Closing in on a Medical Mystery
SPH leads team searching for Gulf War illness answers
It is a medical mystery that has confounded doctors and patients alike for more than two decades: why tens of thousands of veterans of the first Gulf War continue to be dogged by a complex and debilitating web of symptoms 22 years after they were exposed to potential toxins, such as pesticides and sarin gas.
Now, researchers from a consortium of institutions headed by the School of Public Health are launching a massive four-year, $5 million study to test the theory that a chronic inflammation in the brain is activating brain and immune pathways to cause ailments such as joint and muscle pain, memory problems, fatigue, headaches, and gastrointestinal distress.
Funded by the Department of Defense, the study will bring together neuropsychologists, neuroscientists, immunologists, geneticists, and others from nine institutions to try to pinpoint a physical cause for symptoms—affecting an estimated 175,000 to 250,000 veterans of the 1991 Gulf War—that have so far defied explanation.
“I’m excited about this because I think we’re really at a point of figuring out what’s causing Gulf War illness,” says study lead investigator Kimberly Sullivan, an SPH research assistant professor of environmental health. “I think we’re close. Hopefully in four years, we’ll be a lot closer.”
The study will probe whether exposure to chemicals may have kicked off a process in which damaged neurons are continually activating the immune cells in the brain, called microglia, which can cause inflammation, muscle pain, headaches, and concentration problems, among others. Past studies, including several by Roberta White, SPH associate dean for research and a professor and chair of environmental health and a School of Medicine professor of neurology, found that the brains of veterans exposed to toxic chemicals had lower volumes of white matter, a component of the brain that helps nerve cells communicate, a deterioration that could be activating the microglia.
“There’s been a convergence of studies showing an impact on the brain and immune system,” says Sullivan (right). “If you get caught in these chronic activation loops, one of the results is that you could suffer chronic symptoms. When in pain pathways, this could result in chronic pain; in memory pathways, it could cause cognitive problems.
“The good news is, if we can identify the mechanism, there are treatments being developed for this kind of inflammation in the brain. Treatment options could be targeted directly to the problem.”
As many as one-third of the 700,000 U.S. military personnel who participated in the short-lived 1991 Gulf War suffer from a chronic multisymptom illness believed to have been triggered by chemical and biological agents. A congressionally mandated panel of experts that includes White and Sullivan has affirmed that the condition is linked to exposure to toxic chemicals, among them pesticides and pyridostigmine bromide (PB), a drug given to troops to protect against nerve gas.
But the mechanism of the illness has remained a mystery. Just last month, the Institute of Medicine (IOM) issued the latest in a series of studies, conducted on behalf of the Department of Veterans Affairs, which cautioned against a one-size-fits-all approach to treating Gulf War illness, recommending instead individualized treatment by teams of clinicians.
For years Gulf War veterans have been frustrated with the government’s slow response to their health problems and the lack of effective treatments. Some veterans’ advocates have complained that the VA has not taken their health ailments seriously, portraying them as psychological rather than physical.
The consortium’s work has taken on added importance because some of the symptoms reported by the more recent Iraq and Afghanistan veterans—including headaches, chronic pain, disrupted sleep, fatigue, and memory problems—overlap with the Gulf War veterans’ symptoms, although they may be triggered by a different mechanism.
Sullivan, who is associate scientific director of the congressionally directed Research Advisory Committee on Gulf War Veterans’ Illnesses, says the first step in determining treatments is pinpointing the cause.
The consortium members, Baylor University, Miami VA Medical Center/Nova Southeastern University, Australia’s University of Adelaide, Drexel University, the University of Colorado, Temple University, the BU School of Public Health, the Centers for Disease Control and Prevention, and the National Institutes of Health, will perform studies examining markers in the blood and brain fluid, in addition to brain imaging (MRI and PET scans) and memory testing, to try to identify the source of the inflammation and biomarkers of the condition. Studies also are planned on animals, to test initial treatments.
Much of the imaging work on Gulf War veterans will be conducted at the BU Medical Campus, while animal and other testing will be done at other institutions.
