PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. According to the National Institute for Mental Health, there are five diagnostic criteria that must be met for this to be a valid diagnosis.

1. Presence of Obsessive-compulsive disorder and/or a tic disorder
2. Pediatric onset of symptoms (age 3 years to puberty)
3. Episodic course of symptom severity
4. Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep. or history of Scarlet Fever.)
5. Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)

By definition, PANDAS is a pediatric disorder. It is possible that adolescents and adults may have immune mediated OCD, but this is not known. The research studies at the NIMH are restricted to children.

Case discussion from the American Journal of Psychiatry Am J Psychiatry 1998;155:1592-1598

PANDAS is not a diagnostic label, but an acronym designating a subgroup of children with OCD and tic disorders whose symptoms appear to be triggered by streptococcal infections.

The fourth criterion, temporal association between GABHS infections and symptom exacerbations, is the most important one for determining whether or not a child should be included in the PANDAS subgroup. The relationship between symptom exacerbations and GABHS infections must be established by demonstrating that the symptoms worsen in association with streptococcal pharyngitis and remit when the child is free of GABHS.

From Pediatrics Vol. 113 No. 4 April 1, 2004 pp. 883 -886

Therapy
What treatment should be considered for patients who present with the manifestations associated with the PANDAS constellation of symptoms?

Neuropsychiatric Drugs
Children with disabling tics or OCD should receive appropriate treatment for their symptoms, including medications (eg, tic suppressants such as ?-agonists, classical or atypical antipsychotics, or antiobsessional drugs such as selective serotonin-reuptake inhibitors) or nonpharmacologic approaches (eg, cognitive behavioral therapy for OCD).24

Antibiotics to Prevent Strep Infections
The only published clinical trial of prophylactic penicillin in children with this syndrome revealed no conclusive evidence that the antibiotic reduced clinical exacerbations.25 Admittedly, the duration of that study was too short to allow definite conclusions. A later report suggesting improvement of new-onset or acute exacerbations of symptoms in such children with antibiotics provides inadequate support for such an approach, because treatment was not placebo-controlled and was unblinded.26 It is well known in treatment studies of TS that there is a substantial placebo effect; the natural course of TS and OCD is such that exacerbations are followed by remissions. This latter phenomenon of “reversion to the mean” implies that virtually any intervention at the time of peak symptoms may seem successful. Only a double-blind, placebo-controlled study can identify a true therapeutic effect.

Another reason to feel comfortable with avoiding antibiotic treatment for these patients is that, to date, no cases have been reported to develop any rheumatic carditis as occurs in patients with Sydenham’s chorea. This is a very important point to remember, because some have attempted to relate this syndrome to rheumatic fever. It is recognized that as many as one third of patients with Sydenham’s chorea ultimately will have evidence of rheumatic valvular heart disease.27 This issue requires additional investigation, because the lack of heart disease strongly argues against a relationship between PANDAS and Sydenham’s chorea or other forms of rheumatic fever.

PANDAS references:
National Institute of Mental Health
NYS Department of Health report released February 3, 2012
Peter D. Springberg, M.D., FACP
International OCD Foundation PANDAS Fact Sheet
What every psychiatrist should know about PANDAS: a review Clinical Practice and Epidemiology in Mental Health 2008, 4:13
PANDAS – PITAND Awareness & Research Support
International PANDAS Foundation
PANDAS Resource Network

The New York State Department of Health has released an interim report titled Investigation of Neurologic Symptoms among Le Roy Jr/Sr High School Students, October 2011 – January 2012. The report details the investigation of this illness outbreak to date and discusses the various diagnoses which have been talked about in the media. This report represents the clearest and most detailed public look at the medical, social and cultural demographics of the twelve young women involved.

* 12 female patients ages 13 to 19
* Patient symptoms began at various times in the period May through October 2011.
* All attend LeRoy Central Junior/Senior High School. 10 in grades 10-12, 1 ninth grader, 1 eighth grader.
* Four cheerleaders, two soccer players.
* 1 patient with a pre-existing diagnosis of Tourette Syndrome and 2 patients with pre-existing medical conditions associated with tic disorders.
* 7 patients were tested and passed a drug test.
* 5 patients were tested and were negative in testing for heavy metals.
* 7 of the patients had received the vaccine Gardisil. 5 had not.
* 11 patients were found to have significant life stressors.
* 8 patients have been diagnosed with conversion disorder.
* None of the patients meet the diagnostic criteria for PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci.
* Tests for mold, air quality, water quality and trichloroethene indicate no exposure risk for the patients.

The report concludes:

The wide dispersion of cases over time, lack of affected faculty/staff, and the involvement of only female students argue heavily against a common environmental or infectious source for the cases.

Review of clinical history, medical diagnoses, epidemiologic and environmental exposure information on the cases, as well as information from environmental assessments and case interviews revealed no common infectious etiology or environmental exposure.

The investigation continues by a number of public health agencies. The environmental activist Erin Brockovich has sent investigators to LeRoy. Eight of the girls were seen at the Dent Institute in Buffalo. Some of the girls have been examined at the University of Rochester Medical Center and by physicians in other cities.

NOAA photo of tornado damage to St. John's Mercy Hospital in Joplin

The heart of Joplin Missouri was, in many respects, St. John’s Mercy Hospital. The city’s residents were born there, healed there and often spent their final days there. On May 22, 2011, an F5 tornado tore its way through downtown Joplin and left the hospital in ruins. That ended an era but yesterday a new era was begun with the groundbreaking ceremony for a new Mercy Hospital Joplin.

NOAA photo of damage to St. John's Mercy Hospital in Joplin after the tornado.

The entire St. John’s campus will be leveled as the work begins on a new hospital on donated land at the intersection of I44 and Main Street. A farewell service was held in Joplin on Sunday for the old hospital and a groundbreaking ceremony for the new one.

