Gulf War syndrome update: Gulf War illness, the series of symptoms ranging from headaches to memory loss to chronic fatigue that plagues one of four veterans of the 1991 Persian Gulf war, is due to damage to the autonomic nervous system, a study released Nov. 26 shows.

“This is the linchpin,” said the study’s lead author, Robert Haley, chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas. “The disease itself is so difficult to express and to understand,” Haley said, explaining that veterans described simply that they “don’t feel well” or “can’t function,” without being able to further explain a disease that affects the automatic functions of their bodies, such as heat regulation, sleep or even their heartbeats. “Docs don’t know what the disease is, so they can’t help,” Haley said. “But if you can figure out what the disease is, the other problems will fall in line.”

Researchers spent 15 years researching a hypothesis, and then “we planned the ultimate study that proved that hypothesis,” Haley said. Along with Steven Vernino, chief of the neuromuscular division at Southwestern, Haley sent 97 veterans through 25 tests, including brain imaging, in seven days. The group had been drawn from a sample of 8,000 Gulf War veterans.

“Veterans have high faith in Dr. Haley’s dedicated and informative research,” said Paul Sullivan of Veterans for Common Sense and a Gulf War veteran.”This finding is important because for the first time physicians who care for Gulf War veterans now have a medical explanation for many of the unusual symptoms.”

The team conducted several studies, and then built a theory based on the results of that work. The doctors had funding from Congress until 2010, when they were dropped by the Department of Veterans Affairs after being accused of wasting millions of dollars in research money. That came directly after a 2009 study from Haley showed that neurotoxins such as anti-nerve agent pills, insect repellent and the nerve agent sarin caused neurological changes to the brain, and that the changes seem to correlate with different symptoms.

After they lost funding, Haley and the other researchers continued their work on their own time. For years Gulf War veterans have been told the symptoms were all in their heads, which Haley and other researchers say isn’t true. There is no known treatment for Gulf War illness, Haley said, but a diagnosis can lead to clinical trials and a possible solution. Veterans of suffering from Gulf War illness tend to fall in three categories:

• Syndrome 1, or cognitive and depression problems.

• Syndrome 2, or confusion ataxia, which is similar to early Alzheimer’s disease.

• Syndrome 3, or severe chronic body pain.

The disease affects up to 250,000 veterans, according to the Institute of Medicine.

“Knowing the medical basis for a disease focuses the search for specific treatments and makes it possible to test them in clinical trials,” Sullivan said. “If VA continues to be reluctant to fund research, then Congress should hold hearings that prompt VA to do the right thing for our veterans.” (Source: USA TODAY | Kelly Kennedy | 26 Nov 2012)

DoD lawsuit — combat exclusion: Four women and an advocacy group are suing Defense Secretary Leon Panetta, alleging that the policy excluding women from combat units is unconstitutional. The combat exclusion policy puts women at a disadvantage and “sends a clear message to the world that women are not capable of serving their country to the same extent as men,” according to the federal lawsuit filed Nov. 27 in California.

Major Mary Jennings Hegar, a combat helicopter pilot in the California Air National Guard; Staff Sgt. Jennifer Hunt, a civil affairs soldier in the Army reserves; Capt. Alexandra Zoe Bedell, a logistics officer in the Marine Corps reserves; and 1st Lt. Colleen Farrell, an active-duty Marine air support control officer, are the plaintiffs in the suit, along with the Service Women’s Action Network. They are represented by the American Civil Liberties Union, the ACLU of Northern California and the law firm Munger, Tolles & Olson LLP.

Hegar said she knew she wanted to be an Air Force pilot at a young age and has proven she can do the job. “The ability to serve has very little to do with gender,” she said. “It has everything to do with heart, character, ability, determination and dedication. This policy is a disservice to those women who put their lives on the line for their country.”

All four women have deployed to Afghanistan, and two were awarded Purple Hearts. Hegar was awarded the Distinguished Flying Cross with Valor for her actions after her helicopter was shot down in 2009 during a casualty evacuation mission. The lawsuit alleges that all the women’s careers have been limited by the policy. It also alleges that male and female Marines were put into more danger than necessary because of a policy related to the exclusion that required Female Engagement Team members to return to a main forward operating base every 45 days, instead of staying with the combat units they served. [Source: Stars and Stripes | Jennifer Hlad | 27 Nov 2012]

Traumatic brain injury update: The hunt for brain injury treatments has suffered a big disappointment in a major study that found zero benefits from a supplement that the U.S. military had hoped would help wounded troops. The supplement is marketed as a memory booster online and in over-the-counter powders and drinks. It is also widely used by doctors in dozens of countries to treat traumatic brain injuries and strokes, although evidence on whether it works has been mixed. U.S. scientists had high hopes that in large doses it would help speed recovery in patients with brain injuries from car crashes, falls, sports accidents and other causes. But in the most rigorous test yet, citicoline (see-tee-KOH’-leen) worked no better than dummy treatments at reducing forgetfulness, attention problems, difficulty concentrating and other symptoms.

