Honoring the Health Sacrifices of Our Veterans

VETERANS-DAY-poster-2012On Veterans Day, America pauses to honor every service member who has ever worn one of our Nation’s uniforms. Each time our country has come under attack, they have risen in her defense. Each time our freedoms have come under assault, they have responded with resolve. Through the generations, their courage and sacrifice have allowed our Republic to flourish. And today, a Nation acknowledges its profound debt of gratitude to the patriots who have kept it whole.

As we pay tribute to our veterans, we are mindful that no ceremony or parade can fully repay that debt. We remember that our obligations endure long after the battle ends, and we make it our mission to give them the respect and care they have earned. “

These two paragraphs are taken directly from the 2013 Veterans Day Presidential Proclamation.

But getting Veterans the care they deserve is not always easy.  The wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they’ve left the battlefield, veterans face a multitude of health troubles either unique to their service or more frequent among them than the general population.

Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder. They include nonspecific symptoms such as fatigue, pain and cognitive disturbances such as memory and concentration problems.

Here are seven of the most commonly seen health conditions confronting veterans:

vetsparade-79576Musculoskeletal injuries and pain

Just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders.  According to a study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain.

Mental health issues

PTSDWhile post-traumatic stress disorder (PTSD) among soldiers has been well publicized, other mental woes can also result from the trauma of war. A study in the journal Archives of General Psychiatry [now JAMA Psychiatry] found that one in 10 Iraq war vets develop serious mental problems, including violent behavior, depression and alcohol abuse. The study found that PTSD or depression seriously impaired daily functioning in 8.5 – 14% of these vets.  Disabling on its own, PTSD is also linked to the development of physical illnesses for veterans as years pass. Researchers from Walter Reed Army Medical Center reported that 54% of veterans with PTSD also had sleep apnea, compared with 20%of PTSD patients in the general population. PTSD in vets is also associated with a greater risk of developing dementia.

Chemical exposure

syria1Research by the American Heart Association found that exposure to nerve agents such as sarin – which can trigger convulsions and death on the battlefield – may cause long-term heart damage in Gulf War veterans. The damage can include an enlarged left ventricle, heart rhythm abnormalities or a reduction in the pumping strength of the heart.

Infectious diseases

Although all military personnel are given routine vaccinations before deployment, veterans suffer disproportionately from certain infections that civilians almost never experience.  They include bacterial infections such as brucellosis, which may persist for years; campylobacter jejuni, which causes abdominal pain, fever and diarrhea; and Coxiella burnetii, which in chronic cases can inflame the heart.

Leishmaniasis, a parasitic disease caused by the bite of a sand fly native to the Middle East, is a particularly brutal condition veterans experience. Those infected suffer weight loss, fevers, headaches, muscle pain and weakness, anemia, and enlargement of the spleen and liver. It can be fatal if untreated, according to the VA..

army-mil-2007-06-28-113715Traumatic Brain Injury (TBI)

TBI, often brought on by a blow or jolt to the head, disrupts brain function and has been called the signature wound of the fighting in Iraq and Afghanistan, according to the National Academy of Sciences. Blast exposures and other combat-related activities put service members at greater risk for sustaining a TBI compared to their civilian counterparts, according to the Defense and Veterans Brain Injury Center.

Common effects of TBIs include cognitive issues such as shorter attention span, language disabilities, and an inability to process information. Vets can also suffer from lack of motivation, irritability, anxiety and depression, headaches, memory loss and PTSD.

However, you choose to mark Veteran’s Day 2013, please remember the sacrifices made by all of our vets and be mindful of the long-term health problems they face. Ladies and Gentleman of the military, we thank you for your service.

SRxA-logo for web

NSAID’s in the News (again)

Medication - Over the Counter - otcLet me start by saying, that despite spending the last 20-something years in or around the pharmaceutical industry, I don’t like taking pills. That said, I’m not particularly partial to pain either. So when my knees or back hurts or I’m doubled over with dysmenorrhea, like many other people, I’ll reach for the ibuprofen.

But that may be about to change. Results from a new, large international study of non-steroidal anti-inflammatory drugs (NSAIDs), showed that high doses of them increase the risk of a major vascular event such as heart attack, stroke or death from cardiovascular disease by around a third.

In other words, for every 1,000 people with an average risk of heart disease who take high-dose ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.

vioxxThis puts the heart risks of generic NSAIDs on a par with Vioxx – the painkiller that U.S. drugmaker Merck famously pulled from sale in 2004 because of links to heart risks.

The study team from Oxford University in the UK, gathered data, including on admissions to hospital, for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.

This allowed them to pool results from 639 trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.

In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.

Researcher, Colin Baigent stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of for long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.

He also warns patients not to make hasty decisions or change their treatment without consulting a doctor.

For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs. They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”

Donald Singer, a professor of clinical pharmacology and therapeutics at Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects.

In the meantime, I for one, will be revising my pain versus pill-popping habit, or switching to naproxen.

SRxA-logo for web

Papal Poor Health

frail Pope On February 11, Pope Benedict XVI stunned the Catholic Church and the world when he announced his resignation by saying he no longer had the mental and physical strength to carry on.

At 8pm local time yesterday, he ended his difficult reign, marking the first time in six centuries a pope has resigned instead of ruling for life.

But what do we really know of his health or that of other popes before him?

The Vatican recently confirmed Benedict had a pacemaker for years, indicating a long-standing heart problem. And his older brother told the press that age had taken its toll.

