US Military Casualities: Amputations at Record Numbers

Last summer a report from the Congressional Research Service based on Department of Defense information was sent to Congress detailing the US military casualty statistics in Operation Iraqi Freedom and Operation Enduring Freedom. Twenty percent of soldiers injured have multiple injuries - and may have traumatic brain injury (TBI) as well as traumatic amputations. All most half of the amputations are caused by IED's. These could be prevented if the transportation vehicles our troops are using had undersides designed to bear the impact of this well known threat. The MRAP is one such vehicle that the Marine Corp is now contracted to produce. It has a V-shaped underbelly desgned to protect against underground devices.

Advances in battlefield medicine have saved many combatants who might have died - but is the rehabilitation they receive up to par? The Center for the Intrepid, a $50M rehabilitation center in opened its doors in San Antonio, Texas in January, 2007 to treat the record number of amputees and troops with severe burns. Amputee rehabilitation programs are run at Brooke Medical Center in Texas, Walter Reed Medical Center and Bethesda Naval Medical Center. Housing has been built at Center of the Intrepid for families of the soldiers in rehab. The Center was funded by private donations from 600,000 US citizens, which means the world to the beneficiaries of the services provided. State-of-the-art technology is provided to military amputees including advanced prosthetics, computerized and video monitoring, biomechanical studies and advanced physical therapy methods.

One of these programs is the art program at the Center, a collaboration between the General Services Administration (GSA) and the Fallen Heroes Fund. The art work was chosen to complement the architecture, to remind visitors of the heroes and the sacrifices they have made for the US, and to support the physical rehabilitation programs and motivate participation in extreme sports. The Intrepid Fallen Heroes Fund and the Wounded Warrior Project has also just made available a publication " A Handbook for Injured Service Members and Their Families". The handbook provides information about what to expect, resources available and issues that will crop up. The handbook is available at www.fallenheroesfund.org.

New generation prosthetic devices are being designed by researchers at Arizona State University's Polytechnic campus and the Military Amputee Research Program at Walter Reed Army Medical Center. The Otto Bock C-Leg has a microprocessor knee and was introduced in 1997. It allows the wearer to go up or down hills and slopes and provides greater freedom of movement. Otto Bock also makes a myoelectric hand that is lightweight, compact and responsive.

If you want to get up close and personal with some of the amputees returning from Iraq, watch HBO's Alive Day Memories: Home From Irag from Executive Producer James Gandolfini. The documentary film premieres on September 9, 2007 at 10:30 PM and continues through September 16, 2007. Don't miss it - I have had a chance to see it and it is very moving. These American heroes have sacrificed their health and well being - they don't want us to forget them.

Labels: amputees, HBO, injuries, Iraq, prostheses, veterans, warrior

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Thank you, Susan Palwick, for Grand Rounds 3.49!

Rickety Contrivances of Doing Good hosted Grand Rounds this week and my post, Diary of a Tired Black Man: The Movie, made the Second Cut. Not surprising since the subtitle of the blog is Science Fiction Progressive Christianity and Other Improbable Optimisms. Can't fit in with everyone, now can we?

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The Warrior Archetype and Violence

The Warrior archetype is a fundamental aspect of the human psyche. The Warrior is trained to regulate aggression and violence inherent in our species to defend any threat against his/her safety and well-being and those he/she vows to defend. Physical prowess in defense skills, athletic capabilities, strategies are critical to generating health and vitality, longevity, stamina and courage in the face of danger whether it be on the battlefield or in every day civilian life.

Our culture is oddly ambivalent about the warrior archetype. We venerate Michael Vick and reward him with money, fame and adulation. We worship professional wrestlers, basketball players and have love-hate relationships with people like Barry Bonds, Lance Armstrong and other sports champions who may or may not use performance enhancing drugs. Testosterone is the male hormone that not only determines sexual drive and prowess, but affects the psyche in powerful ways. Testosterone - in men and women - provides the drive to fight, to win, and to win again. Philosopher Ken Wilber calls it the " f*** it or kill it response". Testosterone masks feelings of pain and discomfort, increasing tolerance of pain and allowing men to maintain their stamina in fights, especially when testosterone levels are high. Testosterone dependent secondary sexual characteristics in males also signals to females that the male is healthy in other ways - strong, dominant and possessing immunological toughness.