St. John’s Mercy sits over abandoned lead mines that date to the mid 1800′s. Engineers were uncertain if a controlled demolition would be safe so the site will be cleared using conventional methods. During the six weeks of demolition, as much of the existing structure as possible will be salvaged. The buildings will be stripped of wiring and pipes that will go to the scrap yard. The concrete and asphalt will be ground up and used for fill on the site.

Science will also be served during the demolition. Some parts of the building will be sent to various labs for study of the effects of the tornado on the building and its components.

The hospital has donated about 12 acres of the old site to the Joplin schools. An elementary school will be built there to replace two schools destroyed by the tornado.

At the new site, an innovative project is rescuing about 400 trees from the bulldozers. The site was scoured by certified arborists for the best saplings. They were tagged and have been transplanted to a local nursery where they will be cared for. In 2014, in preparation for the opening of the new Mercy Hospital Joplin, they will be replanted as part of the final landscaping. The trees selected are the ones best suited for Joplin’s climate and soil.

The FEMA blog describes the recovery efforts in Joplin.

• 1.2 million cubic yards of debris removed
• 3,600 building permits issued
• 167 temporary classrooms and 67 temporary safe rooms
• 337 families in temporary housing
• 50 percent of the homes destroyed are being rebuilt
• 90 percent of the businesses damaged have reopened

The National Weather Service has released a report titled Joplin, Missouri, Tornado – May 22, 2011.

The tornado was rated EF-5 on the Enhanced-Fujita Scale, with its maximum winds estimated at more than 200 mph. The path of the entire tornado was 22.1 miles long and was up to 1 mile in width. The EF-4/EF-5 damage path was roughly 6 miles long from near Schifferdecker Avenue along the western portions of Joplin to near Interstate 44 east of Joplin, and generally ½ to ¾ of a mile wide along the path. NOAA map.

Maj. Josh Neilson and Tech Sgt. Randy Powell played a role in the evacuation of fishermen badly injured off the Antarctic coast on Jan. 11, 2012. Photo by Master Sgt. Corine Lombardo

An LC-130 Hercules “Ski Bird” belonging to the New York Air National Guard’s 109th Airlift Wing evacuated seven badly burned crew members of a South Korean ship from the United States McMurdo Station in Antarctica to Christchurch, New Zealand, on Jan. 13.

The seven crew members–four Vietnamese and three Indonesians–were injured when the crew compartment of the 167–foot long fishing vessel Jeong Woo 2 caught fire in the Ross Sea, 372 miles from McMurdo Station and 2,301 miles from New Zealand on Jan. 11.

“Most days we transport cargo and passengers to a variety of outposts. On this day, we were the ambulance driver,” said Major Josh Neilson, the plane’s pilot.

Neilson and Tech Sgt. Randy Powell, the loadmaster on the flight, spoke to Albany, N.Y.-area reporters about the incident during a press conference on Jan. 20. They outlined the wing’s role in the rescue.

The wing provides logistic support to National Science Foundation research efforts in Antarctica and Greenland.

Nearby vessels rescued 37 of the 40 crew members from South Korea, Vietnam, Russia and Indonesia. Three crew members died.

Responding to a request by the New Zealand Rescue Coordination Center, the National Science Foundation research vessel, the Nathaniel B. Palmer, transported the injured crewmen from the Jeong Woo 2, to McMurdo Station, the United States Antarctic Program’s main research and logistical hub. Medical personnel at McMurdo then prepared the individuals for transport to Christchurch.

“When we loaded the patients, you could see the apprehension on their faces, knowing they had been rescued from a burning ship, flown by helicopter to the ice cap and loaded onto a C-130 with skis was way out of their routine,” Tech Sgt. Randy Powell, the crew’s loadmaster said.

“They didn’t speak English so our only way to communicate was with hand signals. The thumbs up and smiles we received after the 2,300 mile, eight and a half hour flight was a clear sign they were grateful and relieved to be rescued,” Powell said.

The New York Air National Guard’s 109th Airlift Wing, based here, flies the only ski-equipped aircraft in the United States military.

This is not the first time the 109th Airlift Wing has been involved in rescue missions.

In November 2008 a crew from the 109th Airlift Wing transported an Australian Antarctic Division employee from Antarctica to Hobart, Australia after the Australian researcher suffered multiple fractures to his leg.

And in 1999 a crew from the 109th landed an LC-130 at the Amundsen-Scott South Pole Station to pick up Dr. Jerri Nielsen who was treating herself for breast cancer. The crew landed earlier in the Arctic spring than had ever been done in the past.

DVIDS

In a study released just before Christmas, researchers estimate that 14,000 Americans died due to the effects of radioactive materials released by the Fukushima nuclear power plant accident in March 2011. Joseph J. Mangano and Janette D. Sherman authored the paper which was published in the December 2011 International Journal of Health Services. The paper is titled “An Unexpected Mortality Increase in the United States Follows Arrival of the Radioactive Plume from Fukushima: Is There a Correlation?”. The full paper can be found at this link at radiation.org.

The researchers used data from the Centers for Disease Control’s Morbidity and Mortality Weekly Report (MMWR). The MMWR includes data from 122 U.S. cities reporting deaths for the week. The numbers of deaths for each city are broken down by age group, and the deaths related to pneumonia and influenza are also broken out. All data is preliminary and it takes nearly two years for the CDC to finalize the numbers. This report does not specify the cause of death.

The authors used the data from the MMWR reports for weeks 12 to 25, March 20 to June 25, 2011. That data was compared to the same period in 2010, as well as the fourteen weeks prior.

We took a look at infant deaths, children under 12 months of age. The study reports that infant deaths in the 122 cities rose by 1.8 percent year over year. Year over year for the prior fourteen week period, they declined 8.37 percent. They calculate that 822 infant deaths during the fourteen week study period were “excess”.

Recall that we used the term “preliminary” to refer to this data. We used the CDC’s database to search for the same data for the entire country for the study period. We found that our fourteen week total for infant deaths for 2011 agrees with the study, 2,743 deaths. However, the total for 2010 differs, and alters their analysis. They report 2,722 infant deaths for the period in 2010, while the current CDC count is 2,754. infant deaths went down year over year, not up by 1.8 percent.

