% improvement in pain (45% versus 31%), PGIC (42% versus 26%), and ≥6-point improvement in physical function (40% versus 31%).

The results indicate that milnacipran 100 mg (50 mg BID) could offer an alternative for patients who cannot tolerate the FDA-approved 200-mg dose, said Datta. If physicians choose to start patients on 100 mg and then titrate up to the approved dose, that also would appear feasible, he said.

The studies were supported by Forest Laboratories and Cypress Bioscience.

All but two of the authors are employees of the study sponsors.

Primary source: American Academy of Pain Medicine
Source reference:
Mease P, et al "A day-to-day analysis of the analgesic efficacy of milnacipran in the management of fibromyalgia" AAPM 2010; Abstract 110.

Additional source: American Academy of Pain Medicine
Source reference:
Arnold LM, et al "Milnacipran 100 m/day in the management of fibromyalgia: a randomized, double-blind placebo-controlled trial" AAPM 2010; Abstract 109.

Selective Channel Blockers Improves MS Fatigue, may prevent further functional impairment

Written by Anthony Hardie

(91outcomes.blogspot.com) -- A new study suggest that the use of selective channel blockers improves fatigue in people with multiple sclerosis (MS), a condition thought to be more prevalent among veterans of the 1991 Gulf War than among people who did not have similar military service.

Additionally, the use of these blockers may also help prevent secondary axonal degeneration and the functional impairment that follows.

The study noted that among people with MS, “activity and heat typically serve to exacerbate symptoms of fatigue,” – a cause-and-effect reported among some veterans of the 1991 Gulf War suffering from Gulf War Syndrome (e.g. Gulf War Illness) who do not have MS.

Selective channel blockers like Famipridine – a Potassium channel blocker – are used to treat MS, because, according the manufacturer:

Patients with MS display a range of symptoms that arise from demyelination (loss of myelin sheath) in the central nervous system (CNS), which includes the brain, spinal cord and optic nerves.

While symptoms vary between patients, they commonly include blurred vision, slurred speech, numbness or tingling in the limbs and problems with balance and coordination, due to the loss of control over vital functions such as seeing, walking and talking.

Prominent inflammatory and autoimmune responses are also evident in patients with traumatic and compressive SCI, in whom there may also be demyelination.

Demyelination alters the structural and functional relationships of voltage-gated ion channels along the axonal membrane of the nerve cell.

Exposed channels cause potassium ions to leak, so causing the axon to 'short circuit'. By closing exposed potassium channels in these damaged nerve fibres, fampridine-SR enables the axon to transmit nerve impulses again.

The abstract (article) for the published study results is as follows:

Fatigue in multiple sclerosis: Mechanisms and management.

Multiple sclerosis [MS] is a chronic immune-mediated disorder of the central nervous system [CNS]. Fatigue may be a debilitating symptom in MS patients, adversely impacting on their quality of life. Clinically, fatigue may manifest as exhaustion, lack of energy, increased somnolence, or worsening of MS symptoms.

Activity and heat typically serve to exacerbate symptoms of fatigue.

There is now strong evidence to suggest that fatigue results from reduced voluntary activation of muscles by means of central mechanisms.

Given that axonal demyelination is a pathological hallmark of MS, activity-dependent conduction block [ADCB] has been proposed as a mechanism underlying fatigue in MS.

This ADCB results from axonal membrane hyperpolarization, mediated by the Na(+)/K(+) electrogenic pump, with conduction failure precipitated in demyelinated axons with a reduced safety factor of impulse transmission. In addition, Na(+)/K(+) pump dysfunction, as reported in MS, may induce a depolarizing conduction block associated with inactivation of Na(+) channels.

These processes may induce secondary effects including axonal degeneration triggered by raised levels of intracellular Ca(2+) through reverse operation of the Na(+)-Ca(2+) exchanger.

