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BOSTON (AP) -- A 64-year-old cancer patient has received the nation's first penis transplant, a groundbreaking operation that may also help accident victims and some of the many U.S. veterans maimed by roadside bombs. In a case that represents the latest frontier in the growing field of reconstructive transplants, Thomas Manning of Halifax, Massachusetts, is faring well after the 15-hour operation last week, Massachusetts General Hospital said Monday. His doctors said they are cautiously optimistic that Manning eventually will be able to urinate normally and function sexually again for the first time since aggressive penile cancer led to the amputation of the former bank courier's genitals in 2012. They said his psychological state will play a big role in his recovery. "Emotionally he's doing amazing. I'm really impressed with how he's handling things. He's just a positive person," Dr. Curtis Cetrulo, who was among the lead surgeons on a team of more than 50, said at a news conference. "He wants to be whole again. He does not want to be in the shadows." Manning, who is single and has no children, did not appear at the news conference but said in a statement: "Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries. In sharing this success with all of you, it is my hope we can usher in a bright future for this type of transplantation." The identity of the deceased donor was not released. The operation is highly experimental - only one other patient, in South Africa, has a transplanted penis. But four additional hospitals around the country have permission from the United Network for Organ Sharing, which oversees the nation's transplant system, to attempt the delicate surgery. The loss of a penis, whether from cancer, accident or war injury, is emotionally traumatic, affecting urination, sexual intimacy and the ability to conceive a child. Many patients suffer in silence because of the stigma their injuries sometimes carry; Cetrulo said many become isolated and despondent. Unlike traditional life-saving transplants of hearts, kidneys or livers, reconstructive transplants are done to improve quality of life. And while a penis transplant may sound radical, it follows transplants of faces, hands and even the uterus. "This is a logical next step," said Dr. W. P. Andrew Lee, chairman of plastic and reconstructive surgery at Johns Hopkins University School of Medicine. His hospital is preparing for a penis transplant in a wounded veteran soon, and Lee said this new field is important for "people who want to feel whole again after the loss of important body parts." Still, candidates face some serious risks: rejection of the tissue, and side effects from the anti-rejection drugs that must be taken for life. Doctors are working to reduce the medication needed. Penis transplants have generated intense interest among veterans from Iraq and Afghanistan, but they will require more extensive surgery since their injuries, often from roadside bombs, tend to be more extensive, with damage to blood vessels, nerves and pelvic tissue that also will need repair, Lee noted. The Department of Defense Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013. It's not clear how many victims lost all or part of the penis. A man in China received a penis transplant in 2005. But doctors said he asked them to remove his new organ two weeks later because he and his wife were having psychological problems. In December 2014, a 21-year-old man in South Africa whose penis had been amputated following complications from circumcision in his late teens received a transplant. Dr. Andre van der Merwe of the University of Stellenbosch told The Associated Press that the man is healthy, has normal sexual function and was able to conceive, although the baby was stillborn. But his recovery was difficult, with blood clots and infections, the doctor said. For congenital abnormalities or transgender surgery, doctors can fashion the form of a penis from a patient's own skin, using implants to achieve erection. But transplanting a functional penis requires connecting tiny blood vessels and nerves. A bigger challenge than the surgery itself is finding donor organs. "People are still reluctant to donate," van der Merwe said. "There are huge psychological issues about donating your relative's penis." In the U.S., people or their families who agree to donate organs such as the heart or lung must be asked separately about also donating a penis, hand or other body part, said Dr. Scott Levin, a hand transplant surgeon at the University of Pennsylvania and vice chairman of UNOS' committee on reconstructive transplants. In Boston, Cetrulo said the transplanted penis has good blood flow and so far shows no signs of rejection. He said that Manning should be released from the hospital soon, and that the surgery had three aims: ensuring the transplanted penis looks natural, is capable of normal urination - which he hopes will resume in a few weeks - and eventually normal sexual function. Reproduction won't be possible, he said, since Manning did not receive new testes. Dr. Dicken Ko, who directs the hospital's urology program, said Manning has been shown post-operation photos but hasn't actually seen his new penis, since it is still bandaged. A big test, Ko said, will be when reconnected nerves start to take hold, bringing feeling back to the organ. "We don't know how he would feel until that times comes," he said. --- Associated Press writers Patrick Mairs in Philadelphia and Maria Cheng in London contributed to this report. Neergaard reported from Washington.