“We need all these experts in different fields because we want to approach this problem from different angles,” Sullivan says, noting that previous studies have focused on “a piece of the puzzle—neuropsychologists look at their piece, immunologists and gastroenterologists look at theirs. We’re trying to bring all the pieces together.”
If the brain-immune pathway is confirmed as the root of the problem, she says, researchers hope to be able to “treat the mechanism, as opposed to the individual symptoms.”
In a separate trial, Sullivan and her colleagues are developing a possible treatment, involving intranasal insulin, to target such neuroinflammation. Researchers from the Boston VA Medical Center, the James J. Peters VA Medical Center in the Bronx, and the Icahn School of Medicine at Mount Sinai are involved in that trial, funded by a $1.7 million award from the Department of Defense. Intranasal insulin has been found to improve memory and attention, reduce neuroinflammation, and modulate cortisol levels.
Sullivan, whose research grew out of work she had done with White, has been chasing the cause of Gulf War illness for almost two decades. She says it is impossible to give up the hunt when so many veterans are still suffering and leads for developing treatments are now within reach.
“These vets are still having symptoms 22 years later,” Sullivan says. “It’s clear something happened to them that isn’t resolving over time. This is different than the primary kinds of trauma and blast exposures that many Iraq and Afghanistan veterans are experiencing” during a prolonged ground war.
Lisa Chedekel can be reached at firstname.lastname@example.org.
1991 Jan.-Dec. I spent 7 mos. in country. It wasn’t until Oct. 2011 that I became even aware that I could seek D.V.A. medical help, what I’ve experience since………………………..will be the price I pay. My life. My livelihood, MY death. 22 yrs. later, Over 80 symptoms and conditions have me very concerned. From what I’ve learned and personally experienced, For Desert Storm Veterans, it doesn’t get better.
Research Advisory Committee on Gulf War Veterans’ Illnesses
Boston University School of Public Health
Department of Environmental Health
715 Albany Street
Boston, MA. 02118
Kimberly Sullivan, Ph.D.
February 4, 2013
Subject: Response to the Gulf War Illnesses IOM/ NAS Report 1-23-2013
Re: Gulf War Illnesses, Returning Veterans, Non-Deployed and Families
Dear Committee Members,
It is again another committee ( IOM / NAS ) that ignores the veterans and doesn’t know of gulf war Illnesses. The IOM did not use any military medicine of any kind. This is discrimination to the U.S. Congress and Veterans. The number of Injuries and Diseases from the gulf war and returning veterans have gone in the upward numbers from 175, 000 to over 1,250,000 veterans injured, total amount of troops today are in the millions. These are the combined totals from the 1990-2013 war and these totals continue to rise, until 2025. The IOM only came out with Chronic Multisymptom Illnesses ( CMI ), the Committee is stuck on minimizing gulf war health issues, Undiagnosed Illnesses and the environmental health effects from the 1990/1991 War. The IOM / NAS forgot the Neurological Issues and treatment Protocol for Neurological, Natural and Alternative Medical Treatments along with other medical intervention to help alleviate the symptoms from the Environmental War. The IOM has it wrong, the Gulf War Veterans do not receive care outside of the VA, we cannot, no referral otherwise. The Civilian doctors tell us to go to the VA for the medical care, they ( VA ) would be the first to treat an endemic disease or chemical injury from other parts of the world. The IOM / NAS thinks the Gulf War was only ( 4 ) Four Days of Warfare, well we had the Bombing campaign, Air Campaign and Ground Campaign in which took over a year up until September 11, 2001 and dubbed by the Pentagon that the Gulf War was the largest war since World War Two, not four days. Gulf War August 2,1990 through and ending on September 11, 2001, 11 years of War, not four days combined up to Today’s Date ! The IOM still has the Veterans going in medical circles. We have to look closer at Beatrice A. Golomb, MD, PhD research on CoenzymeQ10 with different Mgs’.
Vs. http://www.mayoclinic.com/health/coenzyme-q10/NS_patient-coenzymeq10 . The concern with lumping too many cases under the label Gulf War syndrome ? Dr. Golomb fears it could lead to a one-size-fits-all research and therapy that won’t work. We need help !