Restoration of normal conduction in demyelinated axons with selective channel blockers improves fatigue and may yet prove useful as a neuroprotective strategy, in preventing secondary axonal degeneration and consequent functional impairment.

Metabolic Syndrome associated with Chronic Fatigue Syndrome, study shows

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- A new study, published January 25 in the medical journal Metabolism, found that metabolic syndrome was found more frequently in people suffering from Chronic Fatigue Syndrome/Myalgic Encephelopathy (CFS/ME) than people who did not have the disease.

In turn, metabolic syndrome further worsened the fatigue symptoms.

According to Google Health:

Metabolic syndrome is a name for a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes.

Alone, the symptoms can cause medical issues. Combined, they can present severe health problems.

Symptoms include:

• Extra weight around your waist (central or abdominal obesity)
• High blood pressure
• High triglycerides (a type of blood fat)
• Insulin resistance
• Low HDL ("good") cholesterol

Tests that may be done to diagnose metabolic syndrome include:

• Blood pressure measurement
• Glucose test
• HDL cholesterol level
• LDL cholesterol level
• Total cholesterol level
• Triglyceride level

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following:

• Blood pressure equal to or higher than 130/85 mmHg
• Blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

Preventing (and managing) the condition involves:

• Eating a diet low in fat, with a variety of fruits, vegetables and whole-grain products
• Getting regular exercise, at least 30 minutes of moderate activity almost every day
• Losing weight so that your body mass index (BMI) is less than 25
• Managing blood pressure and blood sugar
• Not smoking
• Trying to include fish, preferably oily fish, in your diet at least twice a week

Chronic Fatigue Syndrome is one of three conditions presumed by the federal VA to be service-connected for veterans of the 1991 Persian Gulf War. 

The abstract (summary) of the published study, Chronic fatigue syndrome is associated with metabolic syndrome: results from a case-control study in Georgia, is as follows:

Chronic fatigue syndrome is associated with metabolic syndrome: results from a case-control study in Georgia.

We hypothesized that persons with chronic fatigue syndrome (CFS) would have a higher prevalence of metabolic syndrome compared with well controls, and that unwell persons with insufficient symptoms or fatigue for CFS (termed ISF) would have a prevalence of metabolic syndrome intermediate between those with CFS and the controls.

We also sought to examine the relationship between metabolic syndrome and measures of functional impairment, fatigue, and other symptoms. Our analysis was based on a population-based case-control study conducted in metropolitan, urban, and rural areas of Georgia, United States, between September 2004 and July 2005. There were 111 persons with CFS, 259 with ISF, and 123 controls.

Metabolic syndrome was determined based on having at least 3 of 5 standard risk components (abdominal obesity, high triglycerides, high blood pressure, elevated fasting glucose, and decreased high-density lipids) according to the National Cholesterol Education Program Adult Treatment Panel III definition. Persons with CFS were 2-fold as likely to have metabolic syndrome (odds ratio = 2.12, confidence interval = 1.06, 4.23) compared with the controls.

There was a significant graded relationship between the number of metabolic syndrome factors and CFS; each additional factor was associated with a 37% increase in likelihood of having CFS. The association of ISF with metabolic syndrome was weaker (odds ratio = 1.72, confidence interval = 0.94-3.16). Among persons with CFS, the number of metabolic syndrome factors was significantly correlated with worse fatigue on a standardized summary measure of fatigue (r = 0.20, P = .04).

In conclusion, CFS was associated with metabolic syndrome, which further exacerbated fatigue. Published by Elsevier Inc.

Self-Pacing in chronic fatigue may provide modest symptom, daily functioning improvements

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- A new Belgian scientific study suggests that patients with Chronic Fatigue Syndrome/Myalgic Encepholopathy (CFS/ME) may feel slightly better by pacing their daily activities.

The study by J. Nijs of the Vrije Universiteit Brussel in Brussles, Belgium and colleagues found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning.

