Outlook: War's Wounds Need More Study
Monday, October 1, 2007; 1:00 PM
"A year and a half ago, I was critically wounded in Iraq while on a reporting assignment. Since then, I've learned more about how the medical profession puts injured troops back together again than I ever wanted to know. I've also learned that surgeons like the ones who've helped me heal need more information - and quickly - about how to deal with the kinds of traumas that troops are suffering today."
CBS correspondent Kimberly Dozier as online Monday, Oct. 10 at 1 p.m. ET to discuss the injuries she sustained in a Baghdad car bombing, and why doctors need to learn from them and the complications that followed.
The transcript follows.
Kimberly Dozier: Hello. Thanks for reading and following up with so many questions -- my e-mail inbox has been full of positive responses from people, including a few who knew about extremity war injury problems, and a couple who want to know more. The best e-mail I read this morning was from Assistant Secretary of Defense Ward Casscells, who wrote:
"Your article has prompted us to review the extremity program, incl its funding. I have asked MG (dr) eric schoomaker to review, and suggested he get input from the Army Surgeon general's orthopedic consultant, and Dr Pollak, AAOS, and COL(dr) jon holcomb, as well as Acinetobacter expert Dr (CPT,USN, ret) Joe Malone.
"As for follow-up, you will get an invitation to breakfast briefings we will start next month at the pentagon or national press club."
It's the best news I've gotten in a long time -- so anyone out there who feels like writing and encouraging their senator or congressmen to step up and say "yes" to the funding -- please do. As a journalist, I can educate, but try to stay away from direct lobbying for a particular program (which is why I mentioned all those I knew about). But anyone reading this can help...
Boston: I am so sorry about your injuries and appreciate your concern for others who are wounded. Are you familiar with a program called the Medical Free Electron Laser Program (MFEL) which is dedicated to understanding these injuries and developing new medical interventions? If not, I think you would be interested in the multiple success stories of this program as well as the fact that it was zeroed out of Defense budget in Fiscal Year 2008 without clear justification. Many medical interventions, such as nerve photobinding (restores function of severed nerves with the ability to walk restored) will be lost, as will new light-based methods to treat infections, including multidrug-resistant infections.
This program is competed and peer reviewed -- and has enlisted the talents of major medical centers to study combat casualty injuries and to develop new medical interventions. Many military docs and others have reviewed the work and are in fact utilizing the developments from this program. The action to cancel the program will result in the loss of at least 17 current, important interventions that are ready for clinical studies or deployment. This action has been protested by major political leaders in the Senate. In fact it was canceled by one individual (who may have a confirmation hearing next week) against the recommendations of the program managers. I hope you will investigate this action because it would be a shame if our wounded troops, and anyone else who suffers these kinds of injuries, were to be deprived of the best medical care possible. For more information, you may want to refer to an article by Roxana Tiron that was published in "The Hill" a week ago Thursday.
Kimberly Dozier: I didn't know about that program -- but I'm glad to hear about it (especially as nerve damage to my right leg means the outer surface will always be numb on much of it.)
As I mentioned in my first post, I'm trying to educate the public about what's out there, so more information is welcome.
Washington: Hello Kimberly. A fellow Wellesley alum here, Class of '88. I remember seeing you on campus. I am happy that you have progressed so well in your recovery and wish you continued improvement. An interesting note is that my parents have been following you closely since you started covering Iraq. Perhaps they can see me in your shoes, I don't know. But they have been very moved by your bravery and solid war coverage and are rooting for you. I just wanted to pass that on.
Kimberly Dozier: Ah, yes. The way I used to dress, you probably couldn't miss me on campus. Some people in college did drugs ... I did hair. Got any pictures? Please thank your parents for me -- and if you go to war zones in your job, wear more Kevlar, and also fire-retardant clothes, which I didn't.
Annapolis, Md.: In the opening paragraphs, as well as in several other portions of your article, you allude to the fact that surgeons and doctors need more information on which treatments work, which do not, or when do infections tend to flare up, etc. Did you have any conversations with Department of Defense Medical providers on the computer systems/databases they relied upon -- or better yet, what results they would like to see from these systems that may not exist today?