CHICAGO (AP) -- Rep. Tammy Duckworth lost both legs when her helicopter was shot down in Iraq, then went on to hold leadership roles in the Illinois and U.S. Veterans Affairs departments. Yet, the Democratic Senate hopeful now finds her record on helping military veterans under attack by her opponent, Republican Sen. Mark Kirk, as he tries to hold on to a seat Democrats believe is key to their efforts to regain the Senate majority. Kirk, one of the GOP's most endangered incumbents, has accused Duckworth of failing to protect veterans in her care and putting her political ambitions ahead of her duties. He's also touted the more than two decades he served in the Navy Reserve and his own high-profile efforts to highlight problems at the VA. This week his campaign launched an online ad featuring a hearing on a lawsuit two Illinois VA employees filed against Duckworth, accusing her of retaliating against them when she led the agency- complaints that have twice been dismissed. Kirk also has repeated claims by two whistleblowers who say Duckworth ignored their reports of misconduct at a federal VA hospital west of Chicago. Trying to take down Duckworth on veterans' issues is a bold move for Kirk, with even some Republicans saying they don't think voters will buy it. The strategy also could backfire. Kirk acknowledged during his 2010 Senate bid that he had exaggerated some of his own military record. And he risks alienating voters who see Duckworth as a hero. Garrett Anderson, who lost part of one arm and suffered traumatic brain injury in a roadside-bomb attack in Iraq, said Duckworth was the first service member the U.S. Army sniper spoke to when he woke up from a coma at Walter Reed National Military Medical Center in 2005. The 39-year-old University of Illinois graduate student plans to vote for Kirk this fall for a simple reason: Anderson is a Republican. But he said the ads targeting her are out of bounds and called Duckworth "a nice person" who has a strong track record of looking out for veterans. "I've seen a few of (the ads) and I don't like them because she served her country very well, and she's a decorated war veteran," Anderson said. Kirk's campaign says Duckworth's record is a legitimate area for criticism, and that there's no shortage of people who agree. They point to two employees at Edward Hines, Jr. VA Hospital near Chicago who say they took their concerns to Duckworth and other Democrats but heard nothing, and to an Illinois Auditor General report of the state Department of Veterans' Affairs that found inadequate financial controls and programs that were supposed to be implemented but weren't during the time Duckworth was leading the office. The two other employees, whose lawsuit is in court Thursday, say she tried to fire one employee and gave another a bad review that cost her raises after the women complained about facility leadership at an Illinois VA home, where they still work. Duckworth was appointed to lead the Illinois VA in 2006 by now-imprisoned ex-Gov. Rod Blagojevich. "Of course Duckworth is a war hero, and that's what makes this entire court case even more tragic," said Kirk campaign manager Kevin Artl. "These VA employees only wanted to prevent veterans from being abused, but instead were ignored and punished by Duckworth while American heroes suffered," Deputy campaign manager Matt McGrath called it "a cynical and desperate ploy." He said Duckworth gets most of her own health care at Hines and is "deeply familiar" with issues at VA medical centers. Duckworth was born in Thailand to a Chinese mother and an American father, who fought with the Marines in Vietnam. She joined ROTC during graduate school and later signed up with the Illinois National Guard. She was co-piloting a Black Hawk in 2004 when Iraqi insurgents hit it with a rocket-propelled grenade. Among her accomplishments, her campaign says, is launching the first 24-hour hotline for suicidal veterans and introducing legislation to improve mental health treatment that was signed by President Obama. Jon Soltz, who leads the liberal political action committee VoteVets, which is backing Duckworth, said the group is prepared to spend significant money to attack Kirk. "It's just a very dangerous strategy for them to continue to try to define Tammy Duckworth in this way, when if you just look at a picture of her you can see she's a war hero," Soltz said. Anderson, who works at the University of Illinois' Center for Wounded Veterans in Higher Education, doesn't believe either candidate has clear offered a plan for veterans. "They haven't given us a blueprint of what their objectives are," he said.   by SARA BURNETT
VIRGINIA BEACH, Va. (AP) -- A retired Navy veteran must pay for two flags after stealing one from his Virginia Beach neighbor because it wasn't being illuminated at night. News outlets report a judge on Monday found John Parmele Jr. guilty of three misdemeanors after Parmele's neighbor Mike Anderson presented footage of the crime being committed. Parmele said he took the American flag to the Veterans of Foreign Wars to give it a proper retirement. Parmele says he had tried in vain to get Michael to illuminate the flag on his mailbox at night so it would be in accordance with federal code. Parmele was found guilty of stealing the flag, trespassing and destruction of property. He was ordered to pay a $300 fine and reimburse Anderson about $100. His 90-day jail sentence was suspended.
