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June 22, 2005

U.S. wars and post-traumatic stress disorder

While post-traumatic stress disorder (PTSD) was not officially recognized as a clinical condition until 1980 -- it was called "battle fatigue" or "shell shock" in wars prior to Vietnam -- there have been studies of the symptoms in earlier conflicts.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/06/22/MNGJ7DCKR71.DTL&type=health

U.S. wars and post-traumatic stress disorder
Jack Epstein, Johnny Miller
Wednesday, June 22, 2005

WORLD WAR II
-- The National Center for Post-Traumatic Stress Disorder estimates that one of every 20 World War II veterans suffered symptoms such as bad dreams, irritability and flashbacks.

-- According to Department of Veterans Affairs' statistics in 2004, 25, 000 World War II veterans were still receiving disability compensation for PTSD-related symptoms.

-- Studies suggested that the most poorly treated prisoners of war had fewer symptoms than front-line soldiers because the prisoners were no longer in a position where they had to kill.


KOREA
-- While there are no major studies readily available, a Korean researcher claimed that as many as 30 percent of U.S. troops who fought in Korea and are still alive today may have symptoms of post-traumatic stress disorder.


VIETNAM
-- 15.2 percent of all male veterans (479,000 out of 3,140,000 who served in Vietnam) and 8.1 percent of women (610 out of 7,200) were diagnosed with post-traumatic stress disorder in a 1986-1988 study by the National Vietnam Veterans Readjustment Survey (NVVRS).

-- Almost half of all male Vietnam veterans suffering from PTSD had been arrested or in jail at least once, 34.2 percent more than once and 11.5 percent had been convicted of a felony, according to the same survey.

-- VA statistics in 2004 showed that 161,000 veterans were still receiving disability compensation for PTSD.

-- A major VA study found that about 31 percent of men and 27 percent of women had suffered from PTSD at some point after their return from Vietnam.

PERSIAN GULF WAR, 1991

-- According to a 1996 study in the Journal of Traumatic Stress, rates of PTSD are generally lower among Gulf War veterans than among military personnel from prior wars, perhaps due to lower levels of exposure to combat.

-- A 1999 study by the Journal of Consulting and Clinical Psychology found that rates of PTSD in Gulf War veterans increased significantly over time, with a rate of 3 percent for men, 8 percent for women immediately upon return from the war, climbing to 7 percent for men and 16 percent for women followed up 18 to 24 months later. Approximately 697,000 service members were deployed to the Persian Gulf.


AFGHANISTAN
-- A recent study showed that 18 percent of 45,880 veterans were diagnosed with psychological disorders, including 183 with PTSD.


IRAQ
-- According to a 2005 VA study of 168,528 Iraqi veterans, 20 percent were diagnosed with psychological disorders, including 1,641 with PTSD.

-- In an earlier VA study this year, almost 12,500 of nearly 245,000 veterans visited VA counseling centers for readjustment problems and symptoms of PTSD.

-- The Marines and Army were nearly four times more likely to report PTSD than Navy or Air Force because of their greater exposure to combat situations.

-- Enlisted men were twice as likely as officers to report PTSD.

-- 8 percent to 10 percent of active-duty women and retired military women who served in Iraq suffer from PTSD.

-- Studies show that U.S. women serving in Iraq suffer from more pronounced and debilitating forms of PTSD than their male counterparts.

-- A Defense Department study of combat troops returning from Iraq found 1 in 6 soldiers and Marines acknowledged symptoms of severe depression and PTSD, and 6 in 10 of these same veterans were unlikely to seek help out of fear their commanders and fellow troops would treat them differently.

-- A 2003 study published in the New England Journal of Medicine said about 1 in 6 soldiers returning from Iraq suffered from PTSD. Interviews with those at risk showed that only 23 percent to 40 percent sought professional help, most typically because they feared it would hurt their military careers.

Source: Department of Veterans Affairs; New England Journal of Medicine, Defense Department, National Center for Post-Traumatic Stress Disorder, Journal of Consulting and Clinical Psychology, Journal of Traumatic Stress.