This tells the American Taxpayers and The U.S. Congress that the IOM / NAS is only skimming and minimizing over the Psychiatric reviews and not reporting the Neurological Issues that were peer reviewed and we should have our U.S. Congress demand Military Medicine and Civilian Medicine to work together to find a cause or causation, as you can see the IOM / NAS is not reporting the truth to the U.S. Congress on the January 23, 2013 committee hearing about the Gulf War and Health Volume Number 9. This is very misleading and it is withholding treatments. We have Gulf War Illnesses, Returning Veterans, Non-Deployed and Families suffering from Combat, nerve agents, Environmental insults, Vaccines, and other exposures from our service to our Country. Dr. Soxs quoted that the civilian doctors IOM / NAS ( Sept. 7, 2000 ) don’t know military medicine and nerve agents, well now we must act to bring military and civilian medicine together to get our answers.
We also need help with Conventional, Natural and complementary medicine. To bring relief to suffering veterans and their families. MRE Vs. Chemicals that preserve the food in excess of 90 degrees = 3000 calories/per meal, nerve agents, toxic sand, Multiple Vaccines – causing ALS-ALZ-MS. More neurological issues and veterans are dying at a higher rate, there were over 80,000 deaths since 1990 / 1991. Just the other day in Acton, MA. A 42 year old Gulf War Veteran Passed away, Why ?
There is a casual relationship to our military health from the 1990-2001 ( Bombing campaign, Air Campaign and Ground Campaign) exposures that are having a severe impact on our brains and neurological systems. PTSD and stress are different. The IOM / NAS said that VA can make a significant difference in the lives of veterans who have the condition by helping to ensure they receive more integrated, comprehensive, and responsive health care, this would be a runaway train with no specific guidelines to follow if VA doesn‘t comply. Veterans should undergo a comprehensive health examination immediately after they leave active duty and the results of such exams should be available to clinicians both inside and outside of the VA to ensure continuity of care. The VA doctors have to stop guessing at what is wrong with our health and actually examine us and make out the medical reports. Without minimizing the largest combat exercise since World War Two. This was a quote from the pentagon.
The VA-RAC needs to change it’s charter and mission statement so we can continue looking for research and treatments and strengthen the VA – RAC Mission for research to go to Clinical Treatments, there is no Plan for treatment today or in the future ? The VA – RAC committee also must start looking at neurological issues and brain related exposures in
Desert Shield/Desert Storm and they ( VA ) need to be retrained to treat our injuries and diseases. FM-8-285 Military Nerve Agent Manual ( Military Medicine ) of February of 1990 has treatments for exposures. In 1973 George H. Bush ( Ambassador to the United Nations ), King Faisal ( Saudi Arabia ), Hafez al-Assad ( Syria ), Muammar Gaddafi ( Libya ), Saddam Hussein (1992–2006), Had an argument over chemical weapons and today January 27, 2013 our U.S. Defense Secretary Leon Panetta is reporting more Chemical Weapons from Saddam Hussein Stock Pile in Syria ( January 2013 ) which Colin Powell ( Joint Chief of Staff ) said that they were buried in Iraq and they could move them to Syria, Well it looks like the chemicals went to Syria in 1990/ 1991 timeframe. We have troops from the 1990/1991 war that were exposed to those same or more manufactured chemical weapons. This is the smoking gun everyone is looking for ! The U.S. Congress must see and hear this ?
Public / Veteran statements from the IOM Meeting on January 23, 2013 none !
We need research oversight from the GAO, I.G.’s and H.H.S. and V.A.
Headaches/Diarrhea/Stomach gird/Tired/Joint pain/Skin
rashes/Hearing/Breathing/Sinusitis/CFS/MCS/Vision/Carbon monoxide exposures from oil well fires and exposed to nerve agents from the bombing campaign. This was the largest war since World War Two and of course longer than what CNN reported a 4 day war it was more like 2 years of heavy bombing. We shouldn’t be stuck in a group of Psychiatric Circles, when there are Neurological Defects. There should be a full evaluation for each veteran, the VA isn’t looking at or testing the veterans for gulf war Illnesses. There is No Effective recommendations from this IOM, just more of the total Psychiatric Circles and the discrimination that keeps veterans from getting any kind of treatments. The new IOM committee doesn’t have a thorough Extensive literature review it doesn‘t include Neurological Testing or MRI screenings- No Bio markers. – Chronic Illnesses – C0-morbid Conditions – Cognitive Mild to Severe – Sleep – Depression issues. No Care Management for the VA to implement into a gulf war Illness programs. We are heading into another brick wall for the VA to say No Effective treatments. Only coping mechanisms to go away with. This is an insult with all the studies in the last 12 years that have been completed by our researchers. We now have cancers, Brain Injuries, Heart Attacks and Stress and need Medical Treatments and the IOM ignores all of us, Why ?
