March 2004 several thousand Reserve and National Guard service personnel had already returned to CONUS sick or wounded, the military began a test program to let some part-timers receive active-duty pay while being treated at hospitals and Veterans Affairs sites near their homes. But now very few are receiving that service.
Since January 2003, well over 16,000 reservists and guardsmen have been placed on "medical holdover" waiting for determination of being fit for duty. Of 4,240 of those 904 are treated in their own communities under the Army's Community Based Health Care Initiative.
Most military injured are transferred to the base where their unit assembled prior to going to the Persian Gulf or Afghanistan; or flown to another base due to the military hospital's medical specialty, and some have been delivered to bases closer to home.
Jaime Cavazos, the spokesman for the Army Medical Command said "unfortunately, the timetable of the soldier wanting to go home may not correspond with the treatment they need. We're trying to provide them with the care they need."
Unlike the most gravely injured soldiers, receiving around the clock treatment at the finest military hospitals, there are soldiers with less complicated wounds. The impatient patients can elect to go home, even needing more medical attention. That is a very bad choice; military rules state they lose their active duty pay and allowances even though they medically cannot return to their civilian jobs. To file for VA benefits will also be more difficult. The VA will look in disfavor of the veteran by stating "the veteran left not needing treatment. The condition resolved prior to discharge." I have seen this hundreds of times over the years. The veteran is also at the mercy of the separation examination.
Those who leave active duty and seek treatment from private doctors qualify for military medical insurance, known as Tricare, for only six months. Advocates for the National Guard say one in five guardsmen lacks medical insurance from his regular job, leaving no room for health problems that may linger.
Political and military leaders have pledged to make Veterans Affairs benefits, including access to the 157 VA hospitals and 845 clinics across the country, available to Iraq war veterans for two years, but most soldiers are not eligible until they are retired from military service or discharged from active duty.
There have been exceptions to the rule, VA officials said, but only in cases when the Department of Defense has chosen to refer a soldier to the VA for care.

I will cast no stones!

Dave Barker

[This message was edited by DaveBarker on Sun, 24 October 2004 at 3:40.]

DaveBarker

PTSD Forum Moderator
Returning Iraqi vets need the VA Environmental Physican exam for Leishmaniasis

Leishmaniasis
We have learned some frightening facts from a memo from the Department of Defense. It tells of a deadly Iraq condition for deployed personnel who currently serve or have served in Iraq.
The Assistant Secretary of Defense William Winkenwerder has issued a Memo regarding deadly conditions facing our troops in Iraq.
Leishmaniasis is a parasitic disease spread by the bite of the sandfly. This is a preventable disease native to Iraq. The Assistant Secretary has asked this be given to all distribution possible. It now looks like we are going to have problems with our returnees that could be catastrophic. One condition is cutaneous Leishmaniasis (Baghdad boil) which creates terrible skin lesions which may look like STD’s. This leaves permanent disfiguring. the other is visceral Leishmaniasis (Kala-azar) which can be fatal.
Overview, Causes, & Risk Factors Leishmania are tiny protozoa. Their parasitic life cycle includes the sandfly and an appropriate host. Humans are one of those hosts. Leishmania infection can cause skin disease (called cutaneous Leishmaniasis).
It can affect the mucous membranes with a wide range of appearance, most frequently ulcers. It may cause skin lesions that resemble those of other diseases including cutaneous tuberculosis, syphilis, leprosy, skin cancer (basal cell carcinoma), and fungus infections.
Leishmania can also cause systemic disease (visceral Leishmaniasis) with fatal complications. When introduced into the body by the bite of a sandfly, the parasite migrates to the bone marrow, spleen, and lymph nodes.
Systemic infection in children usually begins suddenly with vomiting, diarrhea, fever, and cough. In adults, fever for 2 weeks to 2 months is accompanied by nonspecific symptoms, such as fatigue, weakness, and loss of appetite. Weakness increases as the disease progresses.
The skin may become grayish, dark, dry, and flaky. The parasites damage the immune system by decreasing the numbers of disease-fighting cells so death usually results from complications (such as other infections) rather than from the disease itself. Death often occurs within 2 years.
Upon separation from active duty the Iraq veterans need to contact the nearest VA Environmental Physician as soon as possible!


Major deadly problems, anyone out there care?

Posts like these get very little attention, for some reason military matters don't seem to matter; so pardon me if I get a little ticked at our government.
Returning Iraqi vets need the VA Environmental Physican exam for Leishmaniasis. Now are they going to know where to go? The answer is the local VA Medical Center or VA Clinic. Somehow the ball is being dropped, the discharged veterans are not getting the information.
Please read the following copy and paste!