Information compiled by Chronicle staff writer Jack Epstein and Chronicle researcher Johnny Miller

June 20, 2005

2nd ANGLICO takes flight

MARINE CORPS BASE CAMP LEJEUNE, N.C.-- (June 20, 2005) -- Constant deployments, changes of command and relocation of personnel can cause stress upon a unit working hard to spread its wings. For the Marines of 2nd Air Naval Gunfire Liaison Company (ANGLICO), II Marine Expeditionary Force, the tremendous amount of work has paid off.

http://www.usmc.mil/marinelink/mcn2000.nsf/ac95bc775efc34c685256ab50049d458/e4c4d0508b9e19c785257026005a972c?OpenDocument

Submitted by: II Marine Expeditionary Force
Story Identification #: 2005620122929
Story by Sgt. Tracee L. Jackson

As little as two years ago, ANGLICO units were a thing of the past. There were artillery regiments, communication battalions and an air support system tailored to the needs of Marines. However, something was missing from what the Marine Corps could contribute to the war effort.

“When we go to war, we don’t go by ourselves,” explained Capt. Robert A. Knauer, firepower control team leader, 2nd ANGLICO. “We go with our allies. We go with the Army and the Navy…our sister services. In order to have a good liaison between all those units, it’s important to have ANGLICO around. It’s why we’re here.”

Staff Sgt. Daniel P. Post, radio technical chief, 2nd ANGLICO, agreed the company is an important asset in the Global War on Terrorism, and the road to recovery after its deactivation in 1999 has been a worthwhile endeavor.

“I started out with nothing, and now my shop has grown enormously,” said Post. “We have lots of stuff coming in compared to a year ago.”

Knauer noted an expansion in manpower that substantially increased the capabilities of the company.

“The unit has doubled in size and has two to three times the equipment it had last year. It’s very healthy right now,” said Knauer.

Having the latest and greatest in equipment is good news to any team headed into the fight, but with this asset comes the responsibility of staying technically and tactically proficient. For Maj. Walter E. Finney of Missoula, Mont., 2nd ANGLICO rear detachment officer in charge, this means his Marines need constant training, formal schools and qualifications to stay at the front of the pack in tactical air support.

“Because of the number of schools we have to go to, as well as the additional training that has to be locked on and coordinated with other units, we need to make sure we hit all the wickets along the way,” said Finney. “We’ve gotten a lot of new technology in the last six months. A lot of people haven’t really used that yet. Basically, it’s a mastery of the various communications systems.”

ANGLICO Marines are the top-notch communicators when it comes to calling in air support, and this means Marines assigned with the unit can attend jump, Survival Evasion Resist Escape and Tactical Air Control Party schools to ensure ANGLICO Marines provide high-speed support wherever needed. A rigorous training schedule ensures units in the field can bring their high-tech communicators with them, regardless of what it takes to get there.

The defining factor that sets ANGLICO apart from an ordinary fire support unit is their ability to direct fire support for coalition forces as well as allied countries. The variances in aircraft, such as fixed and rotary wings, mechanics and lingo make it necessary for ANGLICO Marines to speak a uniform language when telling aviators where to send their punches.

Lance Cpl. Jordan M. Ham, an artillery observer , explained the “nine-line” system of talking to aircraft keeps all involved parties on the same page.

“The nine-lines are a format to get pilots to direct fire where it is needed,” said Ham, “The format tells the aircraft where to start, heading direction, distance and description of the target, where friendly forces are located, and which way to egress.”

“All the coalition forces understand this format when calling in fire. They can plug in the information we give them into coordinates and find their target,” said Lance Cpl. Antonio J. Castillo.

The technicalities of speaking an international language to win wars takes some getting used to, which is why practice exercises are so important.

1st Lt. David P. Snipes, an infantry officer with 14 years of military experience, noted ANGLICO verbiage formalities try to eliminate room for misunderstanding.

“We talk a little different on the radio,” said Snipes, “It’s more natural the more you work at it. It forces you to do it the right way, which is going to cause less confusion. We’re doing everything the way you’re supposed to do it, like giving direction, distances and make sure they know where we are.”

Breaking down air support requests enables ANGLICO Marines to talk to any aircraft, anywhere, and have the aircraft know in no uncertain terms the location of a target. This kind of proficiency is what makes ANGLICO the cream of the crop for calling air support, and they show it with pride.

“I could have gone anywhere,” said Snipes, “I could have sat behind a desk or something else, but I enjoy the tactics we use.”

Knauer expressed enthusiasm for the future of the ANGLICO program.

“It’s a very healthy program,” he said, “Air support is important. With the current conflict in the middle of the desert, it’s not so much naval gunfire, artillery or mortars. It’s in the air, and that’s why it’s very critical.”

Two years ago, most Marines wouldn’t have known much about the unit Post calls “high speed, real fast, and smooth.” Now, ANGLICO is a buzzword in the air support community and unique to the Marine Corps. Commands throughout the Corps are starting to see what Knauer knew a long time ago, “We’re the guys at the tip of the spear controlling air fire.”


