Showing posts with label ALS. Show all posts
Showing posts with label ALS. Show all posts

Wednesday, March 9, 2011

USA Today: ALS disease affects bodies, not determination

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease, has affected well over one hundred Gulf War veterans.

According to USA Today article today:

About 40,000 people live with ALS in the USA. That number has grown higher as medical support has extended life expectancy after diagnosis from three years to four-six years, says Stanley Appel, director of the ALS Clinic at the Methodist Hospital in Houston.

Technology has made it possible for ALS patients to stay connected and have productive lives, Appel says.

Like Lester, Cathy Wolf of Katonah, N.Y., and Augie Nieto of Corona del Mar, Calif., are doing that.

Read the full article here:  http://yourlife.usatoday.com/health/medical/managingillness/story/2011/03/ALS-disease-affects-bodies-not-determination/44655194/1?csp=34news&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+usatoday-NewsTopStories+%28News+-+Top+Stories%29&utm_content=My+Yahoo

Sunday, February 13, 2011

Gulf War Illness, other CDMRP Programs to Remain Fully Funded this Year under Congressional Funding Bill

House Continuing Resolution contains full funding for Gulf War Illness treatment research, funding for ALS, MS, Lung Cancer, and 21 other key military medical research priorities

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) – The continuing appropriations (CR) legislation expected to be considered in the U.S. House of Representatives this week contains full funding for the Congressionally Directed, treatment-focused Gulf War Illness Medical Research Program (CDMRP), a move that will be of great relief to the Gulf War veteran community. 

Since the failure of the omnibus appropriations bill at the end of the 112th Congress last December, the Gulf War Illness advocacy community has remained vigilant as current year funding was left as an unwritten promise by Congressional leaders.

As it was funded in the past few years, the Gulf War Illness peer-reviewed treatment-focused research program on which I have served since its initial funding in 2006 would be funded under the House bill at $8 million.  Our program vision statement directs that funded research must help to improve the health and lives of those suffering from Gulf War Illness. 

Led by Chairman Jim Binns, the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) on which I serve recommended, sought creation of, and has been instrumental in the funding for the CDMRP program for peer-reviewed Gulf War Illness treatment research.

The House CR would also provide an $8 million appropriation for ALS research funding, a substantial increase over last year.  ALS has been found in epidemic-level rates in veterans of the 1991 Gulf War and is a presumptive condition for service-connection for any U.S. veteran.

ALS, also known as Lou Gehrig’s disease, is a rapidly degenerative neurological condition that usually claims the lives of its victims in as short as 18 months after initial diagnosis.  Heavily engaged in advocacy efforts, the ALS Association’s mission is is to lead the fight to treat and cure ALS through global research and nationwide advocacy while also empowering people with Lou Gehrig’s Disease and their families to live fuller lives by providing them with compassionate care and support.

Multiple Sclerosis (MS) funding is also included in the House version of the CR, at $4.8 million.  MS is believed by Gulf War veterans to also be highly prevalent among veterans of the 1991 Gulf War.   The National MS Society, heavily involved in advocating for this funding, is a collective of passionate individuals who want to do something about MS now—to move together toward a world free of multiple sclerosis.

MS is a presumptive condition for VA service-connection if it’s diagnosed within seven years of discharge from active duty. 

Under the House version of the CR, peer-reviewed Lung Cancer research would be funded at $12.8 million.  The Lung Cancer Alliance, the only national non-profit organization dedicated solely to patient support and advocacy for people living with lung cancer and those at risk for the disease, has substantial concerns about lung cancer in Gulf War and other veterans.

Led by House Rules Committee Chairman David Drier, new to the current 113th Congress is a House Rules website that allows for relatively transparent and easy tracking of upcoming legislation and bills currently under consideration by the House.    Internet resources for tracking are posted below this article.

Twenty-one other CDMRP peer-reviewed military medical research programs would also be funded under House CR.   The full listing of the critically important CDMRP military medical research programs and their proposed funding levels under the House CR are as follows:

  1. ALS $8,000
  2. Armed Forces Institute of Regenerative Medicine $4,800
  3. Autism Research $6,400
  4. Bone Marrow Failure Disease Research Program $4,000
  5. Duchenne Muscular Dystrophy $4,000
  6. Global HIV/AIDS Prevention $10,000
  7. Traumatic Brain Injury and Psychological Health $100,000
  8. Global Deployment of the Force medical research funding -Department of Defense requested transfer to maintain full funding for the program $125,000
  9. Gulf War Illness Peer-Reviewed Research Program $8,000
  10. Multiple Sclerosis $4,800
  11. Peer-Reviewed Alzheimer Research $15,000
  12. Peer-Reviewed Breast Cancer Research Program $150,000
  13. Peer-Reviewed Cancer Research Program $16,000
  14. Peer-Reviewed Lung Cancer Research Program $12,800
  15. Peer-Reviewed Orthopedic Research Program $24,000
  16. Peer-Reviewed Ovarian Cancer Research Program $20,000
  17. Peer Reviewed Vision research in conjunction with the DoD Vision Center of Excellence $4,000
  18. Peer-Reviewed Prostate Cancer Research Program $80,000
  19. Peer-Reviewed Spinal Cord Research Program $12,000
  20. Research in Alcohol and Substance Use Disorders $5,200
  21. SBIR to the core funded RDT&E $1,200
  22. Tuberous Sclerosis Complex (TSC) $6,400
  23. Pain Management Task Force Research $4,000
  24. Peer Reviewed Medical Research Program $50,000
  25. Neurofibromatosis Research $16,000

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MORE INFORMATION:

H.R. 1, Full Year Continuing Appropriations Act, 2011:  http://rules.house.gov/Legislation/legislationDetails.aspx?NewsID=100 

CR DoD Funding Tables:  See Page 54 of 55 --  http://www.rules.house.gov/Media/file/PDF_112_1/legislativetext/2011crapprops/FY%202011%20Department%20of%20Defense%20Base%20Funding.pdf

Wednesday, December 15, 2010

Senate: $11.8 million for Gulf War related health research in Omnibus

 

Written by Anthony Hardie, 91outcomes

(91outcomes.com) - According to a key staff member in the office of U.S. Senator Bernie Sanders (I-Vt.), a longtime, leading champion of Gulf War Illness treatment research and other Gulf War related efforts in the U.S. Senate:

Here is what I found in the most recent FY 2011 Omnibus DOD Appropriations currently under consideration. 

Provides $8 million for the Peer Reviewed Gulf War Illness Research Program and $3.8 million for the ALS Therapy Development Institute Gulf War Research Project.

This will ensure continued funding at this year’s level, a wonderful outcome that is even more exceptional given the current challenges facing a lame duck Congress trying to get a lot done in a matter of days left before the end of the year.

And, General “Mic” would probably have been pleased to see this continued, designated funding for Gulf War related ALS funding.

So, in total, it appears highly likely that the FY11 funding for Gulf War related research in the CDMRP will be at $13.8 million, as described above.  Excellent news!

And, according to another key Hill insider from one of the leading veterans service organizations on this issue:

We have no influence on the current funding levels (they have been set by CBO and will not be impacted).