Infant mortality in the United States. CDC data as of January 2, 2012. Click on the image for a larger view. Chart by Charles Simmins

Infant mortality in the United States. CDC data as of January 2, 2012. Click on the image for a larger view. Chart by Charles Simmins

Infant mortality in the United States. CDC data as of January 2, 2012. Click on the image for a larger view. Chart by Charles Simmins

Looking at the prior fourteen weeks’ data, MMWR weeks 50-11, the difference is even more striking. In the 2009-2010 period, infant deaths from our CDC data set equal 2,859. For the fourteen weeks prior to the study period, our 2010-2011 infant death total is 2,608. Infant deaths fell far more than the study states.

Among the weaknesses in this study are the failure to correct for pneumonia and influenza deaths. We included 2009 in our data. Weekly infant mortality totals for 2009 in the study period are much higher than for either 2010 or 2011. The novel H1N1 pandemic was affecting mortality in the United States. The flu is a key factor in mortality during the same time periods that the study examined.

The cities represent about 25 percent of the national population. Other questionable assumptions are that any effects from radioactive fallout would be evening distributed throughout the 122 cities in the data and that the effects in the cities would be equal to those in the rest of the nation.

The population rank tables provided in the study, tables four and five, demonstrate mortality variances that do not correlate with geography. One would expect West Coast cities to have a higher exposure to any Fukushima fallout, and thus demonstrate higher mortality rates. Houston leads with respect to an increase in mortality in both tables, not Los Angeles or San Diego.

We believe that the study’s authors have not proven their thesis. The current data refutes part of their analysis with respect to infant mortality. The authors use of just one prior year fails a commonsense test that you need more than two data points to establish a trend. They authors have not corrected the data with respect to the actual geographic distribution of fallout, nor did they make any attempt to correct for the effects of seasonal influenza or other variables such as violent deaths. Without a cause of death, any “excess deaths” which may be found cannot be related to Fukushima radiation and fallout.

At this point, if excess deaths exist, it is just coincidental that measurable amounts of radioactive byproducts from the Fukushima nuclear accident were found in the U.S. during the same time period.

Gary Hughes, Director of Media Relations at MVP, has provided a clearer explanation of the situation in a e-mail received this afternoon.

The situation is related to Medicare Advantage Insurance Premiums withheld from Social Security. A Medicare contractor made an error that affected people in Medicare Advantage plans who have their plan premium deducted from their Social Security payment. This affected about 3,000 MVP Medicare members and approximately 140,000 nationwide . This is not an MVP error, but Medicare has directed MVP and other Medicare Advantage plans to collect the premium amount that should have been deducted directly from the affected members.

The specific announcement from CMS states:
Due to an error in the End of Year MARx process that updates the premiums for 2012, some beneficiaries that were in SSA withhold status during 2011 have been changed to direct bill for 2012. The error was not immediately known so Plans were not notified at that time. SSA has processed the transactions and sent notices to the beneficiaries to advise of the change to direct bill.

The story below has been updated. MVP did not submit incorrect data to the Social Security Administration. The numbers nationally and for MVP of affected members have been corrected.

MVP Health Care is a family of insurance companies that provide to over 750,000 subscribers in New York as well as Vermont and New Hampshire. Just in time for the new year, MVP and the Social Security Administration have teamed up to give MVP Medicare Advantage plan members an unpleasant holiday surprise. Social Security has stopped automatically deducting and paying the insurance premiums for this plan from the monthly benefits of MVP subscribers.

Social Security notification letter. Click for a larger image.

Just before Christmas, around 140,000 people across the United States received a letter from Social Security. That letter informed them that beginning with the December 2011 benefit payment to be made in January 2012, Social Security would “no longer deduct money for health plan premiums and Medicare prescription drug plan costs.” No explanation was provided in the letter and beneficiaries were directed to contact their health insurance provider with any questions. Our phone call to Social Security resulted in the same statement.

Social Security has withheld these premiums and paid MVP directly for many years. The subscriber is charged with telling MVP how they would like their bill handled. All of these subscribers had told MVP that they would like to have the premiums deducted from their monthly Social Security benefit payment.

We spent much of December 22 and 23 trying to track down an explanation. An MVP customer service rep was the first to tell us that “lots” of people were affected. He also indicated that this situation involved other insurance carriers. No one at Senator Charles Schumer’s office or Congresswoman Louise Slaughter’s office was able to provide any clarification. Gary Hughes, Director of Media Relations at MVP, told us by phone that he was unaware of the situation and that after reviewing our just sent e-mail he would respond.

Letter from MVP about premium problems. Click for a larger image.

A letter from MVP to plan members was received on December 24. It spells out two problems. The Social Security Administration (SSA) had received inaccurate premium amounts for 2012 billings. The SSA has stopped the automatic withdrawal of the monthly premium from benefits.

MVP states that about 3,000 plan members have been affected by one or both of these issues. The company promises that the situation will be corrected by March 1 and deductions will resume after that date.

MVP’s present to their plan members affected by these issues is to bill the members directly. In mid-January, these members will receive a bill for two months insurance premium, January and February. The amount of the Social Security benefit that these members will receive “may” increase for January and February. The MVP payment for both months, however, must be received by MVP by February 1 for the subscriber’s MVP membership not to be affected.

To recap the facts as we understand them:

1. MVP submitted incorrect premium amounts for 2012 to the SSA.
2. The SSA has advised up to 3,000 beneficiaries that it will no longer withhold MVP premiums from their benefits.
3. MVP will bill these plan members in mid-January for two months premium, January and February.
4. The payment for the two month billing must be received by MVP by February 1 in order for the member’s plan not to be affected in any way.
5. Because no premium will be deducted, the January and February Social Security benefit amount “may” increase.
6. The benefit for the month of February will be paid to beneficiaries after February 1.