June 19, 2005

Proactive Marines place posters, attempt to get community involved

CAMP DELTA, Iraq (June 19, 2005) -- Lance Cpl. Toben Medeiros and Marines of Company I, 3rd Battalion, 8th Marine Regiment passed out leaflets to citizens and posted them on trees and light poles, encouraging them to alert coalition and Iraqi forces of insurgent activity in their city.

http://www.marines.mil/marinelink/mcn2000.nsf/main5/3AD6D2A765B40CDC8525702600158572

June 19, 2005
Story ID#: 200561923554
By Lance Cpl. Athanasios L. Genos, 2nd Marine Division

After the success of Operation Clear Decision, the Marines continue to work with the local community in an effort to keep up citizens’ involvement in reporting suspicious activities or known whereabouts of the insurgents to the Marines and ISF.

Medeiros, led by Sgt. Nicholas W. Jenkins, 1st Squad Leader, 2nd Platoon, moved through the outskirts of the city to hang posters with the same messages to help root out attackers.

“We stopped to put up some posters on a couple of trees and a man came up asking us in broken English if something was wrong and if he could help us,” the 2003 Dartmouth High School graduate said.

“Along with our counter IDF (indirect fire) operations we were putting up the posters to be proactive in getting the community involved in eliminating the insurgents who are placing IED’s (improvised explosive devices) and shooting mortars,” said Jenkins, a Twin City, Ga. native explained.

Medeiros began the patrol as point man for his squad, searching the roads and ditches ahead for improvised explosive devices. He scanned the area for anything suspicious while checking his global positioning system to make sure he was taking the squad in the right direction.

The locals played a large part in feeling out the area to see if there were any indications of insurgent activity in the area.

“It’s like a see-saw, some days it’s good and then the insurgents will get to the people and intimidate them and we go back out passing candy and medical supplies to them, attempting to get them to work with us again,” Medeiros explained.

Though this is Medeiros’ first deployment supporting Operation Iraqi Freedom, this is not the first time he’s deployed. He has a short deployment to Haiti under his belt. In Haiti, he worked in the streets conducting raids, ambushes and regular patrols on a daily basis.

“Haiti was a good stepping stone for us coming here,” he explained. “There’s a lot of good experiences we brought with us, helping us be more prepared for what was to come here.”

Company I, and the rest of the battalion work as much as possible with the Iraqi Security Forces and the local public to help work toward a free Iraq.

“We are working with the local public to stop the everyday attacks that injure civilians and our Marines in an attempt to one day make this country free,” Jenkins explained.

June 13, 2005

Healing by degrees, Troops burned in war find recovery a painful journey, both in mind and body

SAN ANTONIO — While making a turn in his lumbering, 7,500-gallon fuel tanker in a night convoy through Taji, Iraq, last fall, Spc. Justin Burgess swerved to avoid a roadside bomb.


Too late — a fireball erupted outside the truck cab.

http://www.marinecorpstimes.com

By Deborah Funk
Times staff writer


“I just knew I had to stop the truck. … The tanker was full of fuel, so it takes quite a while to stop,” Burgess said.

As he focused on wrestling his big rig to a halt, the next few moments became sheer terror.

“I heard my passenger scream. I was like, ‘What is he screaming about?’ I thought it was over. Then I look over and I see him on fire — then I see myself on fire.”

The cab door had melted shut, so Burgess went head-first out the window and rolled in the dirt.

“I could see my hands and the skin was hanging off. … I could see it hanging off my face,” said Burgess, with the Army Reserve’s 660th Transportation Company out of Cadiz, Ohio.

The bomb that destroyed his truck Sept. 18 marked the first night of a long journey for the 21-year-old reservist from Columbus, Ohio — one that is far from over.

He was whisked to a combat support hospital, then picked up by a medevac helicopter, where he passed out and did not come to until he was half a world away.

Like other service members who suffer burns in Afghanistan, Iraq and elsewhere, Burgess was taken here, to begin months — if not years — of painful treatment and recovery.

Army Lt. Col. (Dr.) Evan Renz, assistant director of the Defense Department’s only burn center, tells patients and their families that they will know the burn team for at least a year.

“It’s a long-term adjustment,” Renz said. “It’s physical, spiritual, mental — all of it.”

Burns are complex wounds. Destroyed skin leaves the body more vulnerable to infection. Heart rate is elevated. Sunlight is felt much more keenly.

“You need more calories. You break things down quicker, you go through electrolytes,” said Army Maj. Louis Stout, chief nurse of the burn intensive care unit, housed at Brooke Army Medical Center.