Kimberly Dozier: I did not have talks about specific database systems -- only with doctors all along the way who wished there was some way to track their cases. When I revisited Landstuhl, some of my trauma docs were still there, so when I told them I had a memory stick with CT scans of my healed femurs, they were thrilled. They said they never get a chance to look at the spiky bone (heterotopic ossification) that many months down the road. One of the docs kept a copy for their files.
I'm trying to point out the need -- at The White House, and the Pentagon, and in Congress, they've got to talk about how to fix it.
Sen. Inouye and Rep. Murtha are the two lawmakers CBS allowed me to meet with, to educate them about the need for funding this type of research. They are the guys in charge of the defense budget purse strings. I imagine if they hear from the public, too, that would surely give them the ammo they need to ask for the funding they need.
Annapolis, Md.: I am new to this kind of forum and submitted to you a technical question a few minutes ago regarding databases used by the surgeons. What I should have started with was a mention of how moving your article was, in conveying the frightening ordeal you have been undergoing. You also brought into the article some very matter-of-fact information that was extremely helpful in understanding what our wounded soldiers have been undergoing for the past four years. Thank you so much.
Kimberly Dozier: Thanks very much -- and I'm new to this forum too, but it's great to have feedback, and know that people who've read the article take the issues seriously, and want to help do something about it.
Washington: What needs to be done to get more research dollars Is that the answer, or this there more to be done?
Kimberly Dozier: Some of the different surgeons I've spoken to -- who are backing a couple different research programs -- say the most useful thing for them would be if The White House would make some of these programs part of their budgetary priorities.
As I mentioned in an earlier post, Sen. Inouye and Rep. Murtha are the two lawmakers CBS allowed me to meet with, to educate them about the need for funding this type of research. Both of them were extremely receptive, but staffers from both of their offices explained they were surprised by a gaping area of need they weren't aware of.
In a sense, it seems partly because of our (the media's) reporting, that certain conditions become "in vogue" -- in the first couple years, it was combat amputees, and Congress worked hard to fund some amazing programs for that -- but that doesn't actually encompass all the issues I mentioned. (Amputees battle acinetobacter and heterotopic ossification, though.)
Then TBI -- traumatic brain injury -- became 'in vogue, so the congressmen's staffers told me they worked hard on that. Then I walk in the door and remind them of something else -- which when you look at the numbers is a huge and sweeping problem (or several.)
(FYI -- I had TBI too, because of shrapnel to the brain, but joked with Bob Woodruff that he could handle educating the world on that, and I'll handle the extremity issue.)
Truth is, it all needs to get fixed. And all this research also will be applicable (or at least much of it will) in the civilian world.
Washington: A lot of Iraqis have had it worse than you, thanks to a war that Americans have waged on them based on false information. The Americans have failed to provide them the even the most basic medical treatment. Why should I feel any sympathy for you and your kind who allowed this war to happen?
Kimberly Dozier: One of the very first things I wrote to be published after the bombing, while I still was learning to walk again, was that every time I saw news of a bombing in Iraq, I'd study the screen and see Iraqis with my injuries, and know that even if they made it to the hospital, there was almost no way they'd survive, or if they did, no way they'd keep their limbs.
The doctors I've worked with on this subject -- like Dr. Andrew Pollak at University of Maryland's Shock Trauma Center -- actually have traveled to Iraq to see how civilian doctors can help. They went to military hospitals, thinking they'd see where they would supplement treatment of troops. In a little more than a week, they operated on thirty Iraqis at the Air Force hospital in Balad, injured by every manner of explosion, gunfire, rocketfire, etc. Now they're working with Gen. Casey and the U.S. Army to see if they can visit Baghdad's trauma hospitals, with a new goal: to see how and where they can supplement Iraqi trauma healthcare.
Problem is, even if they can pass on skills and supplies to Iraqi doctors, the insurgents are taking Iraqi doctors out -- as we've been reporting since 2003.
On a personal note, I hate sympathy, thanks, and so do the injured troops I've met. Makes my stomach turn. Empathy is welcome, however, and appropriate for anyone injured in that conflict, whatever any of us think about how it started, and whatever way any of us think it should end.