Putting all of our energy into planning a concerted effort to influence the next Authorization funding cycle will be a much more worthy endeavor.

In everyone’s opinion [on the Hill, this year’s GWI funding level] is set in stone at this point.

As noted in the 91outcomes’ earlier article, the House version already had a provision ensuring that DoD funding continues, for the most part, at FY10 levels.  As such, this includes $8 million for the peer reviewed $8 million Gulf War Illness research program.

And, if the Senate should also change course from the proposed “omnibus” appropriations act and move to a “clean” Continuing Resolution like the House has already passed, this will also result in the same funding outcomes for CDMRP Gulf War related health research.

So, good news all around!

NEXT YEAR:

Now is the time to begin thinking about preparing for a concerted effort in the next Congress to seek increased funding for DoD-Army-CDMRP GWI research. 

Given the possibility of new inter-agency, inter-institution research consortiums being funded, having a coordinated message by all organizations and individuals contacting Congress will be of critical importance. 

WHAT NOT TO DO TODAY:

Fragmented messages and random calls by individuals not really clear on what it is for which they’re asking has the strong potential of derailing efforts. 

Anything perceived by members and staff in Congress as having a lack of clear unity on a particular issue -- like CDMRP GWI funding -- can lead to lots of calls and confusion and result in that particular issue – like CDMRP GWI funding -- to be left in the “too hard to do” category and left off from funding entirely.

And, the current “CR” and omnibus appropriations bills do not contain “line items” for these research programs – they’re mostly “clean” bills that simply say to continue funding across the board at last year’s levels.

This also means that there is little if any possibility of changing funding from last year’s levels.

WHAT TO DO TODAY:

So for now, individuals interested in contacting their members of Congress should simply say, “thank you” for the continued funding at this year’s level for all programs, including the DoD-Army-CDMRP peer reviewed Gulf War Illness research program. 

WHAT TO DO AFTER JANUARY 3RD:

Stay tuned here on 91outcomes for updates on concerted efforts in the next Congress, which begins in January. 

It will be important that Gulf War veterans speak with one voice on these critically important issues, particularly with the possibility of a need to fund consortiums with FY12 funding.

Friday, December 10, 2010

Legislative Update: Current Status of DoD Gulf War Illness Research Funding Remains Volatile

 

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) – Just like last year, monitoring Congressional appropriations actions for the FY11 peer reviewed Gulf War Illness (GWI) research program administered under the Congressionally Directed Medical Research Program (CDMRP) and efforts to ensure the program’s funding success remain highly challenging. Gulf War Illness Program Booklet

As of today, it appears that both House and Senate actions suggest final GWI CDMRP funding for FY11 might be at $8 million, the same level as FY10. However, it should be noted that the situation continues to change rapidly. As always there are no guarantees until the entire Congress sends a final bill to the President.

Continued careful monitoring, combined with veterans advocates and organizations at the ready to contact key members of Congress, will be required.

House

On Wednesday, December 8, 2010, the House narrowly passed by a vote of 212-206 a Continuing Resolution (CR) that provides -- with various unrelated exceptions -- continued FY11 appropriations at FY10 levels, through September 30, 2011.

Under the CR, funding for the GWI program administered by the CDMRP reportedly would be retained at the FY10 funding level of $8 million.

Thirty-five House Democrats sided with 171 House Republicans in voting against the CR, while Eight Democrats and eight Republicans did not vote. This deep division suggests that future prospects for a final omnibus appropriations bill after Senate and conference action may also be challenging.

Senate

The Senate appropriations committee’s FY11 Defense appropriations act report language, which provides detailed funding by line item, directs $8 million for the Peer Reviewed Gulf War Illness Research Program.

The funding was requested in a letter by Senators Sanders, Bond, Feingold, Kerry, Tester, Schumer, Leahy, Durbin, Burris, Brown, Boxer, Snowe, and Kohl.

The Senate bill passed out of committee on September 16, 2010 by an 18-12 vote. Like all the other FY11 appropriations bills, the defense appropriations bill was not considered by the full Senate. However, it may very well remain a guide for future Senate action as discussed below.

Under the report accompanying the Senate bill, total appropriations for the military medical research programs currently operated by the CDMRP would be $358 million. In addition to the GWI appropriation, $150 million would be designated for peer reviewed research on breast cancer, $10 million for ovarian cancer, $80 million for prostate cancer, $60 million for psychological health and traumatic brain injury (TBI), and $50 million for the multifaceted peer reviewed medical research program (PRMRP).

FUTURE PROSPECTS

It is currently expected that the Senate will combine the House’s CR into a Senate omnibus appropriations bill. Any action must be completed by the end of the current Congress on January 3, 2011.

Additionally, the FY11 National Defense Authorization Act (NDAA) remains an unknown variable in the legislative equation. It remains unclear whether or not the NDAA will pass before the current Congress ends and what impact, if any, an enacted NDAA might have on the CDMRP’s GWI research program.

------------------------------


Looking Back at Last Year: Who to Call

Last year, retaining funding for the Gulf War Illness research program was, as usual, extremely challenging for the handful of veterans advocates and organizations involved.

Initially, the Senate version of the FY10 Defense Appropriations Act lumped Gulf War Illness under the Peer Reviewed Medical Research Program (PRMRP), a catch-all that included more than two dozen conditions including GWI and funded at just $50 million. While the PRMRP restricts research to the listed conditions, there is no guarantee that research will be funded for any particular condition from among those listed.

Initially, the House failed to include funding for the GWI program at all.

However, as the bill went back and forth between the House and Senate, advocacy efforts resulted in amendments to the final bills in both chambers and final FY10 GWI funding at $8 million.

A last minute save on October 1, 2009 by Sen. Bernie Sanders (I-Vt.) and four of his colleagues amended (SA 2559) the Senate’s bill to include an amendment that would have appropriated $12 million for the GWI program. Those Senators included Robert Byrd (D-W.Va.), Russ Feingold (D-Wis.), Dick Durbin (D-Ill.), and Sherrod Brown (D-Oh.).

And, a December 11, 2009 letter by Rep. Dennis Kucinich (D-Oh.) and 25 other Members of Congress called for the conference committee to fund the CDMRP’s GWI research program at the Senate’s $12 million level.

Ultimately, the conference committee set final funding for the FY10 GWI program at the original, lower House level of $8 million. Both the House and Senate agreed and the final Defense funding bill was enacted by the President.

GWI research supporters Sanders, Durbin, and Brown remain in the Senate.

However, Byrd died on June 28, 2010 and is being succeeded by former West Virginia Governor Joe Manchin (D-W.Va.). Feingold was defeated in the November 2010 election and is being succeeded by Ron Johnson (R-Wis.), a Tea Party favorite.