Traumatic brain injury (TBI) is considered the signature injury of the wars in Iraq and Afghanistan. Military personnel sustain a TBI is many ways. Non-combat related incidents such as motor vehicle crashes or falls are one way. In combat, TBI is caused by collision with another surface or the force from a blast, or both. The causes of a combat TBI and its aftereffects can be very complex.

TBI diagnoses in the military by year

220,430 – number of traumatic brain injuries in the military from 2000 – June 30 2011
169,209 – number of TBIs classified as mild in that time period (concussions)
5,929 – number of TBIs that were classified as severe or involved penetration of the skull

Severity of TBI diagnoses in the military by year

Diagnoses of TBI by military branch and year

Army data
126,545 – total traumatic brain injuries suffered by Army personnel from 2000 – June 30 2011
76 percent suffered by active duty Army personnel
17 percent suffered by National Guard soldiers
7 percent by Army Reserve soldiers

Navy data
31,167 – total traumatic brain injuries suffered by Navy sailors from 2000 – June 30 2011
93 percent suffered by active duty Navy personnel
7 percent suffered by Navy Reserve sailors

Air Force data
30,754 – total traumatic brain injuries suffered by Airmen from 2000 – June 30 2011
87 percent suffered by active duty airmen
8 percent suffered by Air National Guard personnel
5 percent suffered by Air Force Reserve personnel

Marine Corps data
31,964 – total traumatic brain injuries suffered by Marines from 2000 – June 30 2011
91 percent suffered by active duty Marines
9 percent suffered by Marine Corps reservists

Yearly diagnoses
2006 16,958
2007 23,174 – Congress directs Department of Defense to screen for TBI
2008 28,567
2009 29,255
2010 31,353

This data represents all military personnel diagnosed with a traumatic brain injury. The Department of Defense points out that other data is often obtained from screening and assessment tools which are not designed to produce a diagnosis. The data analyzed does not provide the cause of the injury or the location where it occurred.

U.S. Air Force medics, Staff Sgt. April Deluna -right-, from San Antonio, assigned to the Paktya Provincial Reconstruction Team, and Tech. Sgt. Rebecca Rose, from Coleridge, Neb., assigned to the Nebraska Agribusiness Development Team, demonstrate proper arm-bracing techniques at the provincial women’s development center, Nov. 1. The medics taught basic first-aid skills to 13 women from the province. U.S. Army photo by Maj. Katherine Williams

Thirteen Afghan women received life-saving first aid training at a provincial women’s development center shura held in Paktya province, Nov. 1.

U.S. servicemembers assigned to the Paktya Provincial Reconstruction Team and the Nebraska Agribusiness Development Team, both located on Forward Operating Base Goode, taught the women how to treat burns, lacerations and abrasions.

U.S. Air Force medics Tech Sgt. Rebecca Rose, with the ADT from Coleridge, Neb., and Staff Sgt. April DeLuna, with the PRT from San Antonio, conducted an interactive training program for the women.

During the one-hour course, the medics emphasized proper hygiene techniques such as hand washing and the use of gloves while treating wounds.

“The women learned the ‘cold, clean’ method,” DeLuna said. “They’d never heard to clean with cold, clean water and were using alternative methods to treat wounds.”

The women shared stories about their previous home-medical treatments during the shura.

“I’ve used cold potatoes on my children’s wounds to stop the burning,” one student said. “Potatoes and egg yolk both help to prevent the burn from spreading.”

Along with l training, the group also received first-aid medical kits, stocked with bandages, a gauze compress, gloves, antibiotic ointment and other supplies.

The shura was coordinated through Khalema Khazan, the Paktya Director of Women’s Affairs and the Team Paktya Women’s Advocacy Group.

The DOWA is an Afghan ministry-appointed position, with the authority and obligation to raise awareness of concerns and advocate for Afghan women.

“I want a common understanding for every woman to know their rights and freedoms under Islam,” Khazan said. “We have shuras in the women’s development center for Paktya women to teach them important skills.”

In the past, Khazan has organized town meetings, or ‘shuras,’ health workshops and media engagements for women in Paktya.

“Education is very important,” she added. “Our center is focused on teaching the more than 40,000 women in Paktya.”

DVIDS

In the glitz and glamour of Hollywood, appearance is almost everything and plastic surgery – to achieve the perfect body, the perfect face, and perfect skin – is commonplace if tabloids and TV shows can be believed.

So, as soap opera star J.R. Martinez of “All My Children” sees it, he fits right in. After all, he’s had more than 30 surgeries. The only difference between Martinez and other young actors: Instead of getting a nose job or Botox shots from high-priced Beverly Hills surgeons, Martinez spent more than two years at Brooke Army Medical Center in San Antonio, undergoing skin grafts and treatments for burns that covered 40 percent of his body.

That’s because Martinez – who plays Brot Monroe, an Army veteran burned in combat – used to be Cpl. J.R. Martinez of the 101st Airborne Division. He deployed to Iraq during the initial invasion in March 2003 at the age of 19, only six months after enlisting, still so green he wasn’t sure he could find Iraq on a map. Less than a month later, April 5, the front left tire of the Humvee he was driving hit a landmine. Three other Soldiers were thrown from the vehicle and sustained mostly minor injuries, but he was trapped inside.

Minutes before, he and the Soldier riding shotgun had been joking about how cool it would be to get a Purple Heart and not have to wait in line at restaurants back in the States.

“The things you say and never think it’s going to lead to anything,” he remembered, “because humor is the biggest thing you’ve got to maintain while you’re over there. That’s what keeps you going.”

But it wasn’t cool, and instead of laughing, he was soon screaming for help as smoke filled the Humvee and flames consumed him.

“It’s going to end for me. This is it,” he thought.

Raised by a single mother, Maria Zavala, who had emigrated from El Salvador and had already lost one child, he realized that there was no way he could put her through that again. He had to hang on. By the time his buddies were able to get him out (Martinez later learned insurgents had attacked their convoy as soon as the landmine went off), 10 or 15 minutes had gone by and, conscious the entire time, he was in unspeakable pain.