Boston: Is their something we can learn from WWII soldiers who survived the concussive effects of being shelled, in terms of what has happened to them medically in the decades since, relative to the thousands of U.S. soldiers who suffered head trauma in Iraq? Do we have any idea what these men and women are in for in the course of the rest of their lives, and what our response should be to help them?
Kimberly Dozier: Probably so, but it would be hard to collect data from that generation, as most of them (like my dad) are elderly. And as a study, how would you quantify it? Ask them how close they were to shelling for how long? Memory is a funny thing, even weeks from an event, much less months later.
The U.S. Army has rolled out a program called Battlemind, which as I understands it includes the study of TBI in the field. And this summer, the U.S. Army launched a three-month program to teach every single serving soldier how to identify both traumatic brain injury (from mild to severe), and post traumatic stress disorder.
The guys in my patrol, for instance, say they were all very confused and almost hyper after the bomb hit us, as they ran around and tried to treat everyone. Granted, they were pumped full of adrenaline, but it turns out they were also likely suffering mild TBI because of their close proximity to a huge car bomb. They didn't know that then, and beat themselves up for acting "slow." Now, they all know, or are being taught, to self-diagnose or diagnose in their buddies the signs of that type of injury, or the long-lasting emotional injury of post-traumatic stress disorder.
Overseas: Kimberly: Has the IED incident affected the status of your mental health? If so, what is your opinion relative to the care former Iraqi veterans receive from Veterans Affairs or other health support agencies. Thanks, and good luck to you and your family ... and thanks for your service, too!
Kimberly Dozier: PTSD (post traumatic stress disorder) usually occurs when soldiers/marines/diplomats/contractors or journalists (or many Iraqis I've met) try to tough it out, and ignore that they're going through or living through hell. As I understand it, the diagnosis includes mild symptoms like sleeplessness and irritability, all the way to things like withdrawing from your family, having flashbacks, etc. You've got to have something like six things off the list to be diagnosed with PTSD, which I never was because I am two things: a very chatty female, and a journalist.
So from the moment I opened my eyes in Landstuhl, I first wrote down everything I could remember from the bombing, and when they took the breathing tube out of my mouth, I spoke about it, and did not stop talking.
In Bethesda, I refused antidepressants and asked instead to "talk to someone" -- either a psychotherapist, and/or perhaps an injured troops's support group, where there were other people who understood what it was like to lose your team on the mission. I was not given that opportunity, most likely because I barely was well enough to get wheelchaired out of my room once a day -- and maybe because even if there was a group meeting like that, no one wanted a reporter in the room, even an injured one.
My last two weeks there, however, I got to speak to a great psychotherapist -- who came in on his National Guard rotation -- and he said I was doing everything right by talking about the incident, and also crying about it (which he called "exhibiting appropriate levels of grief"). He sometimes had a hard time getting his male patients to do that.
Lastly, having my guy Pete and my family at my side throughout the ordeal helped, and then having Pete as a sounding board. because that has kept me on an even keel. Anyone out there who is injured in something like this really needs to find a confidante like that -- the secret to avoiding PTSD is opening up about what freaked you out, scared you or caused you pain. When I left Bethesda, I left the nightmares behind, and never have exhibited any of the signs my psychotherapist gave me to look for.
The hardest part is ... that seems to disappoint people. They want to hear that you're on antidepressants, or are still some sort of basket case. I feel like the cop at the crash scene where everyone's already been whisked away, and the cop is trying to push the rubberneckers along, saying "nothing to see here, folks."
Ramstein Air Base, Germany: Thank you for sharing your personal experiences and for helping to highlight the continued need for our health care systems (DoD, VA, and civilian) to invest in the discovery of new treatment options for our returning troops. Congratulations on your recovery and thanks again for keeping the spotlight on care for our war wounded.
Kimberly Dozier: Thanks, let's hope it helps some of the guys and gals who don't have quite as loud a mouth as mine.
Amherst, Ohio: It has been reported that soldiers are being sent home with "mental problems" the Pentagon is saying were "pre-enlistment conditions," so they aren't responsible for their care. To your knowledge is this situation being looked into by either the press or Congress?
