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Clinical Experience with Gulf War One Veterans and their Symptoms
J. Wesson Ashford, MD, PhD
Director of California Site War-Related Injuries and Illnesses Study Center (WRIISC) Palo Alto VA Health Care System wes.ashford@va.gov
WRIISC-CA
Most Frequent Symptoms, Affected Systems of Veterans from the First Gulf War
Frequency of Symptoms of 53,835 Participants in VA Registry (19921997)
Symptoms
Fatigue Skin rash Headache Muscle and joint pain Loss of memory Shortness of breath Sleep disturbances
Percentage
20.5 18.4 18.0 16.8 14.0 7.9 5.9
Systems
Musculoskeletal and connective tissue Mental disorders Respiratory system Skin and subcutaneous tissue Digestive system Chest pain 25.4 14.7 14.0 13.4 11.1 3.5 SOURCE: Murphy et al., 1999
Fibromyalgia Cognitive Dysfunction Alcohol Abuse Depression Asthma PTSD Sexual Discomfort Chronic fatigue
Non-GW Veterans 9.6 P<.001 7.6 P<.001 12.6 P<.001 10.9 P<.001 4.1 P<.001 0.8 P<.007 1.1 P<.009 0.3 P<.001
During Operation Desert Storm, Veteran supported the infantry blowing things up, disarming mines. Was at the weapons dump at Khamisiyah and was responsible for the destruction of this facility between March 3-10, 1991.
He reports or believes that he was exposed to: o Sand, Smoke from oil-well fires, o Insecticides (DEET, permethrin), Organophosphate nerve agents, Pyridostigmine bromide (PB) o Paints, Solvents, Petroleum fuels and their combustion products, o Anthrax botulinum toxoid vaccinations, Infectious diseases o Psychological and physiological stress o C4, TNT, mines (direct handling). o Was near large radar trucks.
Veteran recalls no other symptoms before returning to the US in April, 1991. On return, Veteran experienced anger, got into fights, irritability, problems with concentration, difficulty with interpersonal relationships (ended relationship with girl-friend from before War), diarrhea and constipation. Veteran avoided social situations and crowds.
Major symptoms subsequently were: > Chronic fatigue > Muscle and joint pain > Headache > Skin rashes first 2 years after return > Sleep disturbances > GI disturbances > Loss of concentration > Forgetfulness, loss of memory Some of these symptoms have been stable (muscle, join pain), but most have gotten progressively worse. Veteran has 4 combat comrades who had similar problems. Veteran has had TBI x 2 times, major - Fort Bragg, parachuting. Knocked unconscious for 5 10 seconds (witnessed). Some dizziness, no other residual.
Neurological
normal MRI scans abnormal SPECT (? Normal PET, autonomic?)
WRIISC-CA
Since its creation in 2007, WRIISC-CA has evaluated over 200 complex referrals routed through Central Office from most States West of the Mississippi River (and all States West of the Rockies).
Of these referrals, 42% have been Veterans of the First Gulf War.
The largest single problem in the WRIISC referrals has been PAIN!!
In the WRIISC-CA program, Veterans of GWI had more pain and fatigue than Veterans of prior or later deployments. (note this data from a CPRS analysis of 79 cases, percent adjusted for missing data)
GW1
41 33 17 32 21 17 10 27 18 9
Post-GW1
21 16 5 17 14 10 6 13 8 3
71 18 82 65 59 53 71 53 24
80 41 78 51 41 24 66 44 22
76 24 81 67 48 29 62 38 14
1 1 2 2 2 2 3 3 3
Diag_PTSD
Diag_TBI Diag_GI Diag_Derm
Diag_Sleep
Diag_Cog Diag_Pulmonary
*1 = GWI MOST
2 = GWI LESS
3 = AGE-related
FUNDAMENTAL PROBLEMS
Gulf War Illness is considered to exist
(Institute of Medicine, 2009)
There have been many plausible theories for the unique constellation of symptoms that are frequently seen in the Veterans of the First Gulf War, but none has yielded an acceptable explanation There is no clear relation to chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, etc.
References
1. Murphy FM, Kang H, Dalager NA, et al.: The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry. Mil Med. 164(5), 327-31 (1999). 2. Iowa Persian Gulf Study Group: Selfreported illness and health status among Gulf War veterans. A population-based study. The Iowa Persian Gulf Study Group. JAMA. 277(3), 238-45 (1997). 3. Straus SE. Bridging the gulf in war syndromes. Lancet. Jan 16;353(9148):162-3 (1999).