The authors of the study, Can pacing self-management alter physical behavior and symptom severity in chronic fatigue syndrome? A case series, suggest that the next step should be to conduct a larger-scale, randomized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS.

Chronic Fatigue Syndrome is one of three presumptive conditions for VA service-connection for veterans with Persian Gulf service in August 1990 or later.

The study’s abstract, published in the Journal of Rehabilitation Research and Development, is as follows:

Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome (CFS), we examined whether physical behavior and health status of patients with CFS would improve in response to a pacing self-management program. \

We performed an observational study of pacing self-management in seven CFS patients using a single-case study design. Stages A1 and A2 (7-day assessment periods) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior (real-time activity monitoring) and health status (self-reported measures), respectively. Stage B (3 weeks of treatment) consisted of three individual treatment sessions of pacing self-management.

When comparing pre- versus posttreatment data, we found that the patients' ability to perform daily activities and the severity of their symptom complexes were improved (p = 0.043). Concentration difficulties, mood swings, muscle weakness, and intolerance to bright light improved as well. A statistically significant decrease in the mean time spent doing light activity (<3 metabolic equivalents) was observed, but a change in the way physical activity was spread throughout the day was not.

We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning.

The outcome of the present study calls for a randomized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS.

A Call to Action for Fibromyalgia

FIBRO COLLABORATIVE WEBCAST
February 5, 2010

12:30 pm - 1:45 pm CST

The FibroCollaborative Roadmap for Change:
A Call to Action for Fibromyalgia

Please join the National Fibromyalgia Association in listening in to an important Webcast about how we can work together to help improve the lives of people affected by fibromyalgia.

THE WEBCAST

The Webcast will unveil a new Call to Action for Fibromyalgia, a comprehensive roadmap designed to prioritize and address the unmet needs of fibromyalgia in the United States.  

The Call to Action is a product of the FibroCollaborative Advocacy Working Group, a Pfizer initiative in collaboration with 16 medical/professional and advocacy organizations. The Group’s focus is to improve the health and well-being of people with fibromyalgia, one of the most common chronic, widespread pain conditions in the U.S.

The Webcast will also feature new topline results from a national landmark survey on primary care physicians’ attitudes and perceptions about fibro and how it may be impacting diagnosis and care.

Join us at http://fibrocollaborative.stream57.com/february5 on February 5 for the live Webcast, which is streaming from the American Academy of Pain Medicine Annual Meeting:

Some of the Prominent Speakers include:

Daniel Clauw, MD, Director, Chronic Pain and Fatigue Research Center, The University of Michigan Lynne Matallana, President and Founder, National Fibroymalgia Association Bill McCarberg, MD, Founder and Attending Physician, Chronic Pain Management Program, Southern California Kaiser Permanente Medical Center

REGISTRATION INFORMATION

Registration information and questions for Webcast speakers should be sent to Anna Khersonsky (akhersonsky@chandlerchiccocompanies) in advance of the Webcast. We will be accepting questions during the Webcast as well.

ACCESSING THE FIBROCOLLABORATIVE WEBCAST

The Webcast can be accessed by visiting http://fibrocollaborative.stream57.com/february5.

CONNECTION TEST

Participants can test their connection speed at this link: http://test.stream57.com

SYSTEM REQUIREMENTS

• Adobe Flash Player version 8.0 or greater. You can download the latest version of the Adobe Flash Player by clicking here
• Windows XP, 98, ME, 2000, NT, Server 2003, or Vista
• Mac OS X 10.1 or higher
• Most Linux / Solaris distributions with Mozilla 1.4+ or Netscape 7.1+
• Internet Explorer 7.0 or newer, Firefox 1.1 or newer, Mozilla 3.0 or newer, or Safari 3.0 or newer
• Broadband Internet connection for optimal video experience

ABOUT THE FIBROCOLLABORATIVE

The FibroCollaborative brings together a diverse group of healthcare professionals and patient advocacy organizations in an unprecedented effort to:

• Define and prioritize the most urgent unmet needs for those affected by fibromyalgia
• Focus initiatives/resources on fulfilling specific recommendations outlined in The FibroCollaborative Roadmap for Change: A Call to Action for Fibromyalgia.  The FibroCollaborative is a collaborative initiative of Pfizer Inc.