WASHINGTON (AP) — The House has voted to ban the display of the Confederate flag on flagpoles at Veterans Administration cemeteries. The 265-159 vote would block descendants and others seeking to commemorate veterans of the Confederate States of America from flying the Confederate Battle Flag over mass graves, even on days that flag displays are permitted. California Democrat Jared Huffman authored the prohibition, saying the flag represents "racism, slavery and division."   After a mass shooting at a South Carolina black church last year, the state legislature ordered the flag removed from the capitol in Columbia.   The House approved amendments last year to block the display and sale of the Confederate flag at national parks but a backlash from Southern Republicans caused GOP leaders to scrap the underlying spending bill.
A Must Read from NPR— together with member stations from across the country — NPR has been reporting on troubles with the Veterans Choice program, a $10 billion plan created by Congress two years ago to squash long wait times veterans were encountering when going to see a doctor. But as we reported in March, this fix needs a fix. Around the nation, our joint reporting project — called Back at Base — has found examples of these problems. Emily Siner of Nashville Public Radio reported on troubles with overcrowding in Tennessee. And Monday, we reported on hospitals and doctors not getting paid in Montana and veterans getting snarled in the phone systems trying to make appointments in North Carolina. Congress and Department of Veterans Affairs officials are in the middle of overhauling the program. Here are some reasons: • The VA's most recent data show compared to last year, there are now 70,000 more appointments that kept a veteran waiting at least a month to get care. • A March General Accounting Office report shows the Choice program had little impact on getting veterans to see a primary care physician in 30 days. • Thousands of veterans referred to the program are returning to the VA for care — sometimes because the program couldn't find a doctor for them, and for 28,287 vets, because the private doctor they were told to see was too far away, according to data NPR obtained from the VA. • The VA's own inspector general found that Colorado Springs, Colo., veterans were waiting longer than 30 days for care because staff at the local VA hospital was not adding them to the list of patients eligible for the Choice program. The VA recently set up a hotline to help veterans who have issues with their credit because the programs hadn't paid doctors on time. Click Below http://www.npr.org/2016/05/17/478215589/how-congress-and-the-va-left-many-veterans-without-a-choice
It may very well have been the largest American Legion Walk for Veterans yet. An estimated 220 Legion family members and veterans walked alongside a series of memorials adjacent to the National Infantry Museum and Soldier Center in Fort Benning, Ga., on May 14. Part of the success can be attributed to the home field advantage of National Commander Dale Barnett. And in the spirit of a hometown hero, Barnett began the event with a pre-game pep talk to the large group of walkers. “This really is a welcome home,” Barnett said, pointing out that his daughter Michelle was born at the local hospital. “I deployed for Desert Shield/Desert Storm from Columbus, Georgia, with the 2nd Battalion, 18th Infantry. I chose (to visit) Columbus, Georgia, Fort Benning and Callaway Gardens because this truly is a homecoming.” He explained the rationale for the gold T-shirts given to registered walkers. “We are wearing these funky shirts because they stand out," he said. "When people look at us and ask why are we here with our families and why are we here as veterans and why do we do what we do, I want you to tell your story about why you are an American Legion member. I’m proud that my family is part of this journey with The American Legion. I hope you can be visible in your community to raise awareness of veterans. God bless you for being with us." The morning festivities began with a reading of a proclamation issued by Columbus mayor and city council, declaring May 14 as “Commander Dale Barnett Day.” U.S. Rep. Sanford Bishop, D-Ga., also attended the walk. “I want you to know that The American Legion is very, very special. It is the number one veterans service organization,” Bishop said. “As your member of Congress for the Second Congressional District, I can tell you firsthand that because of The American Legion, the issues that matter to veterans and their families are first and foremost on the table in Congress. And whenever (legislation) gets screwed up, The American Legion shows up, just like the cavalry, and gets it straight.” The walk raised $14,811 for Barnett's primary fundraiser, the National Emergency Fund (NEF). The NEF provides