Hospitalization can be lengthy, lasting just over a day for each percentage point of total skin surface that’s burned. Outpatient rehabilitation can take months, if not years. Routine tasks such as shaving become painful chores.

Burn patients undergo multiple surgeries to remove shrapnel, dead skin and tissue, transfer healthy skin to cover the burned areas and remove scar tissue that restricts movement of their joints or mouths, or pulls at their noses, ears or other burned areas. Some require orthopedic surgery, too.

“It’s not uncommon to have two dozen operations,” Renz said.

‘It’s going to blow!’

With third-degree burns over 40 percent of his body — along with shrapnel wounds — Sgt. Joe Washam has undergone more than 10 surgeries already.

“I quit counting when I was waking up screaming in pain,” said Washam, who needs more reconstructive surgery on his hands and face.

Washam has been at the center for a year, arriving badly injured from explosions at a suspected chemical weapons warehouse in Baghdad on April 26, 2004.

He’d had a bad feeling about that mission. “It was noon, in the middle of the day, and the street was empty when we showed up,” said Washam, who was assigned to the Iraq Survey Group, a U.S.-led outfit that searched for suspected weapons of mass destruction in Iraq in 2003 and 2004.

A team went in to scour the building while Washam waited in a Humvee nearby. Suddenly, he heard screams from inside: “It’s going to blow! It’s going to blow!”

He dropped into his Humvee to grab his protective mask, but before he could get it on, a wall of flame engulfed the vehicle.

He ran away from the flames as explosions rocked the building. Fire burned into his face, back, buttocks and legs and melted his neoprene gloves to his hands. As Washam reached for his 9mm pistol, “the skin on my hands started to peel,” he said.

He and other wounded soldiers were put into a Bradley fighting vehicle. When Washam sat down and saw blood pouring from the side of his buttocks, he realized he’d also taken shrapnel; the pain from the burns had overwhelmed everything else.

An Iraqi ambulance that had rushed to the scene took Washam to a local hospital, where Iraqi doctors stabilized and prepared him for medical evacuation.

Washam passed out in the Iraqi hospital and does not recall his evacuation, the combat support hospital or Landstuhl Regional Medical Center in Germany, all stops en route to intensive care at the burn center in Texas.

“I woke up in ICU,” he said.

Burns to the hands are about the most difficult to work with from a rehabilitative standpoint, because of the complexity of motor skills the hands perform: holding a pen, picking up a paper clip or zipping up pants, Stout said.

Washam still fights that fight, wearing gloves to protect his damaged hands as he works out in the burn center’s occupational and physical therapy room.

A constant struggle

The main goal of occupational therapy is to battle scar tissue and regain as much function as possible. Patients exercise for hours a day to stretch scar tissue and prevent it from restricting motion, said Army Sgt. Kim Platt, an occupational therapy technician.

Along with building strength, patients try to regain the control required to drive a car, fire a weapon or just thread a nut and bolt. They are taught how to be their own therapists; seeing a professional once or twice a day is not enough, Platt said.

Washam does pull-ups to stretch the scars on his arms; Burgess shoots baskets. Both use a multifunctional machine to simulate a variety of actions, from driving a car to using a screwdriver, and do other exercises to regain function.

Burgess has recovered a good deal of strength in his hands, which were burned down to the tendons. He’s also regaining movement in some finger joints, but probably will not get it back in all of his knuckles, he said.

His facial burns restrict how far his mouth will open. He loves the hospital cafeteria’s hamburgers, but must mash the buns to fit them between his lips and teeth.

He talks about future surgeries: lip, nose and eyelid release, probable surgery to smooth scars on his young face and one or two more surgeries on his hands. He guesses he’s had 20 surgeries so far, but like some other patients, he’s stopped counting.

Discomfort is constant, a reminder of the severity of their injuries. On a scale of one to 10, most patients say the pain of being burned is off the scale.

“When I was first burned, I blew 10 out of the water and kept going,” said Army Reserve Staff Sgt. Tony Covell of the 182nd Transportation Company out of Traverse City, Mich.

Covell was riding in a 5,000-gallon fuel tanker that folded in on itself when a roadside bomb exploded Sept. 6 near Baghdad. He suffered third-degree burns to his face, hands, arms and legs.

He’s had eight operations and needs more, but his pain level is down to about a two on the one-to-10 scale, he said.

Psychological scars

Burn patients’ wounds are not just physical; they also have emotional pain to confront.