FIBROCOLLABORATIVE CONTACT INFORMATION

Cindy Romano

Chandler Chicco Agency

Ph: 212-229-8425

Email: CRomano@ccapr.com

ABOUT FIBROMYALGIA

Fibromyalgia is estimated to affect more than 5 million Americans.  Despite its far-reaching and potentially debilitating impact, fibromyalgia is still misunderstood by many healthcare professionals and patients, leaving many undiagnosed and undermanaged.

Medical experts and patient advocates believe advancements made over the past decade in the understanding and treatment of fibromyalgia provide the foundation for raising awareness and improving recognition, diagnosis and management to improve health outcomes and patient satisfaction.

ABOUT NATIONAL FIBROMYALGIA ASSOCIATION

The National Fibromyalgia Association is a non-profit 501(c)(3) organization whose mission is to develop and execute programs dedicated to improving the quality of life for people with fibromyalgia by increasing the awareness of the public, media, government and medical communities. www.FMaware.org

Single exposure to mustard gas now linked to lung cancer

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- For years, the cancer-causing properties of long-term exposure to mustard gas have been well known.  In a new study published in the January 2010 edition of Clinical Lung Cancer, two researchers reviewing studies of soldiers exposed to mustard gas have found that a single acute exposure to mustard gas can lead to lung cancer. 

Mostafa Ghanei and Ali Amini Harandi, scientists at the Research Center of Chemical Injuries, Baqiyatallah University of Medical Sciences in Tehran have been studying a cohort of veterans of the 1981-88 Iran-Iraq war who were exposed to mustard gas.

According to the study abstract, entitled, Lung Carcinogenicity of Sulfur Mustard:

Sulfur mustard (SM), a major potent chemical warfare agent, has been used for its acute toxic effects. Over time, unfortunately, many different long-term health effects of exposure to SM have been detected in humans. There are many available data from soldiers or civilians exposed to SM: testing programs, contaminated workers in factories who were involved with the production of SM, and animal and molecular studies.

Today it seems that our data are enough to discuss the carcinogenic effects of exposure to SM—as an alkylating agent—many years after exposure.

Herein, we review all available published documents regarding the lung carcinogenicity of SM after both long-term and especially short-term exposure in humans. In summary, it is well documented that SM can cause human lung cancer after long-term exposure, but there has not been strong and definitive evidence for only short-term and acute, single, high-dose exposure until now.

At least some U.S. and Coalition troops were exposed to mustard gas and Lewisite gas during the 1991 Gulf War that forced Iraqi occupying forces out of Kuwait. 

Saddam Hussein’s troops, ordered by Saddam’s cousin “Chemical Ali” – executed last week for crimes against humanity – led chemical warfare agent attacks against Shiites in southern Iraq and Kurds in northern Iraq shortly after the February 1991 ceasefire again.  Those attacks included the use of mustard gas.

Study of Iranian Mustard Gas Veterans: lung complications of Mustard gas inhalation

Late Pulmonary Complication of Mustard Gas Inhalation

By Mastafa Ghanei, MD Associate Professor Dept. of Internal Medicine Baghiatallah University of Medical Sciences Mollasadra Ave., Tehran, Iran

ABSTRACT

Thousands of Iranian people were injured by mustard gas in the Iraq war [e.g., the 1981-1988 Iran-Iraq War]. This injury results in chronic disabilities of eyes, lung and skin organs.

Chronic cough, dyspnea [shortness of breath] and hemoptysis [coughing up of blood or blood-stained sputum] were the major presenting symptoms in these patients.