financial grants to qualified posts and Legion family members affected by declared natural disasters to help with out-of-pocket expenses, such as temporary housing, food and clothing. “Everything we’ve done for the past few years has been for Dale, our commander, our favorite son," said Department of Georgia Commander Thom Mash. "Our membership reflected that last year, and you’ll see it reflected again this year. We do it for Dale. We’re proud of him.” While Barnett frequently reminds the public of the estimated 22 veterans a day that commit suicide, Mash added a few additional reasons why The American Legion needs to "walk for those who marched for us." “A lot of thought went into that message,” Mash said. “It’s simple and right to the point. People from around the country tell me that they are in anti-veteran or anti-military states. Georgia is lucky in that sense. I think that the VA claims list and VA wait times need to be shortened, although it is going in the right direction.” During an evening homecoming banquet, Barnett reflected on highlights of the more than 30 awareness walks that he has participated in from Florida to California. “I will tell you, my Georgia American Legion family, it would have never happened if you hadn't stood behind me and allowed me to have these wonderful adventures and raise awareness about our great organization.” By John Raughter for American Legion News
Newswise — A University of Iowa researcher is working with the Veterans Administration on a pilot program to help female veterans suffering from postpartum depression. MomMoodBooster is an online intervention tool that helps mothers who live in rural areas cope with their depression. “Women in rural areas often don’t seek out or have access to mental health care,” saysMichael O’Hara, professor and Starch Faculty Fellow in the UI Department of Psychological and Brain Sciences. “Reaching out in particular to rural veteran women seemed to me like it was just something important to do.” Each year, about 300,000 new mothers in the United States suffer from postpartum depression, experiencing low moods, loss of interest in normally enjoyable activities, insomnia, appetite disturbances, difficulty concentrating, and suicidal thoughts—and O’Hara says this estimate is low. So far, about 40 women from across the country have taken part in MomMoodBooster with positive results. Over a six-week period, women participate in six sessions that target managing mood, increasing pleasant activities, managing negative thoughts, increasing positive thoughts, and planning for the future. Phone coaches also call to check in with the women, tracking progress, answering questions, and providing encouragement. O’Hara says it seems possible, given the combat experience of many female veterans, that they may be more at risk for depression, though that has not been quantified. “I was in the Navy for four-and-a-half years, and it’s not an easy life,” O’Hara says. “These are women who have served our country, and we have a way of contacting them. You put that together, and it’s sort of a winning combination.” Treating postpartum depression is important not only for mothers, but also for the well-being of their children. A depressed parent often pays less attention to the baby’s cues, either interacting less and neglecting the child or working so hard to interact that the baby becomes overwhelmed, leading to developmental problems. The self-focus caused by depression can be harmful to children in other ways as well. For example, when parents choose whether to make a meal or drive to a fast food restaurant, depression can influence them to make the easier choice. “Any time a parent is distracted by mental health concerns, this can lead to problems with the children,” O’Hara says. “We know that inconsistent parenting often makes it harder for children to internalize societal rules, a situation that often sets the stage for behavior problems. Having parents who are emotionally stable is quite a benefit to the child.” For some women, postpartum depression represents a recurrence of depression at a stressful time in their lives. For others, it stems from issues surrounding the marriage, finances, or simply the challenge of caring for an infant. Biologically, there is increasing evidence that pregnancy hormones may the set the stage for low mood, which, when combined with environmental factors, may cause postpartum depression. “The most dominant things I see are poor social support systems and conflict with the partner,” O’Hara says. The program will continue at least through the end of September, when the VA will determine whether to continue funding, and O’Hara expects to write a research study based on the results of the pilot. The MomMoodBooster project is funded by the VA Office of Rural Health and the VA Office of Women’s Health Services.
