Health problems stalk veterans on the home front

ST. PETERSBURG - On the streets of Fallujah, Al Miller was the closest thing his fellow Marines had to a family physician.

The hospital corpsman’s work looked nothing like being in a stateside doctor’s office or even a big city hospital emergency room. Serving in Iraq’s Anbar province, Miller’s charge was to focus on survival. Healing was a distant second.

“There were gunshot wounds, bad burns, traumatic amputations,“ he said of his tour in 2006 and 2007. “There’s a whole bunch of things much more pressing than elevated blood pressure.“

War’s brutality demands that those in its midst focus on immediate dangers. But a growing body of research is showing that the long-term health implications for combat veterans is greater than the physical and emotional scars war leaves behind. Chronic illnesses, from back pain to high blood pressure, also take a toll on the men and women who served the country.

The Department of Veterans Affairs has long tracked health problems of its combat vets, even back to World War II, when service members dealt with the residual effects of injuries incurred in cold weather, hearing loss and trauma-related arthritis. But newer studies, including an exhaustive, ongoing analysis of some of the 1.05 million men and women who have served in recent conflicts, have found that physical and mental illnesses are showing up in veterans at a far younger age.

An estimated 41 percent of the servicemen tied to wars in Iraq and Afghanistan are younger than 30 when diagnosed with one or more conditions, according to the October analysis by the Veterans Hospital Administration’s Office of Public Health and Environmental Hazards. The cumulative and preliminary data looks at 480,000 recent war vets hospitalized or served by VA clinics nationwide, tracked quarterly since 2002. It also includes the 4,777 American men and women killed in duty through October.

For the returning servicemen, mental health disorders are identified in nearly half the cases. But musculoskeletal issues such as back problems or joint pain are diagnosed more often, 52 percent of the time. Doctors also frequently identify other physical worries: medically unexplained conditions (45 percent) such as chronic fatigue syndrome, fibromyalgia or irritable bowel syndrome; nervous system problems (39 percent); and digestive disease (33 percent).

Also, a new study of nearly 9,000 vets serving in Iraq and Afghanistan between 2001 and 2003 showed increased risk for high blood pressure, or hypertension, based on the number of times the person was exposed to combat. Witnessing or being exposed to combat-related death or other disaster had a clear association with vets reporting hypertension, said the study published in the American Heart Association journal Hypertension.

About 7 percent of all the vets surveyed reported having hypertension within three years of service, the report said. Of that group, those who had been deployed and exposed to combat situations were 33 percent more likely to report problems with high blood pressure than those who were not.

Of particular interest is the average age of the soldiers who reported high blood pressure: 35, said Mazhar Afaq, assistant chief of cardiology at Bay Pines VA Medical Center in Pinellas County. That’s decades earlier than most American adults traditionally start struggling with hypertension.

“That’s certainly a very young population,“ he said of the study based on the Department of Defense’s Millennium Cohort Study, which looks at the long-term health effects of military service.

Both of these studies point to a growing recognition that combat’s long-term health impact requires a larger understanding of the role of mental health and war. Problems once called battle fatigue are now understood to be part of a larger spectrum of post-traumatic stress disorders, or PTSD, and few people in or out of the military question its significance.

Mental health disorders are cited in more than 47 percent of Iraq and Afghanistan veterans under VA care, according to the October VA Public Health and Environmental Hazards analysis. PTSD, depression and neurotic disorders are cited as larger factors than alcohol or drug abuse.

The correlation between mental stress and blood pressure makes sense, said Iraq veteran Miller, who says combat “is not like the movies. It’s not fun; it’s not glamorous. It’s not exciting; it’s scary.“ He survived a roadside bomb attack, but he will forever carry the memory of having his 22-year-old Humvee driver die in his arms.

“You’re ramped up all the time, you know? I look at it a lot like a heat injury, with heat exhaustion or heatstroke. Eventually your body loses the ability to regulate your temperature,“ said Miller, now serving as the facility compliance officer at Bay Pines. “It only makes sense that that would happen with hypertension.“

Thirty years ago, Jack Doan of Palm Harbor wouldn’t admit that what he experienced in the Marine infantry in Vietnam was damaging his health. He turned his back on the military altogether, rejecting three years of service for which he had voluntarily signed up. Even though he could feel the after-effects of the shrapnel that hit his legs, he denied the emotional trauma that was creating a coronary disaster inside him.

It wasn’t until 2005, when his wife and fellow vets feared for his health, that he got help. Today, Doan, 61, is able to manage his once out-of-control blood pressure with mental and physical techniques learned in a PTSD support group. He said it saved his life.

“The stressors are what make my blood pressure bump, skyrocket. ... I’m functional now,“ Doan said.

Though Doan and Miller served in wars decades apart, both Marines said they wish basic training could better prepare young servicemen for what they will experience. The emotional stress isn’t worth holding onto for decades.

“Kids nowadays are just not mentally equipped to deal with war,“ said Miller, 44. “It’s more fortunate for them now because we’ve got a lot more resources available for them.“

Today, medical screenings are standard operating procedure for men and women returning from active duty, Miller said. He said the chance to get evaluated for medical and emotional issues was a tremendous help to him, as the transition back from war zones is incredibly difficult.

“It took me easily three or four weeks of being home where I felt relaxed enough to be home,“ said the Detroit native who recently moved to Indian Rocks Beach with his wife and three young children.

At Tampa’s MacDill Air Force Base, returning service members and their families are encouraged to take advantage of counseling assistance to address social, physical and emotional concerns related to war, a base spokesman said.

A cross-discipline approach is critical to treating veterans, regardless of whether they were deployed, said Afaq, the Bay Pines cardiologist. The hospital recently launched a Heart Success clinic for that reason, using doctors, social workers and nutritionists to address all the problems affecting a veteran’s heart condition.

“If a patient comes to you with the idea that ‘I’m seeing a cardiologist today,‘ they may not want to speak about additional aspects of their life. But I think as a provider, it’s my duty to see what else is contributing,“ Afaq said.

Doan agrees, adding that there’s no way to improve health without addressing the mind, “the root of your being.“

“You get to a certain place in your life if you’re carrying baggage - bottom line that’s what we’re talking about here is emotional baggage,“ he said. “If you aren’t getting treated for it, it’s going to increase your chances for some kind of psychosomatic disorder.“