The IOM / NAS has to stop talking down to Veterans Groups and the U.S. Congress. The U.S. Congress is looking for answers and we will have to return to Congress to get better support
( Mandatory Support ) to get specific Neurological Testing from the VA-RAC for review. To date the VA-RAC only has Psychiatric Circles for reviews to go on and no Neurological Treatments or any other kind of treatment of any kind, just psychiatric issues. It is not fair to send the troops to war and only have psychiatric treatments.
The Walter Reed program and the War Related Illness and Injury Study Center (WRIISC) are not effective and are only a small representation of gulf war illnesses and are very misleading.
The U.S. Congress has to exclude former Doctors from the DOD / VA that are interfering with Gulf War Healthcare and Returning Veterans Health issues. There is a Big list of Names that should be excluded or we should get a Gold Credit Card ( Congressman Sanders ) to go to a Local Hospital other than the VA / DoD Hospitals, February 28, 1999 at the CDC Conference when the DAV, VFW and American Legion and other groups refused to treat the gulf war veterans then, 14 years ago and today IOM / NAS still cannot get one treatment plan to the suffering Gulf War / Returning Veterans population. The VA / DoD has to have Neurological, Natural and Alternative Treatments along with other medical intervention to help alleviate the symptoms from the Environmental War. The IOM/ NAS must be blind / discriminating from treatments for gulf war veterans. How can this be happening ?
No More rubber stamping and minimizing the medical issues.
No More Road Blocks in the U.S. Congress.
SSG. Edward J. Bryan ( Disabled )
685 Broadway St. Unit # 74
Malden, Mass. 02148
Life Member Whitman DAV # 119
Life Member Medford VFW # 1012
U.S. Army ( Retired ) 1974-2000
U.S. Firefighter ( Medford ) Retired 1986-2000
Health Care Liaison ( VA-BU ) 1994-2001
Researcher for Gulf War Illnesses 1992-Present
VISN-1 Mini-Mac member 1998-Present
Walter Reed Veteran Health Advisory Council ( VHAC ) Deployment Health, 2000-2002
I do hope this won’t be an academic fiasco. In that I mean if soldiers were environmentally infected so were indigenous people. IP’s who were infected should be used as controls.
I am a desert storm veteran. I served with the 24th mech inf div. I had the anthrax vac, pb pills, and sarin gas exposure. My health has become so bad that I just hope to be alive in four years to receive this treatment. My guess is most of us will die in the coming years just like the guys in nam did from agent orange. Sad…….
How to File a VA Claim
Gulf War 1 / 2 / 3, OIF / OEF / OND
Example; Just go over the 18 issues and go over each item. Of course you cannot have all the items as complaints. This is just a guide. All you need is to work your claim through the advocates DAV, VFW, AL. You also can learn from different veterans groups. You may also benefit from going to a vet center nearest you. Bring this to your service officer or send it in as a claim. The Longest War in U.S. History May 1980- Present.
End of War 2025 per the U.S. Congress.