Newswise — Over the last decade, repair of the mitral valve (MV) has become widely favored over its replacement. Data available from such sources as the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) have documented this trend at non-governmental hospitals, but there is little known about mitral surgery practice in the largest federal health system in the US - the Veterans Affairs (VA) Health System. In a presentation at the 96th AATS Annual Meeting, Faisal G. Bakaeen, MD, presents data from more than 4,100 mitral valve surgeries showing that mitral valve operations are performed with low mortality in the VA and that the percentage of repair vs. replacement surgeries has increased significantly since 2001. However, despite the survival advantage for mitral repair in primary mitral regurgitation, the rate of valve repair was quite variable among the VA centers and offers an opportunity for system-wide quality improvement. Baltimore, MD, May 17, 2016 – Little is known about mitral valve (MV) surgical outcomes within the largest US federal health system – the Veterans Administration (VA) Health System. At the 96th AATS Annual Meeting, data presented from 40 VA cardiac surgery centers reveal that although MV repair rates increased from 48% in 2001 to 63% in 2013, a wide variability exists in repair rates among medical centers. This is especially important because MV repair mortality rates were significantly lower in patients with primary degenerative disease. “This large multi-center study adds further evidence to support the use of MV repair over replacement in patients with degenerative MV disease. Despite the benefits associated with MV repair, the rate of valve repair utilization varied widely among centers and presents an opportunity for education and quality improvement”, explained lead author Faisal G. Bakaeen, MD, Department of Surgery, Baylor College of Medicine, The Michael E. DeBakey VA Medical Center (Houston, TX), and the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic (Cleveland OH). The investigators found that between 2001 and 2013, 4,165 mitral valve surgeries were performed, including 2,408 MV repairs and 1,757 MV replacements at 40 VA centers. The overall MV repair rate increased from 48% of the total number of MV surgeries to 63% in 2013. “The increased rate of MV repairs in VA hospitals mirrors the trend revealed by analyses of the STS ACSD,” commented Dr. Bakaeen. “These findings indicate that the introduction and adoption of novel surgical procedures occur in tandem at VA and non-VA facilities. This is expected because all VA cardiac programs are affiliated with academic centers and some share faculty and educational programs with their university affiliates.” The study highlighted other advantages of MV repair compared to MV replacement, including fewer complications around the time of surgery and shorter hospital stays. MV repair also showed some survival advantage. While some differences between surgical groups were sometimes not statistically significant (e.g. unadjusted and adjusted 30-day operative mortality rates), mortality rates for MV repair were significantly lower at both 180 days (2.5% vs. 5.0%) and 365 days (3.0% vs. 5.7%) in patients with primary degenerative disease. After 10 years, mortality was marginally lower for MV repair. When the investigators examined annual MV procedural volume per medical center, they found it varied widely: from 0 to 29, with a median of 7. The median number of annual MV repairs ranged from 0 to 21, with a median of 4 per center. Other studies have suggested that MV surgery volume is a significant predictor of greater MV repair use and better mitral surgery outcomes. In fact, some reports have specified that 40 MV repairs per year should be the minimum number performed annually to maintain a high level of care. This report, however, found that none of the VA centers met this 40 case per year threshold and, in fact, center volume accounted for only 19% of the total variation in facility-level MV repair. Dr. Bakaeen noted that the 40 case per year threshold may not be applicable to the VA system. “VA hospitals are not typical low-volume community hospitals. The shared-faculty model and educational collaboration that exists between some VAs and their academic affiliates may help mitigate these hospitals’ low-volume status, which would explain their good MV outcomes.” Nevertheless, he suggests that determining why MV repair rates are very low in some VA hospitals presents an opportunity for quality improvement.