(Washington, DC) – On Thursday, October 16 at 10:00 AM in Room 334 of the Cannon House Office Building, the Committee on Veterans’ Affairs (Chairman Chris Smith – NJ) will conduct an investigative hearing arising from disturbing reports of gaps in health care coverage for transitioning veterans. Reports have indicated recently separated servicemembers may be experiencing difficulty accessing the services and medical care they are entitled to receive, resulting in physical, emotional, and economic hardships for these new veterans.



3390631
Member

Registered: Wednesday, 12 March 2003
Posts: 830
Dave
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Will the returning troops not be tested as a matter of course? If not, I'm writing my son in law TODAY to tell him to make sure he gets tested as soon as he gets back. I'm not familiar with what sort of physical/psychological examinations active duty troops receive when they return. Can you steer me in the right direction?
posted Thu, 16 October 03 10:15

Dave Barker Response:
Reports have indicated recently separated servicemembers may be experiencing difficulty accessing the services and medical care they are entitled to receive, resulting in physical, emotional, and economic hardships for these new veterans.

My best advice is to inform all returnees you know, there is a definite problem and encourage them to go to the local VA facility and register.
The military/naval services should guide their personnel to good healthcare, but is obvious some have failed to take care of matters.
Apparently we are going to have problems with our returnees that will be catastrophic.

I will cast no stones!

Dave Barker
posted Thu, 16 October 03 11:19

DaveBarker

PTSD Forum Moderator



RONCO
Expert Member

Registered: Wednesday, 20 December 2000
Posts: 4306
DAVE
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KEEP UP THE IMPORTANT WORK.
posted Mon, 20 October 03 07:43

Dave
Good idea re: this forum. Gives people a place to voice their concerns without getting flamed for being whiney on some other forum.
I was dismayed to learn that troops returning from Iraq, especially wounded ones, do not appear to be receiving any counseling unless they are sent home for psychiatric reasons. I would have thought it would have been a routine part of their processing. The FSG's give the family members a pamphlet at least.

Pam:
I certainly appreciate your post and fine comments. I hope you will spread the word to anyone you may know who has loved ones in Iraq, Pakistan or Afghanistan, as I feel disaster is in the room waiting to spring upon the troops.

I will cast no stones!

Dave Barker

Is this a curable condition? How is the diagnosis determined, and what is the general prognosis for those affected by this? Thanks in advance for any info!

Diagnosis is made by scraping the skin lesion and examining the tissue microscopically for the leishmania parasite.

Treatment is complex, usually involving administration of specific IV drugs (pentostam or glucantime) for a period of 20 days. There are clinical trials being conducted in France and Tunisia by the US military for a topical (cream) treatment, but this is not FDA approved for use yet. The patient must be monitored for side effects, which can include liver or kidney damage, during treatment and for a period of time afterwards. Treatment is effective for over 90% of the cases; for the remaining 10%, additional antibiotics may have to be added to the regimen.

US troops are evacuated to the States for treatment if they are diagnosed with leishmaniasis - this is not done in-theater. Both Walter Reed and Bethesda Navy have considerable experience in treating the disease.

Any returned servicemember who has unexplained skin lesions should see a dermatologist or infectious disease specialist - preferably a military one who is more likely to have a high index of suspicion for this disease that is quite unusual in the US. Most civilian doctors have never seen it.

There are few long-lasting effects when treatment is given promptly. There can be scarring where lesions have developed.

Small sand flies can pose large health problems

By Lisa Burgess, Stars and Stripes
European edition, Wednesday, November 19, 2003

Prevention tips
There’s only one way to prevent leishmaniasis: Keep sand flies from biting. Here are some tips:
¶ Try to limit outdoor activity at dusk and during the evening, when sand flies are most active.
¶ Wear protective clothing, with uniform sleeves turned down and buttoned, and pant legs properly bloused.
¶ Apply insect repellent with N, N-diethylmetatoluamide (DEET) to exposed skin and under the edges of clothing, such as under the ends of sleeves and pant legs. Reapply according to directions (the more you sweat, the more you may need to reapply, but check the bottle first).
¶ Keep uniforms properly treated with permethrin. Make sure to apply after every five washings.
¶ Use permethrin-treated bed netting and screens on doors and windows. Fine-mesh netting (at least 18 holes to the linear inch) is required for an effective barrier against sand flies, which are about one-third the size of mosquitoes.
¶ In the field, try to get your sleeping bag off the ground. If you can’t do that, at least use a ground pad.
¶ If sleeping under cover, sweep all loose dust and dirt from concrete, tile or linoleum floors. The cleaner your quarters, the fewer the flies.
¶ Do not wear flea collars designed for dogs and cats, even over boots, medical experts warn. The collars are designed to repel common house fleas and there is no evidence they work against sand flies. Meanwhile, the chemicals in the collars have not been tested for safety with humans, and can cause allergic reactions and sores that may become infected.
Sources: U.S. Army, Centers for Disease Control