Blood sports involving the fighting of animals have been with us since antiquity. If you are a fan of Shakespeare, you know that bear-baiting and dog fighting have been entertainment for our species for a long, long time. It continues in some cultures. Many dog breeds have been developed specifically for fighting. In some cultures and countries, dog fighting is still legal, like Latin America, Russia and Japan. Violent competition as entertainment has been enjoyed by humans since the origin of our species. What Michael Vick did to dogs was appalling, cruel and wrong. But in my mind, he himself is a victim. The child of teenage parents raised in a rough neighborhood where dog fighting was part of the culture, his father was never around to teach him right from wrong. People recognized his talent and rewarded him for it. A lot of people made money from his talent. Everyone was happy as his star rose. There were little signs of trouble - flipping off the fans, giving the gift of Herpes 2 to a girlfriend. Then there are the good things about him - donating funds for the support of the families of the Virginia Tech massacre, support of the Boys and Girls Club. Friends know him as a caring person who just loves to fish.

When these gifted athletes fall, they fall hard, and they fall alone. Look at the WWE superstars, Dennis Rodman, Kobe Bryant, Jose Conseco, the list is endless. Maybe the organizations who profit most from these talented but troubled men - like the NFL - should do a better job taking care of their own. Counseling to help young men who grew up poor in the projects who are suddenly wealthy, famous and celebrated adjust to the change in their fortunes and friendships doesn't seem like a lot to ask. While the NFL is busy castigating Michael Vick, maybe it should take a good hard look at itself.

Labels: archetype, champions, dog fighting, Michael Vick, NFL, testosterone, warrior

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REMEMBER SEPTEMBER 9 10:30 HBO: ALIVE DAY MEMORIES:HOME FROM IRAQ

Beginning Sunday September 9 through September 16, 2007 HBO will be airing the very special documentary by Executive Producer James Gandolfini Alive Day Memories: Home From Iraq. I had the opportunity to see the film this weekend and was struck by how unsentimental it is. Filmed on a black, blank stage, Mr. Gandolfini quietly interviews some truly tough men and women about what lead them to enlist in the service (Army or Marines), what they remember about the day they almost died, and the aftermath. There are no cheap attempts to manipulate our emotions. There are no judgments about the right or wrong of war or this war in particular. There are just ten human beings, aged 21-41, unique, full of life, energy, love, ideas, desires, hopes and dreams sharing their stories with Mr. Gandolfini.

Interspersed with the interviews are videos of the servicemen and women at home or at play or in Iraq before they were injured. There are videos of them in the hospitals and rehab centers or dancing after the injuries. Each has a story to tell.

Some of the facts Alive Day Memories: Home From Iraq educates us about:

• 90% of the wounded of this war survive their injuries
• the majority of the wounded cope with amputations, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD)
• this war is seeing the highest percentage of amputees since the Civil War
• 50% of those wounded suffer from PTSD
• 33% of the injured suffer from TBI
  

Mr. Gandolfini calls them "True American heroes." And as HBO has observed, their fight has just begun. For the 30,000 wounded troops among us, and no doubt many more who will return to our shores, we need to rally round them, and help them with this fight. Watch this movie to gain a better understanding of their struggle.