Other observers have noticed the pope’s reduced energy. The press reported that he was ferried to the altar at St. Peter’s for Midnight Mass Christmas Eve on a wheeled platform and then appeared to doze off during the service.

Pope frailVisiting Mexico last year, he awoke at night and couldn’t locate a light switch in his room, then fell and bloodied his head when he hit the bathroom sink.

Beyond these few facts, we know very little about the health problems that led Benedict to announce his retirement. We don’t even really know if his flagging stamina was the true reason behind his resignation.

And while Pope Benedict XVI might be the first Holy Father to voluntarily resign because of old age and deteriorating health, the papacy has a past medical history of poor health.  According to the history books, these ailments range from depression to gout to cancer.

According to church law, as long as a pope is able to conduct Mass, he can continue in his role even if he is suffering, in pain or even bedridden, as was the case with Pope Alexander VII.

Pope Alexander VII’s surgeon and confessor tried to persuade him not to go before the crowd on Easter Sunday of 1667, but he did it anyway. The pope died three days later, according to author Wendy J. Reardon in The Deaths of the Popes.”

Pope_Clement_XII,_portraitMore than a century later, Pope Clement XIV became known as the pope who drooled and had eyes that “darted in their bulging sockets” as he fearfully clung to walls for fear of a Jesuit assassination attempt. He died after correctly predicting his own death in 1774.

In 1958, Pope Pius XII died after enduring recurring bouts of hiccoughs for five years. At one point, his hiccoughs became so intense, that they tore the lining of his stomach. He died of complications from pneumonia at 82 years old.

Pope John Paul II, was sick until he died on April 2, 2005 at 85 years old. He lived with Parkinson ‘s disease for decades, but he died of cardio-respiratory failure, kidney failure and septic shock.

Death has never been an issue that has worried popes,” says papal historian Anura Guruge,  “Popes talk about no purgatory for popes.” Instead they believe if God is ready for a new pope, he will simply call the current one home to heaven where they will immediately be admitted to God’s house and be in the presence of the Holy Father. Not surprising then, that many popes have gone so far as to express enormous amounts of joy on their death beds.

Emeritus Pope Benedict XVI, was one of the oldest popes when he was elected in 2005 at age 78. In 1991 he had a stroke that reportedly temporarily affected his vision. He fell in 1992 and again 2009. He was also thought to have either arthritis or arthrosis, a similarly painful and debilitating joint condition.

Father Virgilio Elizondo, a professor at the University of Notre Dame in Indiana, said he thinks Pope Benedict XVI made a very difficult but wise decision by resigning. He added that the papacy has a history of unpredictability, and the surprise resignation fits right in.

pope John paulI think when you consider the sincerity of the man, when you consider the weight of the universal church, and the greatest variety of issues affecting the church and the rest of the world, I could see how he could come to that decision,” says Elizondo. “What’s really needed is a younger person with more vigor and up-to-date knowledge about what’s happening. I think that’s the rationality behind this pope.

But not everyone agrees.  “This pope’s resigning is essentially overriding God’s will,” said Guruge. “We had suspected that he had more health issues than had been made public. … A pope resigning is really not the right thing to do.”

Pope Benedict XVI was just 73 days away from being the third oldest pope. However, he will remain the fourth oldest pope because his resigned before his 86th birthday. The three older popes were Pope Clement X, who lived to be just over 86 years old; Pope Clement XII, who lived to be 87; and Pope Leo XIII, who before his death at 93 was known as the “eternal pope” because he kept on living! Back then, it might be argued, the job was less demanding because the pope didn’t have to be on television or travel the world or tweet.

SRxA-logo for web

Ho Ho Ho: health hazards for Santa

santa_claus obesityAfter weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

santa + sackBut even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Santa beardThen there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

SRxA-logo for web

Take up your bed and walk!

For years, “rest” – generally meaning a few days to a week in bed – was the standard prescription for acute low-back pain.  More recently, doctors have started counseling back pain patients to stay as active as they can.

The latter approach has now been confirmed by a new Cochrane Library review. According to Kristin Thuve Dahm, a researcher at the Norwegian Centre for the Health Services and lead author of the review, “Normal daily activity seems to be the best way for patients with low-back pain to get better.”

The review directly compared bed rest and staying active, in patients with and without sciatica (low-back pain accompanied by signs of nerve compression or damage, causing numbness, tingling or weakness in the leg).

The comparison between bed rest and normal activity for low-back pain without sciatica used data from three studies that included 481 patients. All three found improvements in pain intensity with both treatments, with no significant differences between them. One of the studies, however, involved a highly specific group of patients – young combat trainees who were hospitalized for their back pain – “and thus, it’s applicability to the general population is questionable” the authors wrote.

When the reviews pooled data from the other two studies, the group who stayed active found significantly greater improvements in the ability to function four weeks and 12 weeks after treatment.

In comparing treatments for sciatica, the reviewers analyzed data from two studies of 348 patients. No difference existed in pain intensity, directly after treatment or 12 weeks later, between sciatica patients who received advice to stay active and those whose doctors prescribed bed rest. Similarly, there was no difference between groups in patients’ ability to function.

The available evidence neither supports nor refutes that advice to stay active is better than resting in bed for people with sciatica,” Dahm said. “However, considering that bed rest is associated with potential harmful side effects, we think it is reasonable to advise people with sciatica to stay active.”

Given that back pain is the second leading cause of absenteeism from work, after the common cold, this new advice could have a massive economic impact on society. Estimates suggest that back injuries account for 15% of sick leave, or over 100 million lost days of work annually in the US.

If you have a back pain story that you’d like to share, Word on Health would love to hear from you.