ARLINGTON, Va. — They look like flecks of pepper and they love to come out at night to play. They live in the dirt and they bite like you’re their last meal.
Sand flies.
Anyone who’s been deployed to Southwest Asia and lived in “bare base” conditions there knows these little buggers all too well. When they munch, the fierce itching that results can drive you almost nuts before it finally goes away.
But when sand flies attack your skin, they can give you more than just the Mother of All Itches. Sand flies can also give you a disease called leishmaniasis, which is caused by microscopic parasites that are transmitted via sand fly saliva.
“LEASH-man-eye-asis,” as it’s pronounced, is pretty rare: Defense Department officials said they have seen only 52 confirmed cases in two years. But it’s serious enough that servicemembers need to know about the disease and its prevention [see box at right].
“Leish,” as medical experts call it for short, comes in two forms: cutaneous (“affecting the skin”) and visceral (“affecting internal organs”).
The cutaneous form is more disgusting to look at, but less serious in the long run.
The first sign of pending trouble is when one or more of the tiny, hard bumps caused by the bite won’t heal. Instead, after several weeks the bumps start looking red and infected. Then they form an open, flat, circular sore with raised edges. Sometimes the sore scabs over and sometimes it hurts, but not always.
If they aren’t treated, the sores can last for years and leave permanent scars.
The good news is that while cutaneous leish is ugly, it is rarely fatal.
Visceral leish, on the other hand, is fatal if not treated.
Visceral leish infects the liver, spleen and other internal organs. But because the infection is internal, it doesn’t come with any handy warning signs, like cutaneous sores.
To make things even tougher for doctors, it can take two to six months after someone is infected before its giveaway symptoms do begin: high fevers, weight loss and anemia. Other symptoms require medical tests to spot, such as an enlarged spleen and a low white blood cell count.
Both forms of leishmaniasis occur in tropical areas around the world, but it is most common in Iraq, Kuwait, Saudi Arabia, Afghanistan, Pakistan and other countries in Southwest Asia.
Iraq’s sand flies are among the world’s busiest carriers. In fact, of the 52 cases of cutaneous leishmaniasis detected in U.S. servicemembers over the past two years, 50 were diagnosed from members who spent time in Iraq, defense officials said.
There have been no cases of visceral leishmaniasis detected so far, defense officials said.

I will cast no stones!

Dave Barker

There are currently about 76 people with leishmaniasis being treated at Walter Reed, with more on the way.

More funding has recently become available (mirabile dictu!) for further studies and clinical trials.

I wonder how many Desert Storm veterans were not properly diagnosed, due to the lack of available information regarding the sand fly?

I will cast no stones!

Dave Barker

Leishmania was a well-known problem going into and coming out of ODS in '91. Among the briefings I received - like the other half-million or so who went over - were some on the indigenous critters: snakes, rodents, bugs. First on the bug list was our friend the sand fly.

Bottom line, I would strongly suspect that most of these cases - if they presented to military docs - were diagnosed correctly in fairly short order. Those who were de-activated immediately upon return and had follow-up on the civilian side might not have been so lucky ... simply because there is/was not the awareness in the general civilian healthcare provider population about this disease that there is in the military.

and Cider33Alpha we agree "Those who were de-activated immediately upon return and had follow-up on the civilian side might not have been so lucky ... simply because there is/was not the awareness in the general civilian healthcare provider population about this disease that there is in the military. "

Thanks to Cider33Alpha

I will cast no stones!

Dave Barker

The Institute of Medicine and the National Research Council of the National Academies have produced and continue to produce reports on the health and protection of deployed military forces and veterans. These reports build on the Academies' long history of addressing scientific and medical issues related to past and current military conflicts. This site provides information about the Institute of Medicine's work in this area, including summaries and recommendations from past reports, as well as explanations of chemical and biological agents, and links to ongoing projects.

http://veterans.iom.edu/

> Deployment Health
Reports on the health and protection of deployed forces
> Gulf War Gulf War and Health reports and ongoing studies
> Vietnam War Vietnam/Agent Orange reports and ongoing studies
> Korean War Reports on military personnel that served in the Korean War
> World War II Information and resources relating to the health of U.S. veterans of the second world war.