“It’s really hard to explain,” Martinez said. “You know how you burn yourself on an iron or stove and how painful that is, or maybe a sunburn, and the pain is just excruciating’ This was just on-another-world-, on-another-universe-painful. It was just so far beyond what I had ever known and what I’ve ever experienced that there’s no way to explain it. It’s an unbearable pain. Burns are something I would never wish upon my worst enemy.”

The third-degree burns were so deep, and he lost so much fluid and tissue, that after a while, they destroyed the nerves. The smoke damage was so severe that his lungs and other organs began to shut down. Martinez was put in a medically induced coma for the pain-that and because he kept trying to touch his face, thinking he could make it feel cooler.

One of the medics later told him that he had to be strapped to his bed at the evacuation hospital after he bounced up and told everyone to leave him alone because he was “fine.” In reality, when he arrived at BAMC four days later, doctors still weren’t sure if he would make it, and kept him in the coma for almost three weeks.

After he came out of it, he remained completely dependant on others for weeks, and nurses escorted him to the showers every morning for debridement (removing the dead, scarred skin), which Martinez said was even more painful than the initial burns. But after several days of the torture, he became suspicious: “What the hell is going on’ Why is this so painful’ What does it hurt so much’” he thought, and demanded to see a mirror, although his doctors and nurses were vehemently opposed. They thought it was too soon and would be traumatic, but Martinez insisted.

“‘I want to see my face. I want to see my body, now,’” he told them, explaining that he was the one who would have to live with it for the rest of his life. Why bother putting it off? It would be just as devastating later, so surely it was better to get it over with. When they finally agreed and sat him in front of a mirror, the sight of his face, neck and hands was a shock that sent him into a depression so deep, he began to wonder if he would have been better off dying in that Humvee.

The life he had dreamed of was certainly back in its burned out shell. At the age of 19, he was no longer the handsome young athlete everyone had talked about, and he no longer knew how he would ever find a girlfriend, let alone get married or have children.

“I just felt, looking at my body, there’s no way I’m ever going to be able to experience that,” he said. “My life was spared, but for what?”

Martinez grieved for the man he had been, only going through the motions of his recovery, wondering what he had done to deserve such a punishment, until about five weeks after he had arrived at the hospital when his mother — who had gone through her own ordeal watching her only son face death and disfigurement — snapped him out of it. She explained that he had a lot to learn about life. Looks weren’t everything. In fact, she joked, she was proof.

“‘People are going to be in your life for who you are as a person and not what you look like,’” she told him. “‘I remember when I was younger, everyone told me I was pretty and gave me compliments. No one tells me that now.’”

Something clicked and Martinez immediately answered, “‘You know what, Mom? You’re right. And now, I’m actually glad this happened to me.’”

“‘Wait a minute, what do you mean you’re happy?”

“‘Now I get to see who liked me as a person, versus who liked me for being the popular guy in school, being the athlete, being the handsome young man. Now I get to see who really loves me or likes me for who I am as a person,’” he said. In that instant he understood, and he suddenly had a new mission.

Between his 32 (eventually 33) surgeries, and therapies to stretch his tender, growing skin (he even had to wear a mask to compress the scarring on his face), Martinez began to visit other, newly wounded servicemembers on the wards at BAMC. They too were often badly burned, some with faces that had been nearly charred off. They too were devastated and sometimes didn’t want to go on living, but Martinez noticed that after he talked to them, they seemed to cope a little better.

“I said to myself, ‘I think this is my gift. I’m going to share my gift with other wounded troops because a lot of these guys are arriving here without a clue of what to expect. I’ve been through it. Maybe I can just kind of help them and prepare them on what to expect.’ So I started visiting patients on the wards every day,” he explained.

The local and then national media began to pick up his story, and before he knew it, he was in the Washington Post and on “60 Minutes” and “Oprah,” talking about hope and renewal, explaining that if wounded warriors could just find the strength they had in battle, or even when they enlisted, they could make it through this war too.

Due to his heavy scarring, Martinez is used to getting some strange looks when he hits the streets, and he wants injured servicemembers, burn victims and other people with disfigurements to know that that’s OK. In fact, he embraces the strange looks, and if someone wants to ask about his scars, that’s fine too, because Martinez views the looks and questions as opportunities to educate people about true beauty.

“We have the power,” he explained. “The more we sit there, the more we accept the unfortunate things that have happened, the more we embrace those things and own them, we have the power to actually change the mindset and allow these people to be completely comfortable with scarring, with disfigurement. But what we have to do is go out to the public. We can’t be afraid. We have to step up and say we’re going to go out there, because the more they see, the more they start to say, ‘OK, you know what’ There’s nothing wrong with it. It’s unfortunate, but it’s kind of common.’”

In 2006, when one of his noncommissioned officers urged him to stay in the Army and continue motivating other Soldiers after he was finally discharged from BAMC, Martinez explained that his new uniform was his scarred skin, and his new weapons were his words. He spent two years doing motivational speaking and nonprofit work for wounded troops, and then one day in 2008 he got an e-mail: “All My Children” had decided to launch a short-term storyline about the difficulties returning veterans faced, and thought it might be interesting to cast the role with a real veteran. Martinez had no acting experience, but he had done hundreds of speaking events at that point, and figured he had nothing to lose by auditioning.

Getting the role of Brot Monroe, who had let his fiancee and family believe he was dead rather than let them see his scars, was surreal to Martinez, especially because during his recovery at BAMC, while forced to watch his mother’s telenovelas every night from his hospital bed, he had joked with her that he would be on a soap one day. He already knew the plot and everything: Man gets beautiful girl. Man is in car accident or fire. Girl visits man in hospital. Man turns out to be Martinez. Martinez gets beautiful girl.