The study involved 1,213 patients, 18 and older hospitalized at eight U.S. trauma centers. They had mild to severe traumatic brain injuries - blows to the head resulting in symptoms ranging from dizziness to loss of consciousness and with complications including brain bleeding or other damage. Half of the patients received citicoline - also known as CDP choline - in pills or in liquid within 24 hours of being injured. The dose of 2,000 milligrams was much higher than used in over-the-counter products and it was given daily for three months. The rest got a dummy treatment, and all were followed for six months. Most patients improved on measures of memory, learning and other mental functions, but those on the supplement fared no better than those given dummy treatment. That suggests their improvement was due to the normal healing process. Seventy-three patients died during the study, about equal numbers in both groups. Zafonte noted that CDP patients with the mildest injuries did slightly worse than those who’d been given dummy treatments. Those results could have been due to chance, but he said they only reinforce the conclusion that the supplement should not be used for traumatic brain injuries.

More than 1 million Americans suffer traumatic brain injuries each year and 53,000 die. Military data show more than 250,000 cases have occurred in service members since 2000, many during the wars in Iraq and Afghanistan. There is no effective treatment for these injuries. Choline is found in some foods including beef liver, eggs and wheat germ. Commercial versions of choline and citicoline are both sold as diet supplements. Lab studies in animals had suggested that high doses of citicoline could help speed recovery from brain injuries, with almost no side effects. Several studies in humans examined citicoline as a possible treatment for strokes but had mixed results. Still, it is widely used in Europe and Japan to treat strokes and brain injuries. The product used in the study is made by the Spanish pharmaceutical company Ferrer Grupo, which makes prescription-grade citicoline.

Dr. Steven Zeisel, a choline scientist and director of the University of North Carolina’s Nutrition Research Institute, said it’s still possible citicoline would work if used in combination with other potential treatments, but to determine that would require another rigorous and costly study. He was not involved in the research. The National Institute of Child Health and Human Development helped pay for the study, along with grants from several universities. The government institute has spent nearly $30 million since 2002 to fund a research network seeking treatments for traumatic brain injuries. [Source: The Tribune | Lindsey Tanner | 20 Nov 2012]

Tricare pharmacy copay update: The House and Senate will decide in the next few weeks how military pharmacy fees will be raised in 2013, a step that arguably will be the most significant taken to date to slow growth in military healthcare budgets. Out-of-pocket costs for military families and retirees who have prescriptions filled in the Tricare network of retail pharmacies depend on final language in the fiscal 2013 Defense Authorization Act. Congress intends to pass a final defense bill by mid-December. The House-passed plan for pharmacy fees could win over Senate colleagues during final negotiations on the bill. It already is more palatable with military associations. It calls for more modest co-pay hikes than proposed by the Obama administration. But it would achieve the same first-year savings by requiring beneficiaries 65 and older to use the Tricare mail order pharmacy program for refills of all maintenance drugs, those that control chronic conditions like high blood pressure and diabetes. Any brand name prescription filled by mail rather than in drug stores or supermarkets saves the department 27 percent, on average, said Rear Adm. Thomas J. McGinnis, chief of pharmaceutical operations for Tricare.

Officially the administration continues back the pharmacy fee increases it unveiled last spring. Prescriptions would remain free on base, and the co-pay for generic drugs would stay at $5 at retail outlets. But the administration plans to raise the $12 co-pay at retail to $26 for brand names on the military formulary. The formulary is the department’s list of approved drugs based on price and effectiveness. The administration also wants to ban retail outlets from filling prescriptions for non-formulary drugs, forcing beneficiaries to use mail order for the most costly brand name medicines. Also the new higher co-pays would climb by $2 more each year until reaching $34 in 2016. After that, they would be adjusted yearly based on overall medical inflation. Co-pays for brand name drugs at mail order also would jump to $26 from $9, for a 90-day supply, and then climb slowly to $34 by October 2016, under the administration’s plan Tricare already has authority to make these changes. The question is will Congress step in and modify the plan. The Senate Armed Services Committee, in marking up its version of the 2013 National Defense Authorization Act, stayed silent on the issue. So unless the bill is amended on the floor next week to interfere with the plan, the Senate will signal Tricare to proceed with planned fee changes.

Last June, the department even published a proposed regulation to do so, and invited public comment. It withdrew the proposed regulation when the House passed in its version of the defense bill with an alternative pharmacy fee plan. The House proposes bumping the co-pay for formulary brand names at retail only to $17 versus $26 proposed by the administration. It also would continue to allow prescriptions for non-formulary drugs to be filled at retail, but would raise the co-pay for these more costly drugs to $44 versus the current charge of $25. More significantly, the House plan would limit future co-pay increases to the annual percentage cost-of-living adjustments to military retired pay. [Source: Military Update | Tom Philpott | 23 Nov 2012]

Flags: The American Legion Post 70 has on hand American flags, all of the military service flags, POW/MIA flags, and S.C. State flags. Contact a member of Post 70 to purchase flags; the cost is $5.

American Legion Post 70: Meeting at 1800 on the third Tuesday of the month. For more information, please contact Thomas Crisp at 940-2793.

American Legion Post 24: of Newberry, meeting is on the second Tuesday of the month at 1830.

The American Legion Auxiliary – Unit 24 meets the same day at 3 p.m. at Post 24.