I will cast no stones!

Dave Barker

The VA is ready for the troops return. The VA Environmental Physicians are the best equipped in the land to take care of returning troops. If the PGW1 troops would have used the VA many problems in the mid 90's would have been "nipped in the bud."

I will cast no stones!

Dave Barker

Walter Reed handling leishmaniasis cases

March 10, 2004


WASHINGTON (Army News Service, March 10, 2004) -- Health-care providers at Walter Reed Army Medical Center have treated almost 400 patients infected with leishmaniasis since the beginning of Operation Iraqi Freedom last year.

Patients receiving, or who have received care at Walter Reed for

Leishmaniasis, have been treated as outpatients, without having to spend any nights in the hospital, according to medical center officials.

"Most receive antibiotics for 10 days and are then able to return to duty or go on leave," said Maj. Gen. Kevin C. Kiley, commander of WRAMC and the North Atlantic Regional Medical Command. "This treatment keeps our staff busy, but has in no way overwhelmed us.

"We hope the number of leishmaniasis patients goes down, but if it should increase we feel that we're ready to care for them," Kiley added.

Leishmaniasis is a disease spread by the bite of a sand fly, occurring most frequently in tropical areas around the world such as in Iraq, Kuwait, Saudi Arabia, Afghanistan, Pakistan and other countries in Southwest Asia.

The peak season for the sand flies is March through October.

There are two kinds of leishmaniasis - cutaneous and visceral. There have been no cases of visceral leishmaniasis (the more serious infection of the two) detected among patients from Iraq being treated at Walter Reed.

People who get the cutaneous form of leishmaniasis have sores on their skin that may not heal for several weeks. The lesions form weeks after an infected sand fly bites the person. The sores initially appear as bumps on the skin, then form an open, flat, circular sore with raised edges. Sometimes they have a scab and may be tender. If left untreated, the skin sores can last for years and leave permanent scars, but are not life-threatening. Cutaneous leishmaniasis is not contagious.

Visceral leishmaniasis is much more serious, infecting the liver, spleen and other internal organs and may be fatal if not treated.

Since there is no vaccine to protect against leishmaniasis, service members who deploy to areas where there's a chance of contracting the disease are briefed about preventive measures to possibly avoid getting it, said Col. Dallas C. Hack, chief of the Walter Reed Preventive Medicine Service.

These measures include:

* Limiting outdoor activity at dusk and during the evening when sand flies are most active, especially during warmer weather.

* Wearing protective clothing and insect repellent.

* Treating uniforms with permethrin.

* Using permethrin-treated bed netting.

While rare, some forms of leishmaniasis can be transmitted through blood transfusion, medical officials said. There have been no cases of the disease transmitted through blood transfusion in the United States and personnel deployed to Iraq have been deferred from donating blood for one year after departure from Iraq. The deferral, put in place by the Armed Services Blood Program Office, is a precautionary measure to ensure the safety of the blood

supply.

People diagnosed with leishmaniasis are permanently deferred from donating blood. In many cases, it takes two to six months for symptoms of leishmaniasis to show up. Service members returning from Iraq may have been bitten by the sand fly that causes the disease and may theoretically have the parasite in the blood stream, but they may not know it.

(Editor's note: Information provided by Joan Malloy of the Walter Reed Army Medical Center Public Affairs Office and the U.S. Army Medical Command.)

The army's salution to it was to saturate the tents and uniforms in insecticide before they left for Iraq. The only problem with it was that the insecticide made the tents incredibly flamable. The group my husband was with lost all their tents in a fire. This disease if untreated can kill you in about two years is all I remember from it.

The cutaneous form - which is the most common, and the only type our troops have contracted to date - will go away in about two years if not treated. But untreated, it can leave rather bad scars.

The type of leishmaniasis that attacks internal organs can be fatal, but is fortunately quite rare. As I said above, no cases of this type have been diagosed in US troops.

Friends:
I was pleased to note that Colonel David Hackworth has written a column in regards to Leishmaniasis. He has pointed out the Walter Reed Army Hospital, currently is the only facility with complete research available in the USA.
I understand, the VA's Environmental Physicians are prepared to be on the lookout for Leishmaniasis as well.
I still shudder to think only 12% of Iraqi returnees have applied for VA Healthcare.