Newswise — In a Veterans Affairs study of more than 300 enlisted Army National Guard and Army Reserve members who had deployed to Iraq or Afghanistan, a majority reported symptoms consistent with a condition known as chronic multisymptom illness (CMI). The data were collected a year after the soldiers returned home. The results suggest that deployment to these conflicts could trigger symptoms consistent with CMI. The ailment presents as a combination of medically unexplained chronic symptoms, such as fatigue, headache, joint pain, indigestion, insomnia, dizziness, breathing problems, and memory problems. The study, by researchers with VA's War-Related Illness and Injury Study Center (WRIISC) in New Jersey, appeared online Feb. 22, 2016, in the Journal of Rehabilitation Research and Development. "As a whole, CMI can be challenging to evaluate and manage," said lead author Dr. Lisa McAndrew. "CMI is distinct from PTSD or depression. It contributes to significant disability." McAndrew is also with the University at Albany. In the veteran community, chronic multisymptom illness has previously been associated mainly with service during the Persian Gulf War in the early 1990s. At least a quarter of those veterans are affected. Experts aren't sure, though, if that condition is the same one that has emerged among more recent veterans, as documented in the newest WRIISC study and one or two earlier ones. Last year, for example, researchers with the Millennium Cohort Study reported that about a third of combat veterans who served in Iraq and Afghanistan had CMI symptoms. "This condition appears to be similar to that experienced by many Gulf War veterans, in terms of the symptoms, but we don't really know if it's the same condition," says McAndrew. "That still requires study." McAndrew and her colleagues surveyed 319 soldiers about their overall health before they deployed and one year after they returned. The VA team found there were 150 soldiers who did not report many symptoms before they deployed but who reported symptoms of CMI one year after deployment, suggesting a link between deployment to Iraq or Afghanistan and CMI. In total, nearly 50 percent of the overall group met the criteria for mild to moderate CMI, and about 11 percent met the criteria for severe CMI, one year after deployment. The most common symptoms reported were trouble sleeping, moodiness or irritability, joint pain, fatigue, difficulty remembering or concentrating, headaches, and sinus congestion. Not surprisingly, the researchers found that veterans who screened positive for CMI scored significantly lower on measures of physical and mental health function. Of the 319 veterans in the study, 166 had chronic pain, lasting more than three months. Almost all of those with chronic pain--90 percent--also met the criteria for CMI. Similarly, 82 percent of those with CMI reported chronic pain. The finding underscores the strong link between chronic pain and CMI, say the researchers. The study also found that almost all veterans with PTSD symptoms also showed signs of CMI--about 98 percent. Only seven patients had PTSD and did not meet the criteria for CMI. In contrast, though, about 44 percent of the veterans with CMI did not have PTSD. In other words, the link between PTSD and CMI was not as robust as that between chronic pain and CMI. The authors caution that the study looked only at pain and PTSD as factors tied in with CMI. It did not document other conditions that could possibly account for the symptoms of CMI, such as depression, traumatic brain injury, and substance abuse. At the same time, they say these other conditions are unlikely to completely account for the frequency of symptoms seen in the study. By the same token, other conditions not examined in the study, such as arthritis or multiple sclerosis, could cause symptoms similar to those of CMI. More research is needed to tease out those variables. Another limitation of the study: The research team used a definition of CMI, established by the Centers for Disease Control and Prevention (CDC), that is based on Gulf War Veterans. They say it might not exactly fit the symptoms of veterans of the more recent conflicts. Also, it's unclear whether the Guard and Reserve members surveyed in the study are representative of the larger veteran or military cohort who deployed to Iraq and Afghanistan. All in all, the research team advises that the results be interpreted with caution. "We're taking the approach that an abundance of caution is necessary in the clinical implications of the findings," says McAndrew. "Respondents self-reported symptoms on pen and paper surveys. The symptoms were not confirmed or evaluated by a clinician. While the CDC case definition is fairly clear-cut, in clinical practice there is a lot of gray area around applying the label of CMI. We used the term 'symptoms consistent with CMI' to indicate the uncertainty due to the self-reported, clinician-unverified nature of the classification." Pending further research on the topic, McAndrew's group says clinicians in VA or other settings should consider CMI when evaluating Iraq and Afghanistan Veterans, especially those with chronic pain. Once the condition is identified, clinicians in VA and the Department of Defense do have a clinical practice guideline for managing the condition. "Acknowledging the presence of multiple symptoms and taking a holistic approach to achieving patient goals is critical in managing CMI," says McAndrew. For example, pain management may need to be tailored to account for other symptoms of CMI. The WRIISC study notwithstanding, McAndrew says not enough attention has been focused on the issue to date. "There have been few studies of CMI among Iraq and Afghanistan veterans. Our findings suggest this could be an overlooked problem." ### Senior researcher on the WRIISC study was Dr. Karen Quigley, now at the Edith Nourse Rogers Memorial Veterans Hospital and Northeastern University.