Things have been far from that straightforward for Brot as he struggles to come to terms with his scars and civilian life in fictional Pine Valley, Pa., but he has connected with audiences. Martinez’s three-month stint became a long-term contract, with Brot joining the local police force, and even finding possible romance with a beautiful lady detective. The show’s writers and producers, Martinez said, try to be as accurate as possible, and give him a lot of input. They even incorporated his 33rd surgery last summer to fix one of his eyelids into “All My Children’s” storyline.

While his character carries a lot of anger and grief, and occasionally lashes out at friends and coworkers, Martinez hasn’t found those scenes to be especially painful, explaining that because he has already worked through his own pain, he can go to that place for the scene and then turn his emotions off. Many viewers are actually surprised that he’s a real veteran and not a regular actor wearing heavy makeup, waiting for a “miracle” plastic surgery cure.

“I remember one day sitting in Grand Central Station (in New York), waiting for a friend, and all of a sudden a guy’s walking by and he said, ‘Are you guys filming a scene here” At first it’s understandable that people think it’s makeup because TV does crazy things. However, it’s nice for people to understand and learn over time that it’s real and become educated about it,” Martinez explained, adding that “All My Children” is a great way for him to educate people about wounded Soldiers and motivate people going through their own battles.

Martinez is writing a book about his experiences, and hopes to have his own talk show some day. In the mean time, he still does a host of motivational speaking and charity work on behalf of wounded troops, who he’ll often invite to the show’s new Los Angeles set (the show, and Martinez, just moved to LA from New York). In time-honored military tradition, once they’ve finished making fun of him for acting on a soap opera, and bonding over shared experiences, Martinez explains that it might be his name and face out there, but that’s it. He’s out there for them. They inspire him. He’s been home from war for seven years, so recently returning vets are fighting for his freedom as much as anyone else’s, and he has a debt to repay.

“Although a lot of these guys say that I inspire them, a lot of them inspire me,” Martinez said. “When I’m having a bad day, I just think about a lot of them, and I just think, ‘What am I sitting here complaining about’ These guys have gone through so much more.’”

Elizabeth M. Collins
U.S. Army

Military members paused for the cameras while fashioning outdated uniforms as a part the Walter Reed Army Medical Center closing ceremony. The Base Realignment and Closure process is merging Walter Reed Army Medical Center and National Naval Medical Center Bethesda into Walter Reed National Military Medical Center Bethesda, MD. This is the first major medical transition of such a large magnitude in United States military history, and allows Army, Air Force, Navy and civilian medical personnel a historic opportunity to work together as one unit in an effort to provide the best care possible for wounded warriors, military members, retirees and their families. Photo by Sgt. Anderson J. Grant

The last patients at Walter Reed Army Medical Center (WRAMC) were transported to the National Naval Medical Center (NNMC) in Bethesda, Md., Aug. 27.

A total of 18 patients, four of which were in critical care, departed WRAMC around 7 a.m. By 9 a.m., all patients were moved and checked into the new Walter Reed National Military Medical Center (WRNMMC).

NNMC Commander Rear Adm. Matthew Nathan said to those involved in the planning leading up to this day that they are a part of history.

“This is a historic day,” said Nathan. “This is the culmination of 102 years of Walter Reed service, blending and integrating into the service of the National Naval Medical Center. Now we’re taking the best of both practices.”

At the conclusion of the move, Joint Task Force CapMed Commander Vice Adm. John Mateczun discussed the vision of the department for the integration of the two facilities.

When it came to planning for this new venture, the goal in mind, during the last several years, was to take these two facilities and provide the same capabilities, said Mateczun.

“What we’ve been able to do is put capital investment into the infrastructure, so we achieve a world class infrastructure,” said Mateczun. “The department has been intent on making sure we’re able to provide world class standard and keep our covenant both with wounded warriors that come back from Iraq and Afghanistan as well as their families.”

WRAMC Commander Col. Van Coots noted that the transition was almost flawless.

In the weeks leading up to the move, patients and their families, who were identified as those who would be moving, were told that WRAMC staff would be moving right along with them, which helped put their minds at ease, said Coots.

“It was such a smooth transition today,” said Coots. “We’ve been identifying patients over the last two weeks and had informed families about the transition, what they could expect here, letting them know we’re not abandoning them.”

Coots went on to note the amount of pride in not only what WRAMC’s achieved in the last 102 years, but also what they have achieved together with the flagship of Navy Medicine here to create the future of the military health care system.

Due to weather conditions with Hurricane Irene, the patient move, originally scheduled for Aug. 28, was moved to Aug. 27.

“We have always been an agile organization. They have deployed hundreds of personnel at the drop of a hat to human assistance relief missions or disaster relief missions, so we’re pretty adept at having to change plans suddenly and reconfiguring logistics,” said Nathan. “I’m very proud of the crews from Bethesda and Walter Reed.”

The day concluded with handshakes and commendations shared by both organizations.

The National Naval Medical Center Bethesda will now be officially known as the WRNMMC.

By Sarah Fortney
National Naval Medical Center Public Affairs
US Navy

The 332nd EMDG Public Health flight is different because their mission involves taking care of the population at large at Joint Base Balad, Iraq.

“Our mission is to prevent disease, disability and premature death,” said Maj. Kristi Wiechert, 332nd EMDG Public Health flight chief, who is deployed from Andrews Air Force Base, Md. “The most perishable weapon system is the human weapon system.”

Everyone who arrives at JBB helps the flight during in-processing, when medical records are checked for immunizations. These same records are checked again before departing JBB to ensure no one leaves the theater sick. The flight maintains records of disease non-battle injuries.

“DNBI includes things like a sprained ankle or the flu, anything that is not from bullets or a bomb blast,” said Wiechert, who is a native of Lake City, Ark.

As the drawdown of U.S. forces from Iraq continues, there will be fewer amenities available, which may pose some challenges for the flight.

“More people in close contact can cause health hazards, which can degrade the mission, so we will be conducting more facility inspections,” said Staff Sgt. Michael Davis, who is deployed from Lackland AFB, Texas.