“A lot of people who get facial burns have to figure out who they are,” Covell said. “Their identity is taken away. Everybody has to learn to deal with it in their own way, and the people around them need to be supportive.”

Strangers often stare at people scarred by burns, especially when the scars are on the face or some other visible part of the body.

Burgess said sometimes he just stares back.

Washam told of a young woman who mistook his burned face for some sort of mask at a Halloween party last fall.

Having such a noticeable health problem — and being concerned about how others perceive them — is a key difference between burn patients and those with other chronic conditions, said Army Lt. Col. Danny Davison, a psychiatric clinical nurse.

Burn scars, with their potential impact on self-esteem, carry a higher probability of post-traumatic stresslike symptoms, Davison said.

He screens and treats patients for PTSD, depression and other mental health problems such as nightmares, anxiety or anger.

The most common problem is difficulty sleeping. Burgess takes a drug to help ward off nightmares, which may make him flail and further injure his hands.

But he still has bad dreams, he said, often waking up to an imaginary explosion.

Marine Corps Sgt. Luis Aranda, 22, also doesn’t sleep well. He catches four to five hours of shut-eye at night and then naps a few hours during the day.

He always feels discomfort, which turns to plain pain when he exercises, such as bending his arm against resistance supplied by occupational therapists such as Maj. Lynn Burns.

Aranda has no nightmares, but now and then when he watches television and sees a car fire or an explosion, his mind flashes back to his last patrol.

“I see it happen,” Aranda said.

He was vehicle commander and assistant squad leader on a patrol outside Ramadi, Iraq, on Feb. 22 when he stopped to check a suspicious-looking box on the road — a well-placed decoy for an improvised bomb that exploded a few feet away, sending shrapnel slicing into his hand and arm and burning his right arm and leg.

After that, “everything seemed like slow motion,” he said.

The power of family

Family support is vital to burn recovery, experts said.

“We can provide the best care in the world,” Davison said. “However, when they wake up, they want to see their mother, they want to see their wife, they want to see those individuals who are important in their life.”

When he arrived at the burn center Sept. 20, Burgess’ mother was already there. She stayed for two months before returning to Ohio. His grandparents also came and stayed until late in the year, when he could feed himself.

“My grandma and grandpa … they fed me lunch and dinner every day,” Burgess said.

Aranda’s family arrived Feb. 25, and his father was still there more than two months later. His mother returned to El Paso, Texas, to care for Luis’ younger brother, but she drives back to San Antonio for weekend visits.

Washam had dated Jennifer, who would become his wife, for four months when he left for Iraq.

After his injury, she huddled with her father and Joe’s family at the hospital.

“It was very emotional,” Jennifer said. “The hardest part was, he couldn’t talk to me.”

Jennifer transferred her job and elementary education studies to San Antonio. “I came down here because I needed him as much as he needed me,” she said.

She helped tend his wounds at night when she got off work. She has been tough on him in rehab, making him do tasks himself.

They were married Oct. 16 and keep an apartment near the hospital campus.

“If I didn’t have Jenn around, I’d be lost,” Washam said.

As an infantryman, he had two plans for how he would return from war: “A-OK, or with a flag draped over my coffin.”

“When I woke up in my hospital bed, for almost a month I was pretty pissed off to be alive,” Washam said. “If I didn’t have her ... I’d still be angry. I would be a train wreck.”

Uncertain futures

As the troops heal, their futures are uncertain.

Burgess studied accounting at the University of Toledo in Ohio before deploying, and talks of picking up his studies.

Covell, a carpenter, worked for a construction company and did residential work on the side prior to his deployment. His employer wants him back, but the extent of his limitations is unknown, and he must work indoors to protect him from the elements, he said.

Aranda wanted to be a Marine since grade school. Now he plans to get out and try something in public safety — a firefighter, paramedic or emergency medical technician — closer to his El Paso home.

As a fallback, he says he’ll study criminal psychology. The Washams have postponed family plans until they see how Joe can earn a living. He takes classes at a community college and thinks about teaching.

Washam would love to stay in the military if he could — and would return to Iraq, he said.

The odds of that are slim; he passed the function test on the M-16 rifle, which made him “ecstatic,” but he can’t do push-ups, climb a rope or even venture out in sunlight. Being unable to rejoin his comrades on the front lines, he said, is “frustrating.”

Washam is coming to terms with likely leaving the military, and is now eagerly looking ahead.

“With what I’ve already dealt with and overcome, the healing process, letting frustrations go, having people care about me … it lets me know that no matter what, I can get over anything,” he said.

“I’m very grateful to be alive. I’ve learned to live every day like it’s my last.”