For example, battlefield conditions ranging from sun exposure to crowded living conditions to chafing and sweating caused by body armor can create hard-to-manage dermatologic issues. This year’s Compendium discusses the unexpectedly high rate of medical evacuations of troops from war zones because of skin problems, and how a tri-service program brought that under control. The solution was to use telemedicine to transport the expertise of dermatologists to the frontlines so skin conditions could be diagnosed remotely, with only the most serious being evacuated.
War zone situations also produce other medical conditions that, because of how they are intertwined with psychological issues, make them especially hard to diagnose. Are lower urinary tract symptoms a result of harsh battlefield conditions that make bathroom breaks difficult, or are they related to the post-traumatic stress disorder (PTSD) and depression that beset so many servicemembers in the aftermath of their Iraq and Afghanistan experiences? An article in this issue discusses how VA researchers are trying to answer that question.
PTSD and traumatic brain injury (TBI) also are contributors to the increasing number of patients with psychogenic nonepileptic seizures (PNES). On these pages, authors from the Veterans Healthcare Administration Southeast Epilepsy Centers of Excellence (ECoE) discuss how patients with PNES represent a new population that must be evaluated in the ECoEs to ensure the best treatment for war-injured veterans.
Another VA Center for Excellence network, the one overseeing treatment of multiple sclerosis, also is facing new challenges. As discussed in the 2013 Compendium, the MSCoE is grappling with some troubling questions raised by new research: Why are incidence rates for multiple sclerosis increasing in African-Americans compared with other racial backgrounds, and why is the disease more severe in that population?
Research raising those issues was done by VA clinicians, as was another effort that has created a lot of buzz, a study finding that contralateral prophylactic mastectomies are unnecessary in most cases where the surgery is performed. The article in this issue raises concerns about whether healthcare providers are doing enough to educate and advise breast cancer patients about their options.
Like the breast cancer feature, other articles in the 2013 Compendium of Federal Medicine discuss issues primarily affecting the population at the other end of the spectrum: veterans coping with diseases of aging.
The Compendium discusses how recommendations against prostate-specific antigen (PSA) screening for prostate cancer are getting some pushback, with researchers suggesting that screening methodology be revised and not abandoned. Those discussions are having a significant effect on the VA, which diagnoses more than 12,000 new cases of prostate cancer each year.
Another article is on newer anticoagulants and how they offer options for veterans with atrial fibrillation who are ineligible to take warfarin or prefer not to be on it. The drugs bring their own risks, however, but VA experts explain how they might be in a unique position to mitigate those.
Just as military and veteran patients are both alike and different from their compatriots who never served, so are federal healthcare providers. Military and VA clinicians have the unique experience of dealing with patients at every age and in sometimes less-than-favorable conditions.
I’ve thought a lot about the young men we met at the convenience store and what the future holds for them. As the war in Afghanistan winds down, will they be peacetime warriors or will they be frontline fighters in another distant land, such as Syria or South Korea?
We all pray that won’t be necessary. One thing I know for sure, however: No matter where they go as servicemembers or veterans, they will be well cared for by healthcare systems that provide quality of care unrivaled in any setting.
It is my privilege to work with the many healthcare professionals who are so gracious in providing information to U.S. Medicine. Thank you for your commitment and patriotism.
Brenda L. Mooney