The flight inspects all facilities that serve food, as well as public facilities, such as fitness and recreation centers.

“Our bioenvironmental team checks to make sure the water supply is safe, and we make sure the kitchen has the door and freezer doors locked so no one can tamper with the food,” said Davis, who is originally from Oklahoma City.

The flight also inspects facilities that are closing down to ensure no food is left behind that could attract rodents, which would pose a health hazards for JBB inhabitants.

“I like that there’s such a broad range, because I get to do something different every day,” said Davis. “My job’s broadness is also what makes my job most challenging.”

Davis explained that, for example, if someone gets sick, the flight has to investigate how the patient got sick, where the patient last ate, what the patient ate, so the flight is always digging to get to the bottom of an issue.

“We try our best to keep patients out of the clinic through surveillance and intervene any way we can to keep the population safe,” said Wiechert.

Written by Senior Airman Amber Kelly-Herard
332nd Air Expeditionary Wing
US Forces-Iraq

Navy Lt. Cmdr. Rachel Oden, a physical therapist at the Concussion Restoration Care Center, Camp Leatherneck, Helmand province, Afghanistan, treats Capt. Louis Delair, a logistics officer with 2nd Air-Naval Gunfire Liaison Company, while Cpl. Joshua Sheets, a team leader with 2nd Battalion, 8th Marine Regiment, performs exercises specific to recovery for concussed patients, April 22. The CRCC opened in August 2010 and helps prevent injured service members from having to return to the U.S. for minor injury treatment. Photo by Cpl. Katherine Keleher

For service members who experience a concussion or mild traumatic brain injury, there is hope for a fast recovery and return to their unit thanks to the Concussion Restoration Care Center on Camp Leatherneck, Helmand province, Afghanistan.

The center, which opened in August 2010, is a new concept for Regional Command Southwest.

“We’re in the proof of concept stage,” said Navy Cmdr. Earl A. Frantz, the officer in charge of CRCC. “Right now concussion is the number one battle injury, and muscle skeletal is the number one injury on base. We specialize in treating both of those. We have all these specialties under one roof, so we can care for the injured and allow them to get back to the fight.”

Before the CRCC opened, injured service members here typically sent back to the U.S. for treatment. This not only took them out of the battle, but cost money and lowered morale.

“It’s been shown in many studies that if you send them home to the rear it’s emotionally and physically detrimental to them,” explained Frantz, of Petoskey, Mich. “Marines can’t do that. It makes them feel guilty knowing their unit and their brothers are still over here fighting and they’re healed up back home. It can lead to depression, sleeping problems, excessive drinking and other things.”

To allow concussed Marines the opportunity to stay in Afghanistan, the clinic offers concussion care, sports and family medicine, mental health care, physical and occupational therapy, and acupuncture.

“We offer so many things here so we can concentrate on keeping the troops here,” Frantz explained.

Over the last eight months, CRCC has maintained a 97.7 percent return to battle rate, proving their concept to be effective.

“This place is definitely worth coming to,” said Lance Cpl. Michael J. Politowicz, a combat engineer with Combat Logistics Battalion 2. “They provide you so many things. When I first got out of the hospital I was scared to get back to the fight. As my concussion healed and I continued my therapy, I was able to think more clearly and act as a Marine.”

Politowicz recently survived an improvised explosive device blast in the Sangin District of Helmand province. When the blast detonated, Politowicz landed three meters away on his head, causing a concussion.

The people in the CRCC are passionate about their jobs and are here to help, continued Politowicz, of Detroit. They are here to get Marines back to where they were before their injuries.

“Before I left the hospital I couldn’t close my hand, and after coming here for a few weeks I’ve really improved. I can almost completely open and close my hand,” he added.

While treating injured service members is the main focus for the CRCC, the staff there offers more.

“It puts a routine back in your life,” Politowicz said. “When I first got injured all I wanted to do was go home. I didn’t have a routine, and I had really bad anxiety. Coming here gives you people to talk to and a routine.”

While the CRCC is still considered a work in progress, it will be moving to a larger facility in the upcoming weeks.

DVIDS
Story by Cpl. Katherine Keleher

Capt. Isaiah Manigault assists Staff Sgt. Nicholas Sweetman with his chemical protection suit March 20, 2011, at Kadena Air Base, Japan. Sergeant Sweetman was preparing to scan a convoy returning from an urban search and rescue mission in Myagi, Japan. Captain Manigault is the deputy chief of the 18th Aerospace Medicine Squadron Bioenvironmental Engineering Flight, and Sergeant Sweetman is a technician at the 18th AMDS Bioenvironmental Engineering Flight. U.S. Air Force photo/Master Sgt. Kimberly Spinner

Among the typical crews for disaster relief in mainland Japan is an atypical crew.

Amid concerns for the environment, two Airman from the 18th Aerospace Medicine Squadron’s Bioenvironmental Engineering Flight has responded to the disasters there.

While other crews from here perform search-and-rescue operations and work to restore power in the neighboring cities, the 18th AMDS have deployed to Honshu island, sometimes known as mainland Japan, to aid Yokota AB in the testing for radiation and other contaminates in the surrounding environment.

Team members can conduct health assessments for hazards such as the exposure to radiation, (dangerous) chemicals and materials, and anything else that could harm the local populations, according to Tech. Sgt. Joanie Long, the bioenvironmental engineering flight readiness NCO in charge.

Though Sergeant Long stayed behind on this trip, she said the entire unit would have jumped at the opportunity to help more if they could.

“We just keep asking, ‘What could we do more?’” Sergeant Long said. “If we could, we’d all jump on the plane and go so we could help out.”

With these situations being so rare, most of the individuals in this career field may have trained for years without having to implement their skills in real-life situations.

Nineteen-year veteran Senior Master Sgt. Benjamin Winslow, the bioenvironmental engineering flight chief and member of the deploying crew, said the last time he performed in a real-world emergency was 10 years ago, when he worked to detect uranium around a nuclear reactor at his first base.