GWI research funding supporters who signed onto the December 2010 Kucinich letter included the following. Of the 21 who remain in Congress, only four are Republicans, who will hold the majority in the House beginning January 3, 2011.  
  • Rep. Tammy Baldwin (D-Wis.)
  • Rep. Shelley Berkley (D-Nev.)
  • Rep. John Boccieri
  • Rep. Corrine Brown (D-Fla.)
  • Rep. Henry Brown, Veterans’ Affairs Health Subcommittee Ranking Member
  • Rep. Dan Burton (R-Ind.)
  • Rep. Steve Buyer, House Veterans’ Affairs Committee Ranking Member
  • Rep. John Conyers, Jr. (D-Mich.)
  • Rep. Bob Filner (D-Calif.), House Veterans’ Affairs Committee Chair
  • Rep. Charlie Gonzalez (D-Tex.)
  • Rep. Raul Grijalva (D-Ariz.)
  • Rep. Luis Gutierrez (D-Ill.)
  • Rep. John Hall
  • Rep. Rush Holt (D-N.J.)
  • Rep. Dennis Kucinich (D-Oh.)
  • Rep. Steve LaTourette (D-Oh.)
  • Rep. Frank LoBiondo (R-N.J.)
  • Rep. Jim McGovern (D-Mass.)
  • Rep. Michael Michaud (D-Maine), Veterans’ Affairs Health Subcommittee Chair
  • Rep. Gwen Moore (D-Wis.)
  • Rep. Collin Peterson (D-Minn.)
  • Rep. Mike Quigley (D-Ill.)
  • Rep. Janice Schakowsky (D-Ill.)
  • Rep. Patrick Tiberi (R-Oh.)
  • Rep. Timothy Walz (D-Minn.)
  • Rep. Don Young (R-Alaska)
----------------------

FY11 PRMPR

PRMPR research areas in the Senate bill would include the 32 conditions listed below. Four that are particularly relevant to Gulf War veterans are highlighted. The House CR would retain the list the same as in FY10. It should be noted that the final outcome remains indeterminate.
  1. amyotrophic lateral sclerosis (ALS),
  2. autism,
  3. blood cancer,
  4. chronic fatigue syndrome,
  5. chronic migraine and post-traumatic headache,
  6. dental research,
  7. drug abuse,
  8. epidermolysis bullosa,
  9. epilepsy,
  10. fragile x syndrome,
  11. inflammatory bowel disease,
  12. interstitial cystitis,
  13. kidney cancer,
  14. lupus,
  15. melanoma,
  16. mesothelioma,
  17. multiple sclerosis (MS),
  18. neuroblastoma,
  19. neurofibromatosis,
  20. osteoporosis and related bone disease,
  21. Paget's disease,
  22. pancreatitis,
  23. Parkinson's,
  24. pediatric cancer,
  25. pheochromocytoma,
  26. polycystic kidney disease,
  27. post-traumatic osteoarthritis,
  28. scleroderma,
  29. social work research,
  30. tinnitus,
  31. tuberous sclerosis complex, and
  32. vision research.
----------------
SOURCES:

§ FY11 House Continuing Resolution (CR) for combined FY11 appropriations: H.R. 3082 [Would fund GWIRP at $8 million]

§ Senate FY11 Defense Appropriations Act, S. 3800 [Would fund GWIRP at $8 million]

§ Senate FY11 Defense Appropriations Act Committee Report, S. Rpt 111-295 [Would fund GWIRP at $8 million]

§ FY10 National Defense Authorization Act (NDAA), PL 111-84 [Authorized GWIRP at $12 million]

§ FY10 Defense Appropriations Act Explanatory Statement (essentially the conference report), p. 367 [Funded GWIRP at $8 million]

Wednesday, October 20, 2010

ATSDR Launches National ALS Registry

 

(Centers for Disease Control & Prevention) - In a groundbreaking step to learn more about Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig's disease, the federal Agency for Toxic Substances and Disease Registry (ATSDR) has launched the National ALS Registry.

The registry is a national database that provides an opportunity to better understand one of the most common neuromuscular diseases worldwide, affecting people of all races and ethnic backgrounds – especially between the ages of 55 and 75.

The registry will gather and organize information about potential and known risk factors and symptoms of ALS. The information can help researchers evaluate shared risk factors common among patients, such as heredity or possible environmental exposures, and help estimate the number of ALS cases diagnosed each year.

"A National ALS Registry provides researchers and physicians with more thorough information about ALS that will further empower them in the fight to treat and possibly prevent this disease," said Christopher Portier, Ph.D., director of ATSDR. "Today, the cause or causes of ALS are largely unknown; this is the first nation-wide registry created to enhance our knowledge about this disease."

ALS causes human nerve cells to stop functioning and eventually die. A diagnosis of the disease leads to muscle weakness, paralysis, and eventually death. No one knows how many people are living with ALS, though scientists estimate 30,000 people in the United States have the disease.

Each entry in the registry includes a patient health history, work experiences, and family medical histories. Individual patient information on the registry will be confidential and will not be publicly released. Patients choosing to participate can visit www.cdc.gov/als to register.

"The more people participate in the registry, the more comprehensive and diverse the data will be to help researchers and physicians better understand this disease," said Kevin Horton, Dr.P.H., ATSDR's ALS program administrator. "In addition, the registry provides a means to share information about research findings and clinical trials."

For more information, visit www.cdc.gov/als. The ATSDR website is www.atsdr.cdc.gov.

Editor's Note: The Agency for Toxic Substance and Disease Registry, ATSDR, is a federal public health agency of the U.S. Department of Health and Human Services. Its mission is to prevent harmful exposures and diseases related to toxic substances. It is commonly referred to as CDC's sister agency.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Thursday, July 1, 2010

VA Proposes Rule Change to Ensure Total Disability Benefits for All Veterans with ALS

Public Comments must be received by July 23

Graphic:  What is ALS?  Courtesy Huntsville Times

(91outcomes.com) - The U.S. Department of Veterans Affairs (VA) has announced that it proposes to amend its Schedule for Rating Disabilities by revising the evaluation criterion for amyotrophic lateral sclerosis (ALS) to provide a 100-percent evaluation for any veteran with service-connected ALS. 

According to VA, this change is necessary to adequately compensate veterans who suffer from this progressive, untreatable, and fatal disease. VA says this change is intended to provide a total disability rating for any veteran with service-connected ALS.

Comments must be received on or before July 23, 2010.

Written comments can be submitted:

  • ONLINE
  • FAX:  (202) 273-9026
  • MAIL/HAND-DELIVERY – Deliver to:  Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420

Comments should indicate that they are submitted in response
to ``RIN 2900-AN60-Schedule for Rating Disabilities; Evaluation of Amyotrophic Lateral Sclerosis.''

VA proposes to amend its Schedule for Rating Disabilities (38 CFR part 4) by revising the evaluation criterion for ALS under diagnostic code 8017 in Sec.  4.124a, the schedule of ratings for neurological conditions and convulsive disorders. Currently, the schedule provides only a single criterion for ALS, a minimum disability evaluation of 30 percent. VA proposes to remove this criterion and replace it with a minimum disability evaluation of 100 percent. The Secretary has authority to make this amendment pursuant to 38 U.S.C.
1155.