Department of Veterans Affairs
Boston Regional Office
John F. Kennedy Building
Government Center-Room 1265
Boston, Mass. 02203
Subject: Gulf War Injuries and Diseases
Dear service officer
I need to review my claim with your office and find out How my claim can be addressed with my complex issues. My issues should be addressed in some format, the presumption law is still in effect until the end of the year. December 31, 2016. I have been going to the VA Hospital for help and I believe that my medical files and my information that I have here today has enough information to look further in to my claim as its relates to my military service. I still think my commanders did not read the nerve agent book as we were trained and the commanders were removing the mask way to soon from our training exercises as we went to war and practice this over and over. Before Desert Storm I use to run and exercise 2-3 times a week, now I cannot even get out of my way, something happened in the gulf war, this is not me and I wish I had my old self back again. These are the issues to look at with my service in the gulf war that I believe that I was exposed to and are related to my service in the gulf in 1991. To include any and all types of cancers to the human body. Some doctors say it will take over 25 years for cancers and injuries to manifest. I believe that the environmental toxins or the toxic bowl of soup effect that VA Research Investigators quoted is related to my service related injuries in the Gulf War of 1991.
Claims that need to be reviewed and increased because of my current complaints
2). Ear Nose and Throat issues, Diagnostic Code 8865
1). Sore Throat and post nasal drip
3). Sand Storms, Sand exposures. Al-Eskan Disease and Reiter’s syndrome
4). Oil Rain, Oil Fires, Oil Smoke exposures
5). Chemical Alarms going off and on with not proper way to remove masking procedures FM 8-285
6). Hearing Loss – Aircraft Noise – Scuds Alarms ( KKMC ) – Rifle Ranges – bombing campaign
7). Reaction to smells, odors and fumes
8). Green phlegm all the time
3). Lung Issue, and Pleura Diagnostic Code 8868
1). Low level Nerve Gas Exposure Tap Test or MRI Carbon Monoxide or white matter disease
2). Black Lung. Oil Well Fires
4). Shortness of Breathe
5). Chest Tightness
6). Reiter’s syndrome
4). Heart Issues, 8870
1). Heart Attack
2). Skipped Heart Beats
3). High Blood pressure
4). Shortness of Breathe
5). Chest Pain – ongoing
6). Blood thinners
5). Musculoskeletal Issues, 8850 and 8852
1). Upper and Lower back pain
2). Muscle spasms
3). Neck pain
4). Muscle Fatigue and twitching
5). Muscle Aches – Since 1991
6). Muscle Pain
7). Stiff Joints
8). Multiple Vaccines
6). Eyes Issues, Diagnostic Code 8860
2). Sensitive to sun
5). Night vision problems
7). Upper Digestive System Diagnostic Code 8872
1). Stomach Pain
2). Sharp Pain
4). Reflux – omprezole 20mg
5). Teeth problems
6). Cannot chew my food properly
8). Lower Digestive Diagnostic Code 8873
3). Rumbling gas
9). Hemic and Lymphatic Diagnostic Code 8877
2). Blood clotting
3). Blood – infectious disease
4). Any blood disorder
5). Any cancer blood related disorder
10). Systemic Disease Issue Diagnostic Code 8863
2). Reiter’s syndrome exposure ( reactive arthritis )
4). Joint pain – arms and legs ( cannot run )
6). Fatigue ( C F S )
7). General achiness
8). Mosquitoes –
9). Sand Flies
11 ). Neurological Issues, 8881
2). Night sweats
3). Carbon Monoxide Exposure from vehicles, oil rain and oil well fires
5). Sleeping difficulty
6). Leishmaniasis – Mosquito bites
7). Lyme Disease
7). Pesticides Exposures – Used daily
8). Fatigued comes and goes
9). Cannot sleep through the night
10). Sharp pains in my neck and back
11). Any neurological disease
12). Psychophysiologic Issues, Diagnostic Code 8895
6). Difficulty sleeping
1). Bleeding gums
2). Excess tooth deterioration
3). Stomach gas in mouth
4). Vomiting off and on in 1991 war and still have problems with my stomach and vomiting up to the present time. I really didn’t think this was related to my service, doctors said I should submit a claim for this issue.
14). Environmental exposures that could cause some of my medical conditions,
1). Exposure to Nerve Gas and Chemical warfare agents ( low level )
2). Pyridostigmine Bromide Pill
3). Multiple Vaccinations
6). Burning feces – latrine duty – Burning pits
7). Oil and Oil Well Fires 850-1000 oil wells on fire ICD Code E990.9 injury war operations fires conflagrations unspecified ICD-9 Code of 2012
8). Exposure to lead from fuel oil and gas products on roadways
9). Exposure to sulfur and sewer gases
10). Dead animals
11). Depleted Uranium
12). Carbon Monoxide Exposure ( Vehicles and Oil Well Fires ).