Craig Schroeder, who was injured in 2006 while serving with the Marines in Iraq, suffers from traumatic brain injury and pain, for which he has been on a steady regimen of opioids. (Ted Richardson/For The Washington Post)   New federal rules that make it harder to get narcotic painkillers are taking an unexpected toll on thousands of veterans who depend on these prescription drugs to treat a wide variety of ailments, such as missing limbs and post-traumatic stress. The restrictions, adopted last summer by the Drug Enforcement Administration to curb a national epidemic of opioid abuse, are for the first time, in effect, forcing veterans to return to the doctor every month to renew their medication, although many were already struggling to get appointments at overburdened VA health facilities. And even if patients can get appointments, the new rules pose an additional hardship for many who live a good distance from the health centers. Although the tighter regulation applies to everyone on opioid painkillers, it’s hitting veterans especially hard because so many are being treated for horrific injuries sustained during the long wars in Iraq and Afghanistan and have become dependent on the Department of Veterans Affairs’ beleaguered health-care system for medical care. The rules come at a time of turmoil for VA. The agency’s widespread problem with patient backlogs burst into view last year with revelations that employees had covered up how long veterans had to wait for care, even for such pressing matters as cancer and suicide prevention. In dramatically curtailing access to the highly addictive painkillers, the government is trying to roll back what the Centers for Disease Control and Prevention has termed “the worst drug addiction epidemic in the country’s history, killing more people than heroin and crack cocaine.” The rules apply to “hydrocodone combination products,” such as Vicodin. More than half a million veterans are now on prescription opioids, according to VA. Pain experts at VA say that in hindsight they have been overmedicating veterans, and doctors at the Pentagon and VA now say that the use of the painkillers contributes to family strife, homelessness and even suicide among veterans. A study by the American Public Health Association in 2011 also showed that the overdose rate among VA patients is nearly double the national average. But some veterans say they have come to depend on these painkillers to function and now, unable to get a timely renewal of the prescription, are suffering withdrawal symptoms that feel like a panic attack and the flu at the same time. Craig Schroeder was injured in a makeshift-bomb explosion while serving as a Marine corporal in the “Triangle of Death,” a region south of Baghdad. He suffers from traumatic brain injury, which has affected his hearing, memory and movement, and from pain related to a broken foot and ankle and a herniated disc in his back. He has been on a steady regimen of opioids. But after the DEA regulations were put in place, he was unable to get an appointment to see his doctor for nearly five months, he said. He stayed in bed at his home in North Carolina much of that time. “It was a nightmare. I was just in unbearable, terrible pain,” he said. “I couldn’t even go to the ER because those doctors won’t write those scripts. ”His wife, Stephanie Schroeder, said getting him a VA appointment turned into a part-time job and her “main mission in life.” While part of the problem was a shortage of doctors, she said she also noticed that VA had become hostile toward patients who asked for painkillers. “Suddenly, the VA treats people on pain meds like the new lepers,” she said. “It feels like they told us for years to take these drugs, didn’t offer us any other ideas, and now we’re suddenly demonized, second-class citizens. ”Officials at Disabled American Veterans, a veterans service organization, said VA needs to be more compassionate and help veterans through the changes. “We’re hearing from veterans with lifelong disabilities, who never had a problem with addiction issues. They have been on these drugs for decades, and then all of a sudden it was boom, a total change in attitudes,” said Joy Ilem, the group’s deputy national legislative director. Gavin West, a clinical operations chief at VA, said there has been a systematic effort since autumn to contact veterans to explain the new rules, broader concerns about opioid use and alternative options for treatment. At the same time, he said, the