See previous posts: War of Disabilities: HBO's Alive Day Memories: Home From Iraq Tells the Stories
Home From Iraq: HBO, James Gandolfini Focus on New Veterans

Labels: amputees, Gandolfini, HBO, Iraq, PTSD, TBI, veterans

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New Orleans: Two Years After the Levees Failed

HBO has been running When the Levees Broke: An American Tragedy hands down Spike Lee's most important work to date, in my opinion. I got just as angry watching it this time around as I did as it unfolded in 2005. The burning question that haunts me - how many dead remain unaccounted for? What are their names? Will we ever know? Columbia University's Earth Institute lists 595 missing with 84 Jane/John Does among the deceased. The majority of the victims were black males. In 1989, the US Government decided to invade Panama, or specifically, Panama City. The residents of Chorillo, a shantytown of 15,000 poor residents surrounding Noriega's National Defense Forces were of particular concern to the US and business interests in Panama. (See Alma Guillermoprieto's The Heart that Bleeds Knopf 1994 for the full story. It's fascinating). Like New Orleans 9th Ward or the Casbah in Algiers,
the Chorillo was a colorful patchwork of housing where service workers, construction workers, prostitutes and pimps lived. Seven hours after the US invaded Panama, the ordered the evacuation of the area, herded people into a sports stadium operated by US emergency relief personnel where they spent days in the hot sun. The Chorillo was consumed in flames, and when the poor returned home they had nothing left, except, as in New Orleans, Noah's Ark.

Without CNN's coverage of the debacle, we might not have known anything. The pictures of bloated bodies floating down the streets of a major American city - bloated black bodies - is something I am so ashamed of I haven't ventured out of the country since. Maybe I never will again.

New Orleans has received a federal grant of $100 million dollars to expand the network of primary care clinics in the area. Jackie Judd of the Kaiser Family Foundation interviewed Clayton Williams, Director of the Institute for Urban Health Initiatives who is responsible for administering this grant. It is a three year grant to try to stabilize the existing providers in the area. Everyone seems to be expressing "shock" at how slow the response is at the federal level to respond to the needs of people in the region - two years on.

• Unknown number dead
• 780,000 displaced
• almost all suffered emotional trauma or depression but few received services
• the elderly and children were especially vulnerable to psychological trauma
• the health care system in New Orleans is crippled
• those without insurance are going without care
• survivors have difficulty focusing on health care because their basic survival needs are still not being met: food, shelter, transportation
• the loss of connection with family and friends is particularly traumatic for survivors. Mr. Lee's film showed that there was little attempt to keep families and loved ones together in the aftermath of the storm and children were taken forcibly from the parents. One man described how he was forced, at gunpoint, at AK-47 gunpoint, to leave his dying mother behind. In America. In 2005. He never was given the chance to say goodbye.

Volunteers at the National Center for Missing and Exploited Children (NCMEC) worked around the clock for six months to reunite 5,192 children with their families. On March 17, 2006, a four year old girl - the last of the missing children- was reunited with her family following the worst public disaster in American history. The Center also solved 4,000 adult cases.

Labels: grants, levees, New Orleans, primary health care, stadium

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American Psychological Association Continues to Participate in Interrogations

The APA voted to reject a measure that would have banned its members from participating in interrogations. However, they did approve a resolution prohibiting participation in 14 specific methods:

• sexual humiliation
• sleep deprivation
• mock executions

In 2006, doctors and psychiatrists agreed to come out completely against participation in interrogations, leaving only psychologists as the sole health professionals providing what the Bush Administration calls medial supervision of same. According to Mark Benjamin, national correspondent for Salon.com who has been following this story, the CIA, under guidance of psychologists, has honed the ability to make people hallucinate and have their sense of identity break down within 48 hours.

Observers at the APA convention have reported a very heated debate between supporters and dissenters of the programs. One very disillusioned APA Interrogation Task Force Member, Dr. Jean Maria Arrigo, tells her side of the story in a Democracy Now transcript. Another dissident, Dr. Michael Wessells, has resigned from the Task Force due to the activities and operating outside of the Geneva Convention.

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Thank you Med-Source for Grand Rounds 3.48!

Med-Source: Resources for Medical Students presented a special Back to School Special for all health professional types returning to school. They included my interview with Dr. Hoskins at AAO GetSmart: EyeSmart!
Check out Grand Rounds if you want to brush up on many more subjects of interest...