13). Sand ( Al-Eskan Disease ) and Reiter’s syndrome
14). Sewer gases, Burning feces or burning pits
16). Bottled water not refined to U.S. E.P.A. Standards
17). Diesel Fuel exhaust and Tent Heaters
18). Diesel fuel sprayed on roadways
19). Food – Out dated – high bacteria rate –
15). Endocrine System Diagnostic Code 8879
1). Change in Thyroid function
2). Change in Metabolism
3). Weight Gain / Weight Loss
4). Temperature deregulation
16). Exposures to Sun
1). Any Skin Disease
2). Any Skin Cancers
17). Endemic Diseases
1). Mosquitoes bites
2). Sand Flies and
3). Reiter’s syndrome
5). Any endemic diseases
18). Liver Failing.
1). Fatty Liver
2). Over five Pounds
3). More then 20 points
2013 Specialty and Sub-Specialty Testing for Gulf War
and Returning Veterans in DoD / VA Hospitals.
Not being done !
1). Dr. Nicolson Doxycycline Test ( 50 % Positive Showing of 1991 veterans ).
Dr. Engel Walter Reed / Dr. Donta B/U / LTG. Ronald Blank study of Mycoplasma fermentans
2). Exercise Behavior Therapy ( EBT ).
3). Dr. Ya Fang Liu, – Neurodegenerative Disorders.
4). DNA Testing – Chromosome Damage Test, Heavy Metal Testing, others.
5). Dr. Meryl Nass – Vaccines testing. Remove Thermisol . Shots over a period of time.
6). Dr. Hymans Urine Test.
7). Dr. Haleys Brain Test – Confusion / Ataxia.
8). Dr. Haleys Hyperbaric Testing – Wound Care, Currently not being done.
9). Dr. Leisure Murray – Leishmaniasis – infectious disease, Lyme, west nile and triple eee viruses.
10). Dr. Mohamed Abou Donia – CFS / MCS / FM Testing. And Nova Southeastern University’s College of Osteopathic Medicine will also be the first in the nation to study neuroinflammatory and neurodegenerative disorders. Nancy Klimas, M.D. Miami VA Medical Center in the Gulf War Illness research program. March 2012
11). Dr. Baumzweiger – Brain Stem Fungus.
12). Dr. Pam ASA – Autoimmune Condition, arthritis or joints
13). Dave Bergs – Heparin Injections and Virus infections in the heart.
14). Sand Exposure and washing of the Lungs – ( 5 yr. rule ) Al-Eskan Disease
15). Qxci – Testing. Electrical Feed back. ( ALT. Testing )
16). Nerve Gas Testing ( Tap Test ). Neurological
17). Fat Testing ( Chemical load of body ) Internal Medicine test
18). Acupuncture Treatments for gulf war illnesses ( Trial ). 2011
19). XMRV – Testing retro-virus / a type of virus known to cause leukemia / CFS
20). Dr. Michael Mullan motor skills, memory, stability and other problematic symptoms.
21). Alternative and Natural Medicine Testing at DoD / VA Hospitals.
22). Dr. James Baraniuk Georgetown University. MRI’s and CFS
23). Dr. Li is a neurologist at the Washington, DC WRIISC
SSG / E-6 Edward J. Bryan ( Retired )
685 Broadway St. Unit # 74
Malden, Mass. 02148
U.S. Army ( Disabled ) 1974-2000
Life Member Whitman DAV # 119
Life Member Medford VFW # 1012
U.S. Firefighter ( Medford ) Retired 1986-2000
Health Care Liaison ( VA / BU ) 1994-2001
Researcher for Gulf War Illnesses 1992-Present
VA VISN-1 Mini-Mac member 1998-Present
Walter Reed Veteran Health Advisory Council ( VHAC ) Deployment Health, 2000-2002.
Leishmaniasis can be sexually transmitted so this is not just a problem for veterans, but many people. There are victims outside of the VA system that need help too!