agency is working to ensure that veterans get the access to medical care that’s required. “The DEA did a good thing here for opioid safety,” he said. But he added, “How do you balance the sensitivity of patients and the new rules when all of a sudden a veteran, who’s been treated with this medication for 15 years or 20 years, has everything change?” To help patients adjust to the changes, Rollin Gallagher, VA’s national director for pain management, said staff members are meeting personally with veterans. “There is the real anxiety of being in pain and losing control of that pain. We are aware of the fact that we need to pay attention to this,” he said. The agency recently set up a Choice Card program for veterans, which would allow those facing long wait lists or who live more than 40 miles away from a VA hospital to use private clinic visits. Veterans say the initiative iscomplicated and confusing. VA officials acknowledged this month that veterans have been using this program at a lower rate than anticipated. [Veterans say new choice cards are causing more problems] DEA officials declined to comment on the specific challenges that the new rules pose for veterans. Barbara L. Carreno, a DEA spokeswoman, said in a statement that everyone, including “practitioners employed by the U.S. Veterans Administration,” have to follow the new regulations. The officials said the rules are a response to multiple medical studies that have showed that the opioid overdose rate is higher in the United States than anywhere else. DEA officials offer some flexibility, allowing doctors to write prescriptions for up to 90 days by post-dating them. But many VA doctors will not do that because of concerns over fraud or fatal overdoses; doctors are telling patients they need to come back every month, medical staff say. Half of all returning troops suffer chronic pain, according to a study in the June issue of the Journal of the American Medical Association. So a new generation of pain doctors is pushing for alternative ways to help veterans cope with chronic pain. Some alternatives are acupuncture, bright light therapy and medical marijuana. As part of a $21.7 million initiative with the National Institutes of Health, VA is looking for therapies that could substitute for opioids. “Our hospitals are doing some really exciting things to combat chronic pain and take care of our veterans. There are VA hospitals that are using alpha-stimulation devices to treat pain and depression,” VA Secretary Robert McDonald said. “That’s only going to continue and keep getting better. And we are getting there.” [Federal research seeks alternatives to addictive opioids for veterans in pain] In the meantime, however, veterans say they continue to bear the burden of the new restrictions on narcotic painkillers. A retired staff Army sergeant who served in Iraq, who spoke on the condition of anonymity for medical privacy reasons, said he can’t drive because of shrapnel in his femur and pelvis. He takes the bus nearly two hours for “a one-minute consult” to get his medications. He has been taking them for more than nine years and has never had an addiction problem, he said. Mike Davis, a retired Army corporal, said he shattered his left arm from the elbow to the fingertips when he fell off of a Pershing missile during maneuvers in Germany in 1979. Over the years, he has had six surgeries. After the last one, in 2003, he was prescribed opioids and said he has been on them since. Davis, who now works as a social worker in Illinois, said he feels lucky to have found a combination of painkillers that works for him. “It’s just insulting to the veteran to assume they are abusing these drugs,” said his wife, Linda Davis, who works as his personal patient advocate. “I’m fully aware that people doctor-shop, some docs overprescribe. But I think they need to realize that there’s a real difference between addiction and dependence. ”But Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, called the new DEA rules “the single most important change that could happen. The best way to treat any disease, whether it’s Ebola or opioid addiction, is to stop creating more people with the disease.” At the same time, he said, VA needs to do far more to help veterans through the rocky transition. “Unfortunately, veterans are the victims here,” Kolodny said. “The VA created this mess by aggressively jumping onto pills as the solution. But it’s not something you can just abruptly stop.”    by Emily Wax-Thibodeaux