ALS, also known as Lou Gehrig's disease, is a motor neuron disease that results in muscle weakness leading to a wide range of serious disabilities, including problems with mobility. It often affects the muscles that control swallowing, leading to the possibility of aspiration (the inspiratory sucking of fluid into the airways) and pneumonia. It eventually paralyzes the respiratory muscles, and the most common cause of death in ALS is respiratory failure. ALS is a terminal illness; the life expectancy of a person with ALS ordinarily ranges from about 3 to 5 years after diagnosis. Fifty percent of patients die within 3 years of diagnosis, about 20 percent live 5 years, and 10 percent survive for 10 or more years.

ALS is rated under 38 CFR 4.124a, diagnostic code 8017, which currently provides a minimum disability evaluation of 30 percent. However, the guidelines in 38 CFR 4.120 (Evaluations by comparison) direct that disability from neurologic conditions be rated in proportion to the impairment of motor, sensory, or mental function.

Therefore, any level of evaluation, including 100 percent, can currently be assigned for ALS under diagnostic code 8017. However, individuals with ALS have a rapidly deteriorating course of illness and quickly reach a level of total disability. Providing a 100-percent evaluation in all cases would obviate the need to reassess and reevaluate veterans with ALS repeatedly over a short period of time, as the condition worsens and inevitably and relentlessly progresses to total disability. Therefore, VA proposes to change the minimum
evaluation for ALS from 30 to 100 percent. Although ALS may not be totally disabling at the time of diagnosis or when VA compensation is claimed for the condition, ALS is a seriously disabling, rapidly progressive, untreatable, and fatal condition.

VA's schedule of ratings for neurological conditions and convulsive disorders provides a 100-percent disability evaluation for certain other motor neuron diseases that progressively lead to disability or death. See 38 CFR 4.124a, Diagnostic Codes 8005 (Bulbar palsy), 8105 (Sydenham's chorea of the ``progressive grave type''), and 8106 (Huntington's chorea). Given that ALS is a rapidly progressing neurodegenerative disease and that many of its disabling effects are similar to other neurological disorders that VA rates at 100 percent, VA proposes to compensate veterans with ALS similarly. The 100-percent rating would ensure that veterans with ALS are evaluated adequately and would eliminate any delay in reaching an appropriate level of compensation as their disease rapidly progresses.

In addition, VA proposes to add a note to consider the need for special monthly compensation (SMC), which VA says will be quite a common need in these veterans.

Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461-4902 (this is not a toll-free number) for an appointment.

In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at http://www.regulations.gov/search/Regs/home.html#docketDetail?R=VA-2010-VBA-0021, and on the page, select “Public Submissions” as the only selection.

FOR FURTHER INFORMATION CONTACT: Thomas J. Kniffen, Chief, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs, 810 Vermont Ave., NW., Washington, DC 20420, phone: (202) 461-9725. (This is not a toll-free number.)

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For more information on ALS:

Monday, May 3, 2010

Gulf War Veteran’s Death Provides Powerful Reminder of the Urgency of Military Medical Research

Written by Anthony Hardie, 91outcomes.com Publisher/Editor

(91outcomes.com) At the end of July 2007, I had the privilege of meeting and testifying before Congress in Washington, D.C. on behalf of our fellow Gulf War veterans alongside Retired Brigadier General Tom “General Mik” Mikolajcik. 

I learned this week that General Mik’s exhausted body had finally succumbed to the nearly always fatal ALS, a horrifying, paralyzing, degenerative neurological disease that leaves the mind intact, named for taking the life of baseball great Lou Gehrig just prior to the U.S. entry into World War II nearly seven decades earlier. 

Though the “expected” rate of ALS would have suggested at most just a handful of cases of ALS among Gulf War veterans age 60 or older, ALS has been diagnosed in that number of veterans of the 1991 Gulf War many times over.  Mainly in their 20s, 30s, and 40s, these Gulf War veterans’ disease have led involved scientific researchers to call it an outbreak while also potentially providing important clues about the nature of this and the other diseases affecting us Gulf War veterans at highly disproportionate rates.

General Mik’s home state of South Carolina carried news coverage at the time that captured his words from that hot summer D.C. morning:  

"Only by the grace of God am I here to speak with you today," he told the committee that day, "and I have vowed to keep speaking until I no longer can."

"It's been nearly 70 years since Lou Gehrig made his farewell speech, and we have basically nothing," he said. "One questionable drug in 70 years? How many thousands of private farewell speeches must take place before we realize we're not doing everything we can?"

His wife then emptied a briefcase of antique children's blocks on the hearing table, blocks that children would play with during Gehrig's time.

"These blocks represent ongoing ALS research," Mikolajcik said. "All are separate, none are connected and there is no communication going on between them."

Mikolajcik's voice and mind were as sharp as his body was limp.

Sitting next to General Mik on the three-person panel, I testified next.  Like him, and Maj. Denise Nichols, the other Gulf War veteran next to me, we had allowed our private health lives to become public in the urgent hopes of educating and aiding others.  Doing my best to also represent our fellow veterans at the hearing on another of the health issues unexpectedly affecting large numbers of us who served in the 1991 Gulf War -- the chronic multisymptom illness more usually termed Gulf War Illness or Gulf War Syndrome that is today known, according to the Institute of Medicine, to afflict 250,000 of the War’s 696,842 veterans -- I told the Congressional committee:

“For Members of the Committee who may not be familiar, Gulf War troops were exposed to a host of toxic exposures experienced, often in combination, including: multiple low-level exposures to chemical warfare agents, including from bombed munitions factories and detonated munitions bunkers; experimental drugs mandated without informed consent like Pyridostigmine Bromide (PB) pills intended to help survive nerve agent exposure; inhalation of the incredibly high levels of micro-fine particulate matter from the Kuwaiti oil well fire plumes; experimental vaccines like anthrax, botulinum, and others; inhaled and ingested depleted uranium (DU) particulate matter; smoke from the daily burning of trash and feces; multiple pesticides; and petroleum products and byproducts.

“For some of us who developed lasting health effects from this veritable toxic soup of hazardous exposures, it came while still in the Gulf.  For others, it did not come until sometime after returning home. 

“Hearing this list of exposures, most people would find it of no surprise that so many thousands of Gulf war veterans became ill, or that so many remain ill and injured today.  And it should be no surprise that so many have developed diagnosable, serious conditions like ALS, MS, and others. 

“What is stunning is that sixteen years later, there are still few tangible results that might improve the health of those who became ill and remain ill.  And we still have little information of any value to provide to Gulf War veterans or their health care providers that might help to improve Gulf War veterans’ health.

“Years were squandered disputing whether Gulf war veterans were really ill, studying stress, reporting that what was wrong with Gulf War veterans was the same as after every war.  An incredible amount of effort was put into disproving the claims of countless veterans testifying before Congress about chemical and other exposures.  Some of that negative effort appears to continue even today.

“It is stunning that after nearly two decades, we still have little information to provide to Gulf War veterans who remain ill from their service.”