Though it’s been a decade since he had to perform outside of an exercise environment, Sergeant Winslow said the team has been training vigorously over the years to prepare for situations like this one.

“I’ve been training (for this kind of situation) for 19 years,” Sergeant Winslow said. “We spend a lot of hours training every week, and with all of our experience in exercises and training, we’re very capable. I’m looking forward to being able to use my skill to help someone.”

US Air Force
by Airman 1st Class Maeson L. Elleman
18th Wing Public Affairs

Master Sgt. Chelesa Wilds, 1st Maintenance Operations Squadron noncommissioned officer in charge of instructional systems development at Langley Air Force Base, Va., enjoys a day in the sun with 3-year-old daughter, Kamdyn, at the Juvenile Diabetes Association Walk to Cure Diabetes in October 2010. Sergeant Wilds speaks out about the challenges of raising a diabetic child and encourages parents who may face similiar circumstances.

It was a hot May night in 2010 that changed the lives of the Wilds family forever.

Her eyes welled with tears and her voice shook, as Master Sgt. Chelesa Wilds, 1st Maintenance Operations Squadron noncommissioned officer in charge of Instructional Systems Development, recounted the events that led doctors to diagnose her 3-year-old daughter, Kamdyn, with Type 1 diabetes.

“I was just letting her be a kid,” she began with tight lips and heavy eyes. “We had been out all day, so fast food was just easiest. Had I known what would happen…” But before she finished her thought, she quickly composed herself to recount that horrific night.

At 11 p.m., the vomiting began, so Sergeant Wilds reached for electrolytes and juices to quench her daughter’s thirst.

“I was fueling the fire as she complained of thirst every 20 minutes,” Sergeant Wilds explained. “The juices were filled with carbs, and too many carbs raises the blood sugar, causing her to vomit. It was her body’s way of flushing it out her system.”

The following morning, Sergeant Wilds began tracking her daughter’s liquid consumption to eliminate the possibility of an underlying condition. In a 12-hour period, Kamdyn consumed 81 ounces of fluid, took a four-hour nap, and went to the bathroom 13 times.

“I have family members with diabetes, so I knew the symptoms to look for,” Sergeant Wilds said. “In addition to the constant drinking and peeing, her language and fine motor skills showed delays when compared to her peers. Plus, my maternal instinct was telling me something’s not right.”

Two days later, Kamdyn’s pediatrician diagnosed her with Type 1 diabetes, a condition in which the body is unable to produce enough insulin to break down sugars and starches; therefore, blood sugar levels rise to dangerous levels and cause patients to vomit uncontrollably, as in Kamdyn’s case. Treatment for Type 1 diabetes includes daily insulin shots, or pumps, to stabilize blood sugar levels and a constant monitoring of food intake.

“I’m now an expert label reader,” Sergeant Wilds said chuckling with a half smile. “I know that 44 goldfish equals 15 carbs and a cup of milk has 13.”

Nearly a year since her diagnosis, Kamdyn is showing steady improvement in her language and cognitive development; however, she battles diabetes daily. Sergeant Wilds’ best defenses for her daughter are a strict shot schedule and diet.

Each morning, Kamydn receives a 24-hour insulin shot to maintain blood sugar levels in between meals and overnight. After meals, she also receives a rapid-acting insulin shot to counter the rise in levels when consuming carbs.

A drop in levels can be more dangerous for children than a rise in levels. It is also harder for parents to detect, as symptoms mirror that of a cranky or tired child. Parents may not know if the child is in danger or just acting their age, Sergeant Wilds explained.

“If Kamdyn is acting up, my first instinct is to test her blood. If her blood levels are normal then I can tell her, ‘OK, get your butt in the corner. You don’t have an excuse now,’” Sergeant Wilds laughed.

While Sergeant Wilds is able to laugh at such moments, finding a babysitter who can maintain the strict shot schedule and diet is a constant challenge.

“There are things that untrained caregivers could do that could kill her,” Sergeant Wilds stressed. “If they give her the wrong food, wrong dose or miss a dose of insulin, it could mean hospitalization. Caregivers trained to treat a diabetic child are scarce and many daycare centers refuse to administer medications.”

Of all the challenges of living with a diabetic child, flu season poses the largest threat. Diabetic children struggle to maintain immunity from germs, despite receiving the same annual immunizations as their peers. When illness strikes, fluid and food intake becomes lifelines.

“Sick season is the most difficult for us,” Sergeant Wilds said without hesitation. “A normal child may get the flu and not want to eat or drink, but that’s OK. If a diabetic child stops eating or drinking, the parent has to fight the medicine in their (child’s) system.”

Fighting the medicine requires frequent night wakings to force sips of juice. If Kamdyn were to refuse liquids, it may require a visit to the emergency room to administer IV fluids or a “sugar drip” to stabilize her blood sugar levels, Sergeant Wilds said.

“Everything has changed,” Sergeant Wilds said somberly. “I don’t want to say she won’t be a normal kid because she is (normal). Life’s just going to be more of a challenge.”

Sergeant Wilds encourages parents to look for the symptoms, get treatment early on and find others who are facing similar issues.

US Air Force
by Staff Sgt. Heidi Davis
633d Air Base Wing Public Affairs

Commander, U.S. Naval Forces Japan directed that Potassium Iodide (KI) be available for pick-up at 1200 today for all DoD personnel and dependents currently located at Commander Fleet Activities Yokosuka, Ikego Housing Detachment, Negishi Housing Detachment, and Naval Air Facility Atsugi.

- Do not take until notified.
- There is enough Potassium Iodide in Japan for all SOFA personnel.
- There will be mass public notification if you need to take Potassium Iodide.
- If notified to take Potassium Iodide, take recommended dosage only.

DoD personnel and their families are asked to proceed in an orderly manner to one of four distribution points to receive their individual allotment in case a need is identified.

Yokosuka – Purdy Gym
Negishi – Negishi Theatre
Ikego – Ikego Basketball Gym
Atsugi – Halsey Gym

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