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Two Studies Look at Gulf War Illness; Causes, and Treatments
By Douglas J. Gillert
American Forces Press Service
WASHINGTON -- The Defense and Veterans Affairs departments are conducting
two new studies on the possible treatment of illnesses reported by thousands
of Gulf War veterans.
One of the studies is focusing on mycoplasma, tiny bacteria that some
scientists and physicians think could be the root cause of many of the
symptoms veterans have reported. The second, more complex study aims at
changing behavior patterns to alleviate disease symptoms and improve the
quality of Gulf War veterans' lives.
The Naval Health Research Center in San Diego and Walter Reed Army Medical
Center in Washington represent DoD in the studies, which also involve 28 VA
medical centers. Participants are all veterans of the Gulf War and
volunteers who know they're sick but don't know why.
Between 80 and 85 percent of Gulf War veterans who have sought health care
have been successfully diagnosed, according to Army Dr. (Lt. Col.) Charles
Engel, chief of the Gulf War Health Center at Walter Reed. (Between 15 and
20 percent remain undiagnosed.)
"That's a real dilemma in medical care, because physicians use diagnosis to
tailor treatment," Engel said. "If you don't have a diagnosis, you don't
know what to do for the patient." (Fifteen to 20 percent)
A Gulf War veteran himself, Engel knows well the biological and other
exposures service members faced there, such as oil well fires and kerosene
lanterns burned inside tents.
"These are things I was exposed to as well," he said. "Thus far, science
hasn't given us complete information about the relationship of those
exposures to the illnesses that Gulf War veterans experience and similar
illnesses people in the general population experience. It's frustrating --for the doctors and the Gulf War veterans."
If mycoplasma is the culprit for at least some of the reported illnesses, a
common antibiotic used to treat teen-age acne could be the cure. During the
mycoplasma study, participants will receive either the antibiotic
doxycycline or a placebo. To qualify for the study, participants must suffer
from what scientists call "chronic multisymptom illness" -- a combination of
fatigue, pain and memory disturbance.
"We want to develop a sense of how people on the antibiotic do compared to
those who don't get the antibiotic," Engel said.Mycoplasma exist inside and outside human cells, similar to viruses.
Doxycycline attacks and kills the bacteria. The study should prove whether
the bacteria are behind veterans' ailments.
"The antibiotic trial represents an opportunity to look for a good,
off-the-shelf, readily available treatment for many veterans who are ailing
with chronic symptoms," Engel said. "If the study is negative, it can also
provide some relatively compelling information that perhaps symptoms are not
being caused by this organism.
"Positive or negative, the results will be useful to the Gulf War veteran
community and to the scientific community."
Some 450 veterans from all service branches are participating in the
mycoplasma study.
Meanwhile, more than 1,400 veterans are helping doctors understand the
relationship their lifestyles have on their illnesses. Lucille Mitchell, a
former Air Force nurse who suffered symptoms similar to Gulf War veterans
and eventually got help at Walter Reed helped to set up the behavioral
clinical trial there.
Rather than offering a cure, which is impossible until doctors know the
origin and cause of the veterans' illnesses, the study will help veterans
learn to cope with their pain and suffering, Mitchell said. The program's
goal, she said, is to help the veterans purge negative thoughts and
lifestyles in order to cope with their illnesses.
An exercise physiologist is evaluating participants to learn their physical
limitations, then designing individual exercise programs, Mitchell said.
"We don't want to discourage them but build a program that will help them
improve their exercise activity," she said.
A psychologist will train the veterans to control pain with relaxation
techniques and other strategies, Mitchell added.
"Quality of life is what's so important to people who are suffering,"
Mitchell said. "So we want to give them more quality of life by allowing
them to take more control of their lives."
Both the mycoplasma and behavioral studies at Walter Reed are open to more
volunteers, Mitchell said. She said people wanting information about either
program should call the hospital at (202) 782-6563 or DSN 662-6563. More
information about these and other Gulf War illness initiatives is available
on the Internet.
"There's a lot of misinformation and misperception about Gulf War
illnesses," Engel said. "We have a Gulf War illness health literature
database on the Web that is available to anyone at
www.wramc.amedd.army.mil/departments/gulfwar
We teach [the veterans] how to use it and the nuts and bolts of reading an
article out of the medical literature and out of the medical news media --how to decide whether the article is believable."
The veterans also learn to be good health care consumers, Engel said.
"A lot of people with chronic illness don't understand that there are seldom
good, clear-cut answers to chronic illness. What they're left with are
rehabilitative strategies that involve life style changes."
Unfortunately, Engel said, many people suffering chronically become victims
of the medical system. "In their quest for answers, they see a lot of
physicians, get a lot of diagnostic tests. All the tests and medications and
referrals they get are well intended, but also need to be well coordinated
by physicians. Otherwise, patients can end up on multiple medications with
multiple -- and possibly adverse -- side effects.
"So we try to take a big picture approach to this cluster of symptoms that
Gulf War veterans often describe fairly consistently."
Although the current studies are only for Gulf War veterans, Walter Reed may
soon expand its operations into a new Deployment Health Clinical Center to
treat veterans of all deployments.
"When you go off on deployments, you're not working in places approved by
the Occupational Safety and Health Administration," Engel said. "Nobody
promised you that you would be, but just the same, you come back with
questions. What about the oil well fires? What about the [medicines they
gave me]? What about the vaccinations I took?
"We need to broaden our sense of what health is for returning veterans.
These are, by and large, young folks who are free of the illnesses we think
of in the elderly and that show up clearly on diagnostic tests. Sometimes,
the difficulties they experience are more hidden. We have to expend a fair
amount of effort trying to understand the veterans' perspective of the
deployment rather than homing in on the thousand or so diseases doctors
typically look for in the course of routine medical care."
The studies veterans are asked to join demand their time, and may include
frequent travel away from home, Engel said. This discourages many from
volunteering. But it's important they step forward and get into these
programs, he said.
"It's about veterans helping veterans," he said. "This is an opportunity for
people who've stepped into harm's way and paid some health consequences to
be a part of the solution.
"What we are dedicated to doing here at the Gulf War Health Center -- and
soon the Deployment Health Clinical Center -- is developing systems of care
so that we can be there for veterans in ways that go beyond just giving a
pill or assigning a surgery."
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