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War of Disabilities: HBO's Alive Day Memories: Home From Iraq Tells the Stories

Penetrating wounds from improvised explosive devices (IED) create unique patterns of injuries that are challenges for clinicians and rehabilitation professionals. An upward oblique trajectory through the neck region, coupled with chest wall and lung contusions is often seen. Extremity injuries present with extensive comminuted fractures and traumatic brain injury (TBI) due to combat appears to be associated with increased cerebral edema as compared with civilian TBI.

IED's are easily assembled from agricultural and medical supplies. Activated by remote control, they combine blast, fragmentation and armor penetration. Often grouped as "daisy chains ", inflicting damage on the underside of multiple military patrol vehicles and, using time delay, the rescue teams as they rush to help the wounded. IED's then, are an illusive battlefield threat generating deadly blast effect injuries. A wavefront of high pressure spreads out at1600 feet per second from the point of explosions, propelling shrapnel at high velocity. Ballistic trauma injuries, or penetrating brain injuries, are treated conventionally. But blast waves cause invisible brain damage, smashing the soft brain tissues against the hard inner skull. Neither helmets nor body armor can protect against the forces of high pressure wave blasts which can result in loss of consciousness, severe concussion, blindness and other neurological deficits.
1800 US troops are suffering from TBI due to penetrating head injuries but there are concerns that there may be many more suffering TBI due to blast waves from TBI. TBI has become "the signature wound of troops returning from Iraq".

Military records indicate that 60% of military injuries are due to IED's or roadside bombs. According to Defense Update International, Online Defense Magazine, the Iraq war, now in its fifth year, is not a war of death but a war of disabilities. David Eschel states the symbol of the war is not the cemetery, but "...the orthopedic ward, the neurosurgical unit..." Executive Producer James Gandolfini looks at a new generation of war wounded in his upcoming HBO feature documentary, Alive Day Memories: Home From Iraq. The film premieres September 9, 2007 at 10:30 PM and can be streamed beginning Sunday 9/9/07 at 111:30 PM EST through 9/16/07 at 10:30 PM.

Thank you, Google images and mindhacks.com for use of image of Iraq IED.

Labels: blast injury, combat, defense, Gandolfini, HBO, IED, veterans

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Psychologists for an Ethical APA Protest Torture

The American Psychological Association (APA) holds its annual convention in San Francisco August 17-20, 2007, but a group of psychologists is breaking ranks, claiming use of torture a violation of ethical principles. Psychologists for an Ethical APA protests the APA's condoning its members participation in coercive interrogations in Guatanamo and other detention centers, in clear violation of the Geneva Convention. These psychologists are withholding their dues to protest violations of the APA's own code of ethics.

Katherine Eban, reporting for Vanity Fair, delved into the murky practice of "psychic demolition" in her brilliant July 2007 piece, Rorshach and Awe. Every other organization of health care professionals has come out refusing to participate in torture except the 148,000 member APA. Eban wanted to learn why psychologists were participating in military interrogations. In 2005, an APA Task Force decided, against the objections of some of its members, to adopt the (Donald) Rumsfeld definition of "humane treatment". The US military is one of the largest employers of psychologists, according to Eban's article. She learned that psychologists designed the CIA tactics of interrogation, including waterboarding, forced nudity, extreme temperatures, sexual and religious humiliation, agonizing stress positions and trained interrogators under contract to the CIA. (Bourne Ultimatum redux?)

Two psychologists worked in the Survival, Evasion, Resistance, Escape (SERE) program: devout Mormons James Elmer Mitchell and Bruce Jessen. An Air Force intelligence expert was "astonished" that clinical psychologists with no intelligence training were turned loose on interrogating suspects in "the real world". SERE trainers then realized they had a marketable commodity - survival training industry - for corporations and government agencies who send employees overseas. Critic John Sifton of Human Rights Watch accuses the pair of psychologists of "offering the CIA and military officials a patina of pseudo-science..." making it appear they could unlock the human mind. Director of Physicians for Human Rights (PHR), Lawrence Rubenstein says it most succinctly, "...ambition to help national security is no excuse for throwing out ethics and science..." PHR has made its position clear - " those who authorize and use CIA enhanced interrogation tactics risk criminal prosecution." CIA memos indicate psychologists are used at interrogations to make violent, dangerous situations "safer".