It’s true that since that day in 2007, we have seen a few successes towards improving the health and lives of veterans suffering from ALS, Gulf War Illness, and other health conditions affecting Gulf War veterans.  However, given the sharply limited nature and number of useful outcomes to date, this is to reemphasize what I told the Members of Congress that day:

“The five-point statement of goals that came from Gulf War veterans more than a decade ago still holds true today: 

  1. Gulf War veterans deserved then and deserve now an assurance that an exhaustive investigation has been fulfilled to identify all possible Gulf War exposures;
  2. That appropriate scientific research is promptly completed to connect known or potential Gulf War exposures with health outcomes;
  3. That medical treatment is based on that scientific research;
  4. That compensation is provided to those veterans left disabled by their military service if the health conditions cannot be reversed; and
  5. That every effort is made to ensure that never again can what happened to Gulf War veterans be allowed to happen.”

For the Gulf War veterans who have died from or are currently suffering from ALS, MS, brain, testicular and other cancers, and for the more than one-third of us who today still suffer the debilitating effects of Gulf War associated chronic multisymptom illness, we must continue our nation’s efforts on behalf of our fellow veterans until effective treatments – and preventive measures – can be found.

ALS is the most deadly disease of them all, and most other diseases known to science pale in comparison to its dreadful effects.  Yet because it is so rare, it still has only minimal funding aimed at finding life-extending treatments. 

But, the current VA leadership, with its internal Task Force on Gulf War Veterans Illnesses and public report still open for comment through May 3rd, is clearly leading major change that again has hope on the horizon for so many of us.   And ongoing Congressional action on military health research funding is also renewing hope.

But what is urgently needed is an urgently pursued renewal of a comprehensive and coordinated federal health research program related to the causes and treatments of the array of disabling diseases that affect Gulf War veterans, including for ALS, MS, and for Gulf War Illness.  At the size and scope called for by the IOM that would be comparable to a Manhattan Project for today, this program would undoubtedly provide many long-awaited answers. 

Such changes are of course too late for General Mik and for so many of our fellow veterans of the 1991 Gulf War who have gone on before us from diseases directly resulting from Gulf War service.  Hopefully, these changes won’t be too late to provide tangible and potentially cost-saving improvements in the health and lives of those of us still living.  And, pursuing these military research and treatment avenues will help ensure that countless thousands of those who will come after us may well be able to avoid the health outcomes experienced by hundreds of thousands of us Gulf War veterans.

In joyful tribute to his life, in solemn honor of his painful death, in recognition of his work , and in eternal remembrance of his wise, firm, heartfelt words told to Congress that day and both publicly and privately to me and to so many others before and since, General Mik’s extended obituary from his hometown Charleston Post and Courier is shared below.

And for those of us veterans of the 1991 Gulf War still struggling with the enduring health effects of that war, short as wars go but long in impact on those who fought it, I think General Mik would have appreciated sharing the words of the man for whom the disease that would take his life was named, words that have meaning for all of us:

“So, I close in saying that I might have been given a bad break, but I've got an awful lot to live for.”    -Lou Gehrig, 1941

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Retired brigadier general used his battle with ALS to focus attention on disease

Written by Glenn Smith, The Post and Courier, with Diane Knich contributing.

photo

Retired Air Force Brig. Gen. Thomas Mikolajcik campaigned to raise awareness about amyotrophic lateral sclerosis, better known as Lou Gehrig's disease.

photo

 

Retired Air Force Brig. Gen. Thomas Mikolajcik of Mount Pleasant went to Capitol Hill in 2006 to seek support for ALS research and draw attention to a higher incidence of the fatal disease among military veterans.

(Charleston, S.C.) - Retired Brig. Gen. Thomas Mikolajcik, a career military man who waged his greatest battle fighting to help victims of Lou Gehrig's disease, died Saturday [April 17, 2010].

He was 63.

Mikolajcik, former commander of the Charleston Air Force Base, was diagnosed in 2003 with amyotrophic lateral sclerosis, better known as ALS, or Lou Gehrig's disease. The disease progressively kills nerve cells, robbing its victims of muscle control until they become paralyzed and die, usually within two to five years. There is no cure.

Mikolajcik knew there was no chance he would beat the disease. He fought to improve the odds for future victims.

Carmen, his wife of 40 years, said her husband never asked, "Why me?" He told her early on, "I could cry or I could do something to help others," she said. "He chose to do that."

Mikolajcik was "always a very persistent man, very ethical, very principled," she said. "Once he got on a cause, it was usually easier to say 'yes' to him than to say 'no.' "

The Mount Pleasant resident was instrumental in forming the first ALS Association chapter in South Carolina in 2005. He also pushed for the creation of a local clinic that opened in July 2006 to treat those stricken with the neurological disorder. He helped lead an ALS support group, promoted the annual fundraising walk for the ALS chapter and made public appearances to focus attention on the disease.

The brigadier general visited Washington three times to push for ALS research and he testified before a congressional committee in July 2007. He fought to spur government action on the link between military service and ALS. Studies have found that veterans are much more likely to contract the disease than those who have never served in the military. No one is sure why.

Mikolajcik's efforts helped win additional defense funding for ALS research, bolstered Pentagon interest in the disease and paved the way for legislation establishing an ALS database to warehouse information on the disease for scientists and patients. President George W. Bush signed the ALS Registry Act into law in October.

Mikolajcik's work won him much praise and recognition. Last year, the ALS Association South Carolina Chapter honored Mikolajcik and his family for their spirit, work and courage, describing them as role models for people living with the disease.

Rebecca Jordan, the chapter's executive director, said Mikolajcik's work helped thousands of veterans and other people with ALS. "Just being in his presence made people feel better," she said.

The last time she saw him was in February. He was completely paralyzed and was having difficulty breathing, but he told her he wished he could do more.

Mikolajcik spoke candidly about the toll the disease took on his body, but he wasn't interested in sympathy or pity. He saw himself as a strong-willed spokesman who could shed light on a disease that receives little national attention.

"God has given me a cross to bear, but he also allows me to still have the energy, the faculties and the voice to maybe make a difference, whether it be in helping other people or in raising awareness," Mikolajcik said in 2006.

The grandson of Polish immigrants, he made service to country and community a hallmark theme in his life. At his 60th birthday party in August 2006, 250 people from around the globe gathered in North Charleston to pay tribute to the aging warrior. Gov. Mark Sanford lauded Mikolajcik for leading "a true life of service before self." Brig. Gen. Susan Desjardins called him "an absolute hero."

Col. Martha Meeker, Joint Base Charleston commander, said Mikolajcik's favorite quote started with the phrase "Be Strong and Courageous," and he was both. "Throughout his life in the Air Force and in the community he was a leader who others looked up to, and the strength and courage he showed at the end of his life deeply touched everyone around him."

During a 27-year career in the Air Force, Mikolajcik commanded a C-130 Wing in Rhein-Main, Germany, during Desert Shield/Desert Storm, ran all air operations during the Somalia humanitarian campaign, and served as Air Force director of transportation at the Pentagon. He ran the Charleston Air Force Base from 1991 to 1994. He retired from the Air Force in 1996.

Mikolajcik remained active as a military advisor to the Charleston Metro Chamber of Commerce and as a mentor for military commanders in the area. His contributions proved a key factor in local and state efforts to minimize base closures and job losses during the Pentagon's Base Realignment and Closure process in 2005.

