CCMS Medicine Summer 2017 - 25

www.CHESTERCMS.org

Our veterans are supposed to have access to the latest and best
health care, and they don't always get it, partly because the system
is overloaded or maybe broken. But partly also because health care
providers, both VA and civilian, have not kept up with the issues,
don't have the time, or don't have EHRs that even include or
trigger a pathway for them to address these issues. This is not very
surprising.
This nation, in addition to having a history of violence and
warfare, has a long tradition of reneging on its promises to its
returning warriors - sometime out of forgetfulness, or the desire
to just get back to peacetime life, or because of the political
atmosphere attached to a war-drained economy and budget. As
far back as the War of Independence, the Continental Congress
denied Washington's disbanded troops the bonuses and land
grants they had been promised. And, after WWI, the returning
"doughboys" were not only not given their promised bonuses
but, when they marched on Washington and set up tent cities,
they were driven out at bayonet point by infantry, cavalry and
tanks. Returning Korean veterans were forgotten, while Viet Nam
veterans were despised, castigated, and shunned.

So perhaps it should come as no real surprise when we now
hear all the problems, delays and scandals attached to the various
components of the Department of Veterans Administration (VA).
In the US today there are an estimated 22 million living veterans.
Adding the 2.25 million current active military and reservists, the
US now has over 24 million potential users of the VA system's
services, including health care and educational services. Clearly
the costs and logistics of such a complex and open ended system
would be enormous, and that may help explain the reluctance of
Congress and the VA in keeping those services adequately staffed
and funded. It brings to mind the old poem repeated by President
John F. Kennedy at Ft. Stewart, GA (11/26/62):
"God and the soldier all men adore
In time of danger and not before.
When the danger is passed and all things righted
God is forgotten and the soldier slighted."
Keep in mind that these military hazards/injuries no longer
affect solely the primary care physicians. They run the gamut from
traumatic, orthopedic, neuromuscular, CNS, oncologic, infectious
diseases, psychiatric problems, respiratory and CV systems, even to
OB/GYN problems. (Figure 2)

Continued on next page >

Figure 2:
POTENTIAL EXPOSURES UNIQUE TO MILITARY SERVICE
1. Airborne Hazards:
Burn Pits smoke, particulates
Structural fires, explosions
Burning oil wells
aircraft/auto engine fumes
Dust and sand particles

2. Infectious Diseases
Malaria, other vector-borne diseases
Schistosomiasis, Liver Flukes
Tuberculosis, Brucellosis
Salmonella, Shigella, Campylobacter
Leishmaniasis, Chagas Disease
Q Fever, Viral Hepatitis
STDs, HIV

3. Medications, Drugs, Vaccines
Mefloquine
Pyridostigmine
Vaccines (cholera, plague, anthrax
smallpox, YF, HBV, polio
typhoid, meningitis, tetanus
botulinum toxoid, pertussis)
abusable substances (ETOH,
tobacco, marijuana,
opiates)

4. Toxicants
Agent Orange, other herbicides
pyrmethrin, other insecticides
CBR agents (used, burnt)
fuel/exhausts (plane, jet,diesel)
napalm
depleted uranium weapons, dust, particles
Envenomation (snakes, scorpions)

5. Physical Exposures
Heat, cold, dehydration
Microwaves (Radar, LORAN radiation)
Bullet & blast injuries
Contaminated drinking water
Ionizing radiation (McMurdo Station,
nuclear tests Nevada, Bikini
Atoll cleanup, Fukushima response)

6. Unexplained Illnesses
"Gulf War Syndrome"
Chronic Fatigue
Fibromyalgia
Functional GI disorders

7. Genetic concerns
oncogenic mutations (prostate, renal, etc.)
genetic defects in offspring

8. Psychological Trauma
The horrors of war in general
The horrors of being an eye witness, participant
Military Sexual Assault (in a non-caring system
in which the victim is afraid to report it)

SUMMER 2017 | CHESTER COUNT Y Medicine 25



Table of Contents for the Digital Edition of CCMS Medicine Summer 2017

CCMS Medicine Summer 2017 - 1
CCMS Medicine Summer 2017 - 2
CCMS Medicine Summer 2017 - 3
CCMS Medicine Summer 2017 - 4
CCMS Medicine Summer 2017 - 5
CCMS Medicine Summer 2017 - 6
CCMS Medicine Summer 2017 - 7
CCMS Medicine Summer 2017 - 8
CCMS Medicine Summer 2017 - 9
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CCMS Medicine Summer 2017 - 17
CCMS Medicine Summer 2017 - 18
CCMS Medicine Summer 2017 - 19
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CCMS Medicine Summer 2017 - 21
CCMS Medicine Summer 2017 - 22
CCMS Medicine Summer 2017 - 23
CCMS Medicine Summer 2017 - 24
CCMS Medicine Summer 2017 - 25
CCMS Medicine Summer 2017 - 26
CCMS Medicine Summer 2017 - 27
CCMS Medicine Summer 2017 - 28
CCMS Medicine Summer 2017 - 29
CCMS Medicine Summer 2017 - 30
CCMS Medicine Summer 2017 - 31
CCMS Medicine Summer 2017 - 32
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