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WAR VETERANS FIND HAVEN AT WEST HAVEN VA --

In light of the Walter Reed scandal, treatment

at West Haven's VA hospital shines.

 

 

Story here... http://www.yaleherald.com/
article.php?Article=5551

Story below:

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War veterans find a haven in local hospital

In light of the Walter Reed scandal, treatment at West Haven’s VA hospital shines.

BY KENT GARBER

I’m standing in the lobby of the Veteran Affairs Hospital in West Haven, when a man on my left—a tall guy, with a big green vest—turns to me and asks, in a tone of stark, no-shit seriousness: “Iraq?” I must have stared back at him blankly, or furrowed my eyebrows, because the man—the word VIETNAM was stitched to the pocket of his vest—quickly repeated himself. “You back from Iraq?” he said, a bit louder this time.

“No, no,” I said, shaking my head. “I’m just a student.”

“Well, good,” he said. “I’ve been back for 30 years, and they still can’t get rid of me. Lots of flashbacks. Keep remembering things.”

“But at least I’m here,” he added. “For treatment, at least I’m here.”

This last comment is telling; he doesn’t have to elaborate to make me understand. I get it. In this post-Walter Reed era, his point is clear: Here, as opposed to there. At least he’s here, he’s saying, in West Haven, just three miles from Yale, in a clean facility of 5,500 rooms, where 2,100 U.S. soldiers who fought in Baghdad, Kabul, Mosul, Fallujah, Tikrit, or Baquba are now being treated; and not there, in D.C., at Walter Reed Hospital, where the crap—the mouse crap—is literally hitting the fan.

Here, it’s a different story. Yale researchers in West Haven, just four exits down I-95, are running one of the nation’s premier operations for treating combat vets with mental trauma. And here the system is working well, even as the rest of the army’s VA network, thanks to Walter Reed, is getting a thorough reexamination.

In a sense, it’s a story of opposites. Since late February, the U.S. Army’s medical bureaucracy, which runs both hospitals, has been taken to task in the public arena. On Sun., Feb. 18, the Washington Post found rampant signs of institutional neglect at Walter Reed, including “mouse droppings,” “belly-up cockroaches,” and negligent attendants. In one case, patients with brain injuries were reportedly “put in charge of others at risk of suicide.”

Of course, the fingers went flying. Francis J. Harvery, the secretary of the navy, was fired in March. So was his temporary successor. A day later, President George W. Bush, DC ’68, condemned the hospital’s “substandard treatment.” And now politicians of both parties are stepping forward to offer their respective solutions—including Connecticut’s own Joe Lieberman, who introduced the alliteratively phrased “Mental Health Care for our Wounded Warriors Act of 2007” on Tues., April 24, in which he called for the swift creation of “Centers of Excellence” to better handle army medical matters.

This is all fine and well, save for the fact that the U.S. Army medical system has Centers of Excellence already in place—including one right here, in West Haven, where experts from Yale are treating combat veterans in increasing numbers as the War in Iraq slogs on.

“You have to imagine that these guys are constantly on guard,” said Steven Southwick, a professor of psychiatry at Yale and a researcher at the nearby VA Hospital. “In past wars, you could get off the front lines; there were safety zones. But you can’t do that in Iraq—there’s the Green Zone, but even that’s not safe.”

For the past few years, Southwick has been hearing the same story of trauma—played out in different towns, Shiite or Sunni, north or south, all across Iraq, and to a lesser extent, in Afghanistan—from the soldiers he sees in West Haven. It’s a story of constant vigilance, of seeing danger everywhere; of mortar rounds going off overhead, of not knowing where they’ll land; and of driving a humvee down a mottled patch of deserted road and knowing that any bump, any pothole, could be an explosive device.

All this vigilance, Southwick says, ramps up the nervous system. Stress hormones flood the brain; new fears get conditioned. And when the soldier leaves Iraq and returns to the United States, the system is still ramped up, pumping out adrenaline, and that’s when the trauma starts. “Now you’re driving down the road in New Haven, not Iraq anymore, but your brain is still looking for something,” Southwick said. “It’s as if your nervous system is responding to signals that aren’t actually there.”

The reaction fits the bill of Post-Traumatic-Stress Disorder (PTSD)—a disorder of increasing prevalence in the War in Iraq. According to recent reports, more than one in five veterans returning from Iraq meets the diagnostic criteria for PTSD; that’s the highest incidence of PTSD that medics have seen since Vietnam, harkening back to an era of ignorance when the disease was still called “shell-shock.” And as the fighting in Baghdad continues unabated, and as close-quartered fighting and rebel militias remain a reality, psychiatrists predict that incidence rates of PTSD will continue to go up.

This leads back to the question of treatment. In 1989, the U.S. government created five national centers to stimulate research on PTSD. One of them, the Clinical Neuroscience division, was given to West Haven—in large part, Southwick said, because of the potential for collaboration with doctors at Yale. And that wasn’t just wishful thinking, either: From the early 1970s forward, Yale—at times alone—has been a leading researcher of PTSD. Arthur Blank, a Yale psychiatrist, had been one of the first doctors to recognize that Vietnam vets were being misdiagnosed with throw-away cases of schizophrenia: Their symptoms looked like something else—something that, in 1980, would be finally be labeled PTSD. Then, a few years later, John Mason, another Yale psychiatrist, showed that the PTSD hallmarks of hypervigilance and flashbacks could be tied to chemical changes in the brain. And so the research began.

The PTSD center at the West Haven VA, which sits across from an African hair-braiding shop and a small restaurant named Salvadoreno, has been a hub ever since. Most recently, its head research director, John Krystal (who was out of the country at the time of press), was awarded a $6.9 million VA grant to conduct a nation-wide study on the effectiveness of using Risperidone, an anti-psychotic medication, to treat chronic PTSD. The study is now in its first year.

In recent years, the center has pushed ahead with a new form of therapy, “cognitive processing therapy,” that combines exposure and reappraisal techniques, riffing off the “mind-based” regimens of the ’80s. Studies suggest that it might be more helpful than standard anti-depressants in treating PTSD. “It’s about putting the pieces of the puzzle together,” said Southwick, “about giving patients conscious control over their emotions.”

Researchers, meanwhile, have had their hands wrapped up in a plethora of projects: brain imaging studies, genetic studies, and reactivity studies. This activity is a far cry from the rather bleak portrait of the hospital that the New York Times painted in 1992, during the aftermath of the Gulf War: “With a scaled-down military force and a growing, aging veteran population, the West Haven Veterans Administration Hospital is being forced to consider the kind of care it will provide in the future,” the Times wrote. “It appears that the demand will be for long-term nursing care.”

Thankfully, someone didn’t get the memo.

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Larry Scott  --