Cider cut n paste all you desire, you are GREAT!

Dave Barker

Brooke Army Medical Center (BAMC) will soon be treating for leish, using the same protocol as WRAMC - if not doing so already.

This is great for the troops, as many are from the Ft. Hood units.

More places would be doing it (esp. Landstuhl), but there aren't Infectious Disease docs available in enough places. Each treatment location must meet the regulatory requirements for clinical studies (FDA, DoD, etc.).

The other treatment facility referred to is Brooke Army Medical Center, at Ft. Sam Houston in San Antonio.
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WASHINGTON (AP) -- Staff Sgt. Eric DiVona didn't notice the small bumps on his face and left earlobe until he returned from serving nine months in Iraq. Nothing much, he thought, probably just a spider bite.

But soon those bumps erupted into open sores, one growing to the size of a half dollar. The left side of his face puffed up, a swelling that wouldn't go away. And he noticed he was not the only one in his unit with such symptoms.

"A lot of people started coming down with sores," he said, sitting at Walter Reed Army Medical Center with an IV taped to his right arm. "It was like, 'You ain't cool unless you got it."'

What DiVona thought was a spider bite was actually caused by a tiny sand fly with a fierce parasite stewing in its gut, an organism that causes stubborn and ugly sores that linger for months.

Scientists and doctors refer to the disease caused by the parasite as cutaneous leishmaniasis. But soldiers serving in sand-fly rich Iraq call it, with little affection, the "Baghdad boil."

The sores are not painful or contagious, but left untreated they can last up to 18 months and leave permanent, burn-like scars. Since the flies bite exposed areas, many soldiers have sores on their necks, faces and arms.

Doctors at Walter Reed have seen 653 cases of leishmaniasis, and the hospital's infectious disease wards until recently overflowed with soldiers undergoing a 20-day treatment regimen.

"We see a few cases every year, but not the numbers we saw come out of Iraq," said Col. Dallas Hack, chief of preventive medicine at Walter Reed.

The military has made a big effort to treat leishmaniasis, even pulling soldiers out of the field who have confirmed cases and flying them back to Washington for medical care.

But Walter Reed doctors say it was almost inevitable that they would see a high number of cases this year.

Leishmaniasis occurs in hot and tropical countries where sand flies dwell, Hack said. Still, only about 20 soldiers got leishmaniasis during the first Gulf War, and a handful more contracted it in Afghanistan.

This time, though, American forces arrived in Iraq during the peak season for sand flies and were in the field much longer. Many slept outside at night, exposing themselves at the sand fly's favorite feeding time.

Iraqis have also done little to control the problem, such as using insecticide to kill off the flies, Hack said. Local residents have come to accept the disease, he said, exposing young children to sand flies in hopes of building immunity.

Doctors have told soldiers in Iraq what to look for and implored them to wear bug spray. Medical teams with front-line combat troops have tested sand flies for the parasite.

But with enemy bullets flying, the first concern of most soldiers was not slathering on bug spray every morning.

"You didn't think about leishmaniasis too much," said Maj. Eric Moore, who contracted the parasite on the Iran-Iraq border with the 4th Infantry Division.

The lesions will eventually go away on their own and would not affect a soldier's ability to serve. Even so, the military thought it was important that soldiers with bad cases be flown out of Iraq for treatment so they wouldn't be disfigured.

In Moore's unit of about 750 men, more than 200 came down with leishmaniasis during a 10-month tour that ended in March. He was relatively lucky -- he has only one quarter-sized sore on his left arm. Others had lesions all over their bodies, he said.

Moore isn't too worried about scarring. He predicts it will delight his children, especially his 3-year-old, who has a fascination with Band-Aids.

"They will probably think it's cool," he said while getting his daily dose of a drug called Pentostam. "They'll probably say, 'Daddy has an ouchie."'

"For most soldiers, it isn't a war stopper," said Lt. Col. Glenn Wortmann, an infectious disease physician at Walter Reed. "But most patients want treatment so the thing will go away."

Walter Reed is one of only two hospitals where patients are sent because the treatment can only be done in a clinical trial setting. With domestic cases a rarity, Pentostam is not licensed in the United States. However, the Army is developing a treatment that can be used in the field.

Many soldiers didn't realize they had the boils until weeks after exposure. DiVona remembers being bitten constantly by flies, but he and other members of his unit didn't see any sores until after they got home in November to Fort Campbell, Kentucky.



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