We studied late pulmonary complications of these patients. One hundred mustard gas victims were selected through a cross sectional study. All selected had documented criteria, pulmonary function tests, high resolution chest CT scan, bronchioscopy and routine blood tests, which were done in a well equipped center.

All patients had chronic bronchitis in their bronchial biopsy.

Pulmonary fibroses, with different types of histology [microscopic tissue structure], were detected in 80% of patients.

A cytologic [cellular] study of bronchial lavage [removal of secretion, cells, and proteins from the lungs using sterile fluid] did not show neoplastic [tumor] cells.

HRCT [e.g., High Resolution CT Scan] findings were compatible with bronchial [upper airway] thickening and subpleural fibrosis [abnormal thickening of the outer membrane of the lung] with definite correlation with histologic [microscopic cellular] data in all patients.

Late complications of mustard gas includes bronchial [upper airway] and paranchymnal [bulk of the lung] involvement.

Although the causative agent is not [any longer] present, the disease has a continuous nature and sometimes progressive course, with end-stage lung disease the outcome.

[End-Stage lung disease: The final stages of lung disease, when the lung can no longer keep the blood supplied with oxygen. End-stage lungs in pulmonary fibrosis have large air spaces separated by bands of inflammation and scarring.]

Editorial: Chemical Ali and Mustard Gas, Sarin, VX and Tabun

Posted in Medical Issues, Poisons & Drugs by D.P. Lyle, MD on January 28, 2010

Saddam Hussein and his two miscreant offspring Uday and Qusay are no longer with us thanks to the US military. Good riddance. The world is a much better place without these three. But Saddam’s legacy lives on in the form of his cousin Ali Hassan al-Majid, affectionately known as Chemical Ali.

The good news is that Chemical Ali just received his fourth death sentence for crimes against humanity. The bad news is that he ever existed in the first place. Many of the Shiites and Kurds in Iraq can vouch for his horrific cruelty, which can only be compared to things such as The Holocaust perpetrated by Hitler’s minions, the killing fields of Pol Pot, the purges of Stalin, and, well, the list goes on and on. The inhumanity of humanity is sometimes bewildering.

Chemical Ali is responsible for the death of hundreds of thousands of people and these deaths were not pleasant. He employed a wide variety of chemicals such as Mustard Gas, VX, Sarin, and Tabun. Each of these is nasty in its own special way.

Mustard Gas first came to the public’s attention during the trench warfare of WWI. It literally burns the skin, first causing itching and swelling and ultimately large fluid-filled blisters appear over the body. If it affects the eyes it can lead to blindness. If it affects the lungs, as it typically does as the gas is inhaled, it can cause severe burning of the airways and lung tissue, causing the victim to literally drown in the fluids that are released after this type of injury. Even if the person survives the initial injuries, secondary infections often appear in the skin or the lungs and this in turn can lead to death.

Sarin gas is a fluorinated phosphonate that was originally used in insecticides but found its way into modern chemical warfare. It is classified as a cholinesterase inhibitor, which means that it interferes with the function of cholinesterase, a very important enzyme critical to neurotransmissions throughout the body. When exposed the victim will first feel a stuffy head and shortness of breath but very soon will develop chest pains, nausea, vomiting, excessive salivation, loss of control of bowels and bladder, diffuse twitching and jerking of the muscles, full-blown seizures, and finally coma and death. It’s not pretty. Even if the individual survives they can be left with permanent neurological damage. Sarin gas is as much is 500 times more toxic than cyanide.

Like Sarin, VX and Tabun are cholinesterase inhibitors and produce similar symptoms and are equally lethal.

These chemical agents are out there and available to the bad guys who don’t necessarily have our best interests at heart. Isn’t that a pleasant thought?

At least for now Chemical Ali is out of business and hopefully he will soon follow the Hussein Trio to wherever people like them go. I hope it’s a place filled with these very pleasant chemicals. Poetic justice being what it is.