Dissenting psychologists are demanding a vote on a moratorium against these abysmal practices at the convention. We'll be watching and waiting.

Thank you ManilaRyce for use of photo! DOD photo released 12/02

Labels: APA, ethics, psychology, torture

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Home From Iraq: HBO, James Gandolfini Focus on New Veterans

Depression is a serious problem for returning veterans of the Iraq war and their needs are going unmet. Returning veterans report feelings of alienation from their homes and families. The psychological problems, be they depression or post-traumatic stress disorder (PTSD) are creating havoc in family life, with almost half of veterans reporting family conflict or other relationship troubles upon returning from service.

The Veteran Resources Website has rich resources for family members concerned about loved ones with signs of mental illness or distress. That's just not enough though to prevent the alarming public health crisis that is the high suicide rate found in returning veterans. Mark Kaplan MD of Portland State University, has published a study finding that male veterans are twice as likely to commit suicide as civilian males. Oddly, being overweight seemed to confer protection against suicide by 50%. Dr. Kaplan states that being a veteran is a risk factor for suicide, especially for males.

Last week the Pentagon was forced to acknowledge that the suicide rate among returning veterans is the highest it has been in 26 years. Morale is extremely low, troops report little faith in their commanding officers. Problem relationships, legal and financial problems upon returning home are the reasons cited for suicide. "...there was a significant relationship between number of days deployed...and limited evidence to support the view that multiple deployments are a risk factor for suicide behaviors..."


The biggest threat to troops in Iraq and Afghanistan is improvised explosive devices (IED). Experts describe a mind set needed of constant vigilance - no place is safe. There is no safe haven. There is no down time. Devastating injuries from the war are the focus of a new HBO film by Executive Producer James Gandolfini, Alive Day Memories: Home From Iraq.
In this new documentary which first airs September 9, 10:30 PM exclusively on HBO, Gandolfini interviews 10 veterans about their "alive day" - the day they suffered devastating injuries and lived to tell about it. Healthline will be featuring more posts about this event as we approach the date. We are honored to help HBO promote the important message of the film.

Thank you Cpl. Joseph DiGirolamo for use of photo of Lance Corporal William A. Staley while stationed in Iraq, 5/2006.

Labels: depression, Gandolfini, HBO, IED, PTSD, suicide, veterans

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GetSmart: Eye Smart!

H. Dunbar Hoskins, Jr. MD FACS, Executive Vice President of the American Academy of Opthalmology (AAO), was kind enough to spend some time with me today talking about Eye Health. AAO has two important programs Dr. Hoskins wants Healthline readers to know about:

• EyeSmart Campaign:
• 2020 means perfect vision to most of us, but did you know it is also the year that 43 million Americans face significant vision loss or blindness as Baby Boomers become seniors?
• AAO wants to get the word out: age 40 is when we should all start getting checked for
  
• glaucoma : did you know that 50% of people with glaucoma don't know they have it?
  
• cataracts
  
• dry eye
• macular degeneration
• diabetic retinopathy: diabetics should all be getting their eyes checked annually as part of their HEDIS evaluation but they aren't. AAO wants to urge all diabetics to get their eyes checked every year!

• EyeCare America:
• is a Foundation of the AAO whose mission is to preserve sight by promoting access to care. Dr. Hoskins says that Medicare does a good job of covering opthalmologic illnesses, but if we really want to urge early screening at age 40, a lot of people at risk do not have coverage. EyeCare America has Volunteer doctors, sorted by zip code, who have agreed to provide free eye care to people in need! Visit their website or call 1-800-222-3937 for seniors, 1-800-626-6733 for children.
• August is Cataract Awareness Month and AAO is encouraging seniors with low vision to take advantage of this program and get a referral to an eye specialist. Maybe you or your loved ones don't need a new pair of glasses! Maybe you need an eye specialist! Studies are showing that sharp vision helps keep the mind sharp, too. Don't lose sight of what's important to you...65 is getting younger and younger as people live, work and love longer.
  