Last year, the Charleston Air Force Base honored its former wing commander by breaking ground on the Brigadier General Thomas R. Mikolajcik Child Development Center, a $9.8 million facility that will accommodate 305 children.

Meeker said, "every time one of our airmen takes their child to the General Mikolajcik day care center or a sailor arrives at the General Mikolajcik engineering laboratory, he will be remembered. And every time a veteran suffering from ALS receives VA care, he will be thanked."

Mikolajcik also was a founding member of the Mount Pleasant Open Space Foundation and a senior advisor to the National Defense Transportation Association's local chapter.

Wednesday, August 26, 2009

WRAL-TV: N.C. Gulf War Veteran Among those who Receive VA's Errant ALS Letter

Beau Minnick

Web Editor: Kathy Hanrahan

Former Army Sgt. Samuel Hargrove, of Henderson, remembers the feeling he got when he opened a letter on Sunday from The U.S. Department of Veterans Affairs. It was a notification that he had been diagnosed with Lou Gehrig's disease.

“It really felt like the weight of the world had fallen upon my soul,” Hargrove said. “I started crying and wondering why no one had ever told this to me before.”

Like some other Gulf War veterans, Hargrove, 42, has some neurological problems. He suffers from chronic fatigue, fibromyalgia and narcolepsy.

After talking with other veterans in a resource center and online, Hargrove discovered he was among a group of veterans who received the letters erroneously.

With all the other symptoms he has, now Hargrove questions whether he has ALS, too. He wants the VA to pay for a test.

“I don’t want to see anyone else go through this kind of suffering from a mistake again,” Hargrove said.

VA spokeswoman Katie Roberts said the agency will individually apologize to those veterans who received the letters in error.

The veterans also will receive an explanation about how "this unfortunate and regrettable error" occurred and reassurances that the letters do not confirm diagnoses of the fatal neurological disease, she said. Roberts did not say whether the agency has determined how the error occurred.

VA employees were still thumbing through case files, trying to determine exactly how many veterans mistakenly received letters intended to inform sufferers of ALS, or Lou Gehrig's disease, of benefits available to them or surviving spouses and children.

"We understand we made a mistake," Roberts said. "We had every good intention.”

Roberts said the VA mailed more than 1,800 letters last week and has been notified by fewer than 10 veterans who received the letters in error. However, a Gulf War veterans group that provides information, support and referrals about illnesses to military members estimates at least 1,200 veterans received the letters by mistake.

Denise Nichols, vice president of the National Gulf War Resource Center, said panicked veterans in at least a dozen states have contacted her group.

ALS is a rapidly progressive disease that attacks the nerve cells responsible for controlling voluntary muscles. It is usually fatal within five years.

Veterans like Hargrove and former Air Force reservist Gale Reid in Montgomery, Ala., were initially suspicious of the letters, but went through the pain of not knowing whether they had ALS.

Reid said she incurred about $3,000 worth of medical expenses securing a second opinion from a civilian doctor. Reid hopes the VA will pay for the tests, but Roberts said she had to check on any reimbursements.

Jim Bunker, president of the veterans group, said someone at the VA told him the mistake was caused by a coding error in which veterans with undiagnosed neurological disorders were inadvertently assigned the code for ALS. The VA uses more than 8,000 codes for various diseases and illnesses, he said.

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Sunday, August 9, 2009

ALS-Gulf War treatment measure passes House


Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com – Friday, August 7, 2009) – A provision in the defense spending bill currently winding its way through Congress would provide a $2 million appropriation earmarked for an ALS therapy development institute/Gulf War illness research project.

The spending measure was inserted into the version of the federal Fiscal Year 2010 Department of Defense Appropriations Act by Representatives Harry Brown (R-S.C.-01) and Michael Capuano (D-Mass.-08), and would be in addition to $1.2 million first included for the project in the FY08 Defense spending bill.

Previous research has noted rates of ALS much higher than expected in veterans of the 1991 Gulf War, particularly those who were near Khamisiyah, Iraq, when Iraqi munitions stores were detonated. The U.S. Department of Defense notified Gulf War veterans that the detonated munitions included those containing sarin and cyclosarin nerve agents. The detonated munitions may also have included mustard gas and other chemical warfare agents known to have been among those stored by the Iraqi military at the time.

The funding would be provided to the ALS Therapy Development Institute Gulf War Research Project (ALS TDI), a non-profit entity located at 215 First Street in Cambridge, Mass. 02142

According to the request:


Retired “General Mik” Led Efforts to Create the ALS/Gulf War Center in 2007

In his opening statement before a July 2007 Congressional hearing on Gulf War illnesses, Brown introduced Charleston, South Carolina Brigadier General Thomas Mikolajcik, a former U.S. Air Force pilot with advanced ALS, stating:

“Numerous studies have shown that individuals who have served in the military have a high propensity towards being diagnosed with ALS. The work of my friend General Mik has brought to my attention the growing number of veterans contracting ALS outside of service during the first Gulf War. His story serves as a testament to the need for leadership at the Federal level towards developing a comprehensive ALS research program and a clear VA/DoD policy ensuring that all veterans with service-connected-ALS receive the attention they deserve. We must step up to the plate and lead federal research into the causes of ALS and how we can better improve treatment for this terrible disease and we must do so now.”

During the 2007 hearing, Mikolajcik expressed concern over the decentralized research effort and testified, “The government should be compelled to assume a leadership position for ALS research. Some say that a lot of ALS research has taken place. My response echoes the famous words of President Lyndon Johnson: ‘Research is good, results are better!’”

Mikolajcik proposed a congressionally directed task force to identify a lead federal agency for the research of ALS and a strategic plan to address a comprehensive, forward looking and all inclusive research program for the disease.

Brown concluded, “It is our duty to provide our Nation’s veterans with access to the best health care possible. It is necessary for a comprehensive VA/DOD policy to ensure this quality care, and the establishment of a research oversight committee may be the right direction to serve Gulf War veterans and the growing number of veterans with ALS.”
The FY10 Defense spending bill now goes to the Senate for consideration, where the full bill is expected to be addressed in September 2009. A companion version of the bill is already under consideration there.

Letters and emails expressing support or increased funding to the full $4.8 million for the ALS/Gulf War provision should be addressed to:


Rep. David Obey, Chair and Rep. Jerry Lewis, Ranking Member, U.S. House of Representatives Committee on Appropriations, The Capitol, H-218, Washington, D.C. 20515

Senator Daniel Inouye, Chair and Senator Thad Cochrane, Ranking Member, U.S. Senate Committee on Appropriations, The Capitol, S-128, Washington, D.C. 20510


Courtesy copies of the original letters or emails should be sent to the Senator and Representative who represent the state and Congressional district in which their author resides. A nationwide database providing complete contact information on local Congressional representation is available at www.house.gov/writerep.