Kimberly Dozier: I've heard of this, and I know CBS's Armen Keteyian did an investigative piece on this a year ago, and I know other colleagues have looked into it. Keep watching.
Washington: Thanks for your fine article and your bravery first in going to Iraq and second in recounting your experiences. How are you physically and mentally? Do you suffer much from post-traumatic stress syndrome? Would you return to Iraq during the hostilities if you could?
Kimberly Dozier: Physically normal, except I can't do a couple of the more advanced yoga poses I used to do (until I get some more flexibility in my knees).
I've got some nerve numbness in the skin on the outside of my right leg, and on all the huge grafts, but that's normal -- it just feels like your face feels after the dentist gives it a shot, and it's almost back to normal but not quite.
When you look at the laundry list of what was wrong with me from head to toe, it's amazing it's all come back to normal, but that's thanks to great docs, great care, great family support and a stubborn attitude.
The hard part is convincing people I'm okay. I find myself saying over and over, "I'm fine, I'm fine, I'm fine..." And the frustrating thing is dealing with people who are disappointed when I say I'm okay -- as I mentioned in the PTSD response.
It's like they had a mental picture of me as mentally messed up and racked with pain every day, and when I say "no, sorry, doing really good, just not gonna sign up for any bikini contests any time soon, though I'd win a bar-room scar contest hands-down..." they look at me with a combination of frustration and suspicion, and walk away from me in the grocery story/gas station/parking lot with a puzzled/annoyed look on their face.
I used to get angry. Now I just roll my eyes and say to their retreating backs: "Sorry to disappoint. If you want to see a meltdown up close and personal, go watch Britney, okay?" And I finish buying milk/pumping gas/opening my car, shaking my head.
Newton, Mass.: You describe the physical injuries. Please comment on the emotional/psychological injuries you experienced and whether you believe more clinical research should be done in these areas. Please accept my best wishes for your recovery.
Kimberly Dozier: According to what I saw in terms of staffing at Bethesda when I was there last year, they could use more cognitive/talk therapists for their permanent team -- but I was there when the beds on my ward were full. Those numbers go up and down.
Rear Admiral Robinson takes the issue seriously, and offers all the medical staff and injured troops' family members daily mental health timeouts to talk with a mental health professional about what they're seeing/thinking/feeling/going through -- but that's a group setting.
I just know what works for me -- talking/emoting/getting it out of my system. The more people who are available to help injured troops do that, the better, in my personal (non-scientific, non-researched-in-this-case) opinion.
Washington DC: Hey Kim, It's Mary from your old Energy Daily days. You've been in our prayers since the incident, and it's really heartening and humbling to see how you've come out of this experience. I've read everything that's come across the transom on your progress, and yesterday's article was no exception. The advances they've made in dealing with these kinds of injuries is nothing short of amazing. Best to you from Perry and me.
Kimberly Dozier: Hi, Mary (and Perry) -- I was channeling you, obviously, as I remember one of your dreams was to eventually run an editorial page. Hope you guys still are stirring up trouble, in the best kind of way.
Rockville, Md.: I spent six years at the Uniformed Services University (Bethesda, Md.) working at the Casualty Care Research Center on Vietnam data concerning a selected population of casualties. We managed to put all the paper records and some of the color slides into computer files, but we ran out of funds before they were put online for others to use. World War II data was collected by Dr. DeBakey (the heart doctor) and Bebe (NIH) and is still the "gold standard" for that sort of statistic. The only advance to the Vietnam data was that it could be studied by the level of unit involved (company, brigade, etc.). Our office was ready to collect data from the first Iraq war, but our data collection teams were not allowed into the war zone before fighting started and by that time it was too late. Since then, I don't know what has been done. But it would be nice to finish scanning the Vietnam film (100,000 slides) and putting that online for researchers. The few medical researchers who had access to the paper records got more than ten published papers out of the data.
Kimberly Dozier: Frustrating -- please send me your note in e-mail form, and I'll try to pass it to someone who might know more about how/where this could be useful to the current programs being fought for.
Kimberly Dozier: Folks, thanks so much for your questions -- I'll be signing off now, but you can reach me at my e-mail address, firstname.lastname@example.org, for anyone who missed the chat.
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