Thanks so much to Dr. Hoskins and all of the wonderful folks at American Academy of Opthalmology for their time and contributions to Eye Health in the US!

Thank you natala007 for use of retinal photo 2.

Labels: Dr. Hoskins, eyes, glaucoma, opthalmologist

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South Asia Monsoon Creates Staggering Health Crises

"Bangladesh, Nepal, India and Vietnam have been devastated by flooding, creating health crises effecting 30 million people. Children, comprising 40% of the area population, are particularly vulnerable. People have lost shelter, access to clean water, transportation, health care, sanitation and food. The size of the area affected, the scale of the flooding, the number of people who are vulnerable pose an unprecedented challenge to relief agencies like UNICEF.

Emergency assessment and coordination has begun to deliver the following:

• Oral Rehydration Salts (ORS)
• Water purification tablets
• BP-5 nutritious biscuits
• plastic sheets and tarpaulins
• bleaching powder and chlorine tablets
• mosquito nets
• jerry cans
• food
• potable water
• temporary shelter
• buckets
• blankets
• first aid kits
  

Health care problems reported are diarrhea, snake bites, acute respiratory infections, and water borne illnesses.

2007 is proving to be a very busy year for extreme weather around the world - and humans are dealing with adverse health effects. Flooding in Great Britain and Pakistan, heat wave in southeast Europe and China, snowfall in South America. I don't know about you, but I think it's time we stop spending $ on war and arms and spend $ on preventing environmental and health catastrophes.




Thank you Fugu Numb Mouth for use of photo Amidst the Flood (Burma).

Labels: aid, extreme weather, health crises

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Thank You Eye On DNA for Grand Rounds at the Beach

Thank you to Dr. Hsien-Hsien Lei and Eye on DNA for including JC Jones' post "Tony Takes a Trip with a Little Help from a Cactus" on Grand Rounds at the Beach.

Labels: Eye on DNA, Grand Rounds

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Diary of a Tired Black Man: The Movie

A friend of mine, a self-proclaimed tired black man, gave me a copy of a movie to review that is really making some noise. First-time filmmaker Tim Alexander created Diary of a Tired Black Man , a hybrid of documentary and drama as a forum to address what he has termed "Angry Black Woman Syndrome". The film analyzes the breakdown in relationships between black men and women. Alexander hopes to provoke dialog in order to bring healing into the community. An on-line forum has developed in response to the movie, and recently reached the million member mark. The movie has screened in several cities across the US and should be in theaters this Fall.

Why is this important to health? Good Relationships = Good Health for Men. Alexander says that men are looking for respect, kindness, gentleness and peace of mind in relationships.

Maybe everyone would give black men a break if they kept these facts in mind. According to the Men's Health Network:

• Men don't live as long as women do. By age 100, women outnumber men 8:1
• Men are employed in high-risk occupations (mining, fire-fighting, fishing, logging, construction)
• Men are less likely to have health care coverage
• Because of disparities in health care coverage of black males, they have a 60 % higher risk for developing prostate cancer than white males, and dying from the disease.
  
• Black men have a 1 in 30 risk of being a homicide victim as opposed to white females whose risk is 1 in 495
• 55 % of black men earn less than $40,000 year, while only 23% of white males fall into that income category
• Twice as many men die of cancer and heart disease than women
  
• Black females have a life expectancy of 76 years, black males: 69 years.

Black men have good reason to be tired. We are overdue in giving them what they ask for - respect, kindness, a raise and some peace of mind.

Labels: Black men, health disparities, life expectancy

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Thanks David E. Williams of Health Business Blog for Grand Rounds 3.45!

Co-founder of MedPharma Partners LLC, David E. Williams, writes a great blog at Health Business Blog. He hosted Grand Rounds this week and was kind enough to include my post, Shot through the Heart: Dr. Carmona, Nation's Doctor along with many other enlightening posts. Get a tall glass of iced tea and take a peek...

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