Several studies (conducted by DOD and the VA) have concluded that veterans of the first Gulf War develop the fatal neurodegenerative disease known as ALS twice as frequently as the general population. Another study has concluded that military service is an identified risk factor for developing ALS. ALS TDI is requesting $4.8 million for continued support of its cutting edge fast track drug discovery & translational research program and to support clinical trials of effective drugs.1) Identify physiological pathways and molecules in animal models of disease progression. Compare animal gene expression (transcriptome) to that of humans by employing the largest database ever compiled of animal and ALS patient samples. 2) Operate large scale validation program, using profiling technologies, to modulate gene expression in those genes determined to be candidates for disease effect. 3) Create a comprehensive translational medicine initiative to identify biomarkers for disease staging and prognosis, and drug efficacy and patient response. (Visit the ALS TDI website). Request: $4,830,000

Wednesday, May 13, 2009

Tragedy of Another Gulf War Veteran

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) - The case of a Gulf War veteran's parents suing the city of Washington, DC after the police shot and killed the 38-year-old mentally ill veteran is truly a tragedy.

According to a local DC ABC 7 news story, the family was concerned about him and called neighbors to check on him, who in turn called police when they found the Gulf War veteran's condo door ajar. Despite reportedly being known by police to have mental health problems, the Gulf War veteran was shot and killed by police in a tragic incident.

David Kerstetter was healthy enough to pass the military's rigorous entrance exams two decades ago, but didn't survive for Kuwait's 20th anniversary of the liberation that he helped achieve.

How much must Gulf War veterans and their families suffer before Congress, VA, and DOD act to provide effective treatments for Gulf War veterans' illnesses?

Perhaps with effective treatment nearly two decades ago, Kerstetter would still be not only alive, but healthy, his family would not be grieving, and the DC police would not be being sued.

There were only 697,000 troops who served in the 1991 Gulf War. Tragically, we have lost yet another.

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Sunday, May 10, 2009

UPI: Analysis--Gulf War illness still incurable

Published: July 27, 2007 at 11:12 A.M.
Written by ROSALIE WESTENSKOW, UPI Correspondent
Order reprints

WASHINGTON, July 26 (UPI) -- Many U.S. Gulf War veterans continue to suffer from mysterious illnesses more than 16 years after the conflict ended, several witnesses testified this week before a congressional committee.

"One in four of those who served -- 175,000 veterans -- remains seriously ill," James Binns, chairman of the Research Advisory Committee on Gulf War Veterans' Illnesses, said at a House of Representatives Health subcommittee hearing.

Gulf War syndrome or illness manifests itself through a plethora of symptoms, including dizziness, fatigue, diarrhea and other gastrointestinal problems, severe headaches, respiratory problems, stiffness and difficulty concentrating. Veterans began displaying these symptoms before the war ended in 1991, but a decade and a half later, many physicians feel unsure of how to treat these patients

"There remains no effective treatment," Binns said.

In the absence of any cure, many doctors resort to treating each individual symptom with different medications, such as sleeping pills and diarrhea medication, said Meryl Nass from Mount Desert Island Hospital in Bar Harbor, Maine, who has conducted a specialty clinic to treat patients with Gulf War syndrome for eight years.

"It's a piecemeal approach," Nass said at the hearing. "You can improve their functioning maybe 30 or 40 percent, but they certainly don't get cured."

One of the difficulties in treating the illness lies in general confusion over the exact causes of the illness and a lack of effective research on treatments, witnesses said. Although research has not proven definitive causes, the high level of toxins military personnel were exposed to probably caused most of the damage, said Lea Steele, scientific director of the Research Advisory Committee on Gulf War Veterans' Illnesses.

"The most consistent and extensive amount of available evidence implicates a group of chemicals to which veterans were exposed that can have toxic effects on the brain," Steele said. "These chemicals include pills -- NAPP pills or pyridostigmine -- given to protect troops from the effects of nerve agents, excessive use of pesticides and low levels of nerve gas."

Other toxins include smoke from more than 600 burning Kuwaiti oil wells, military vaccines and low-level doses of chemical weapons, Steele said.

While the symptoms of Gulf War syndrome overlap with those of many other illnesses, they manifest themselves much more heavily in Gulf War veterans than those from other eras, suggesting something specific in the Gulf War triggered this new syndrome, Steele said.

"It's not what we see in the general population and it's not what we see in any other veterans group this age," she said.

This hodgepodge of health problems seen in Gulf War veterans is not simply a manifestation of psychological problems either, Steele said.

"Comprehensive studies have found no connection between Gulf War illness and combat experiences in the war," she said. "This stands to reason since, in contrast to current deployments, severe stress and trauma were relatively uncommon in the 1991 Gulf War."

The war itself lasted for less than six months, with only four days of ground combat.

The $260 million spent on Gulf War illness research by the Department of Defense and the Department of Veterans Affairs has resulted in few breakthroughs, Nass said. One reason for this lies in an a focus on psychiatric causes, instead of toxins or vaccines and research that did look at these factors often had faulty methodology, leading to useless results, she said.

"Failed research does not happen by itself," Nass said.

In many studies, the wrong questions were asked, dubious research methods were used or sample sizes were too small to yield statistically significant data.

Much of this research resulted from an effort to discount veterans' claims that their sickness resulted from their military service, said Anthony Hardie, legislative chair and national treasurer for Veterans of Modern Warfare, a veterans advocacy organization.

"Years were squandered disputing whether Gulf War veterans were really ill, studying stress (and) reporting that what was wrong with Gulf War veterans was the same as after every war," Hardie said. "An incredible amount of effort was put into disproving the claims of countless veterans testifying before Congress about chemical and other exposures."

However, Veterans Affairs officials said the department has continuously worked to respond to the unique symptoms of Gulf War veterans.

"Even before the 1991 Gulf War ceasefire, VA had concerns that returning veterans might have certain unique health problems, including respiratory effects from exposure to the intense oil fire smoke," said Lawrence Deyton, chief public health and environmental hazards officer for the Veterans Health Administration. "VA quickly established a clinical registry to screen for this possibility."

But the data collected from the registry does not prove that Gulf War veterans suffer from any unique illness, Deyton said.

"After 15 years, the principal finding from VA's systematic clinical registry examination of about 14 percent of 1991 Gulf War veterans is that they are suffering from a wide variety of common, recognized illnesses," he said. "However, no new or unique syndrome has been identified."

The department did ask Congress for the authority to provide disability coverage, though, to veterans with difficult-to diagnose or undiagnosed illnesses who claimed the problem stemmed from military service.

"This statute as amended authorizes VA to pay compensation for disabilities that cannot be diagnosed as a specific disease or injury, or for certain illnesses with unknown cause including chronic fatigue syndrome ... and irritable bowel syndrome," Deyton said.

However, the government should take greater responsibility for conducting research on how to treat these veterans, said Brig. Gen. Thomas Mikolajcik, a Gulf War veteran diagnosed with amyotrophic lateral sclerosis, ALS or Lou Gehrig's disease, a rare condition that causes a progressive degeneration of the nerve cells in the brain and occurs twice as much in military personnel as among the rest of the population and two times as often among Gulf War veterans as other veterans.

"Establish a congressionally directed ALS Task Force with specific milestones and a time line," Mikolajcik said.

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Saturday, May 9, 2009

Researchers probe geographical ties to ALS cases among 1991 Gulf War veterans

Contact: Monte Basgall
monte.basgall@duke.edu
919-681-8057
Duke University

June 6, 2008

DURHAM, N.C. -- Researchers from Duke University, the University of Cincinnati (UC) and the Durham Veterans Administration Medical Center are hoping to find a geographical pattern to help explain why 1991 Gulf War veterans contracted the fatal neurological disease amyotrophic lateral sclerosis (ALS) at twice the normal rate during the decade after the conflict.

By layering military records of troop locations onto Gulf-area maps, "we've found there were some areas of service where there appears to be an elevated risk," said Marie Lynn Miranda, an associate professor at Duke's Nicholas School of the Environment whose group uses geographic information systems (GIS) to study environmental health problems.

Also known as Lou Gehrig's Disease because it crippled and ultimately killed that baseball great in 1941, ALS causes cellular degeneration in the central nervous system. Its cause is unknown.

"There are no reports on the occurrence of ALS among veterans of other conflicts," the researchers wrote. "There is only a single report that suggests ALS may arise from environmental exposures associated with military service, per se." The cases assessed by Miranda and her colleagues occurred within a group of people who are expected to be at low risk for ALS, because they're mostly under the age of 45.

Miranda is the first author of a report on an initial analysis now published online in the research journal NeuroToxicology. The work was funded by the Department of Veterans Affairs Cooperative Studies Program.

The report's senior author is Ronnie Horner, professor and director of the department of public health at Cincinnati, who led research that first documented twice-normal ALS rates among vets of the first Persian Gulf War in an article published in the September 2003 issue of the journal Neurology.

Horner's group is now assessing possible exposures vets might have had in the Gulf region that could explain the higher ALS rates its 2003 study found.

"As one of the largest contemporary set of cases, it presents a real opportunity to identify clues as to the cause of ALS not only for veterans of the first Gulf War but, perhaps, for ALS generally," Horner said. UC researchers are coordinating their investigations with those of researchers at the Durham, N.C. Veterans Medical Center and nearby Duke Medical Center.

Another UC-led study, published in the July 2008 issue of the journal Neuroepidemiology, found that the risk for developing ALS has now decreased among 1991 Gulf War vets. That suggests that the cause or causes of the ALS had something to do with their deployment in the region between August 1990 and July 1991.

Of the 135 cases diagnosed among the vets within 11 years after the war, only three had a family history of the disease. The small numbers might indicate that there is an environmental cause for ALS, the authors added.

"In the one-year period of military operations, some deployed military personnel experienced numerous exposures to multiple, potentially neurotoxic agents," Miranda and coauthors wrote in the new report. "If the array of possible candidate environmental exposures could be reduced, it may be possible to identify or at least focus inquiry on specific potential causative agents."

To narrow down the possibilities, Miranda and fellow investigators used GIS analysis, which allows researchers to layer different kinds of information onto maps to deduce potential risks.

They began by searching Department of Veterans Affairs and Department of Defense records as well as other sources to identify military personnel diagnosed with ALS after 1991. Department of Defense data also allowed the researchers to identify the military units these veterans with ALS served in during their deployment to the Persian Gulf region.

In a separate analysis, the researchers identified troop units known to have been exposed to emissions from a munitions storage area at Khamisayah, Iraq. Those munitions were destroyed by U.S. forces in March 1991, and a United Nations commission later found many rockets there had been loaded for chemical warfare.

A previous Defense Department modeling study deduced that "some 90,000 veterans may have been exposed to low levels of nerve agent" at Khamisayah, the new report said.

The GIS mapping revealed that "there were some areas where there appeared to be an elevated risk," Miranda said. To narrow down the possibilities, she and co-investigators then used statistical methods that assess the "best guess about the likelihood that space matters" for each grid of Gulf territory, she added.

Applying those statistics, the likelihood of a spatial connection with ALS development "climbed as high as 91 percent" in some grid cells, she said, most notably in a region southeast of Khamisayah. But Miranda cautioned that she will need to do additional analyses that add "time" to "place" before she can be more specific.

For instance, the researchers will want to know whether the ALS victim's units were in the path of emissions from Khamisayah on a specific day. Miranda and her colleagues are also interested in examining environmental exposures that may be associated with smoke plumes from oil well fires.

###

Other authors of the new NeuroToxicology report include Miranda's Nicholas School colleagues M. Alicia Overstreet Galeano and Eric Tassone as well as Kelli Allen, a research health scientist at the Durham VA Medical Center and a Duke assistant research professor of medicine.

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Monday, January 12, 2009

ODVA VETS NEWS: Gulf War Illness is real federal report concludes

A federal report released November 17
concludes that Gulf War illness is
real and that roughly one in four of
the 697,000 U.S. Veterans who served in the
Persian Gulf War suffer from the illness.
According to the Research Advisory
Committee on Gulf War Veterans’ Illnesses,
two chemicals cause Gulf War illness: the
drug pyridostigmine bromide (PB pills)
given to troops to protect against nerve gas,
and pesticides that were widely used – and
overused – to protect against sand flies and
other pests.

The 452-page report compiled by a panel of
scientific experts and veterans serving on the
Committee confirms that, “scientific evidence
leaves no question that Gulf War illness is a
real condition with real causes and serious
consequences for affected veterans.”
According to 38 United States Code 1117,
Persian Gulf War veterans may experience
signs or symptoms of undiagnosed illness or a
chronic multi-symptom illness that includes:
  • Fatigue
  • Unexplained rashes or other dermatological signs or symptoms
  • Headache
  • Muscle pain
  • Joint pain
  • Neurological signs and symptoms
  • Signs or symptoms involving the upper or lower respiratory system
  • Sleep disturbances
  • Gastrointestinal signs or symptoms
  • Abnormal weight loss
  • Menstrual disorders
In combination, these undiagnosed illnesses
have been termed Gulf War Syndrome. The report
also notes a higher than average occurrence of
Amyotrophic Lateral Sclerosis (ALS), often
referred to as “Lou Gehrig’s Disease.”

“This is a bittersweet victory, (because) this
is what Gulf War veterans have been saying all
along,” Committee member Anthony Hardie
said. “Years were squandered by the federal
government…trying to disprove that anything
could be wrong with Gulf War veterans.”

Several previous reports issued by the Institute
of Medicine, an arm of the National Academy
of Sciences, had concluded that there was
little evidence to support Gulf War Syndrome.

However, the Committee’s report concludes
the previous reports were inappropriately
constrained by the VA. According to the panel,
the VA ordered the Institute to consider only
limited human studies and not extensive animal
research, thus skewing the earlier studies.

The Committee’s report, titled “Gulf War
Illness and the Health of Gulf War Veterans” was
officially presented to the Secretary of Veterans
Affairs Dr. James Peake. The report states
that the illness comes as a result of multiple
“biological alterations” affecting the brain and
nervous system.

The report does not rule out other contributing
factors, but notes there is no clear link between
Gulf War Syndrome and oil well fires, depleted
uranium or the anthrax vaccination. The suspect
nerve agent pills and pesticides no longer are
used in the military.

To view the entire report, go to www.oregon.
gov/odva/gulfwar.shtml
.