ANN ARBOR, MI - When they were fighting Saddam Hussein’s army in the Iraqi desert earlier this year, American troops probably weren’t thinking about their long-term health — or anything but their immediate military goals and their own survival.

Video

Watch related video clip. For faster downloading, choose the lo-res option. (Windows Media Player required)

But now that those service members are starting to return home, the strain they faced under fire may start to catch up with them in more ways than they ever could have imagined. From aches and pains to rashes and memory gaps, the lingering effects of the intense stress of war may be taking a toll on their bodies and brains.

Will veterans of Operation Iraqi Freedom suffer a sequel to the “Gulf War syndrome” that still plagues tens of thousands of veterans of the first Iraqi conflict, over a decade ago? With the right help, they won’t have to, say University of Michigan Health System experts.

In fact, scientists and doctors know more now than ever about why veterans of every conflict in American history have suffered some form of post-war syndrome, a cluster of vague but very real mental and physical symptoms that often affect them for life.

Theories about causes ranging from chemicals and bacteria to radiation and viruses have made the headlines after each war. But researchers are finding more evidence that the true culprit may be the only common elements of every soldier’s, sailor’s, airman’s and Marine’s wartime experience: life-threatening and violent situations, extraordinary living conditions, and strange surroundings.

In other words: stress. Stress so intense it can knock a person’s brain and body chemistry off kilter, causing chronic disease if symptoms go untreated.

But, says the U-M Health System’s Daniel Clauw, M.D., treatment needs to come in the first few months after symptoms start to appear — which means that newly returned troops, and their families and doctors, need to be on the lookout now.

“If new veterans have common symptoms like pain in various parts of their body, fatigue and memory problems, then there are a number of things they can do to help manage those symptoms and make them less likely to become chronic,” Clauw says.

Clauw and his colleagues at the U-M Chronic Pain and Fatigue Research Program have created an independent Web site to help returning Iraq war veterans fight their newest battle, against long-term effects of their combat service.

The Gulf War Health site, www.med.umich.edu/gulfwarhealth, is aimed at service members, their families and health care providers, to help them recognize and deal with symptoms.

“Because we know what happened after the first Gulf War, we’re trying to educate the returning service members on what they can do to either help prevent these symptoms, or at least better understand them and get medical treatment,” says Clauw, a rheumatologist who specializes in research and treatment on many multi-symptom illnesses, including fibromyalgia, chronic fatigue syndrome and Gulf War veterans’ illness.

“We don’t like to say we ‘expect’ returning service members to come back with health problems,” Clauw continues, “but we know that after every war the United States has been involved in, going all the way back to the Civil War, there have been veterans who come back with new health problems. And so, we can reasonably expect that some of the people who return from this conflict will have these same types of problems.”

The difference this time, he adds, is the growing knowledge of what stress can do to the body, and what can be done to keep those effects from becoming permanent.

Clauw and his colleagues, as well as other teams nationwide, have done research in recent years that supports the theory that some people suffer the long-term effects of stress more than others, though it’s impossible to tell in advance which people they will be. Others may suffer short-term problems, and others may come through horrific experiences unscathed.

So, as a guide for all service members, their families and health care providers, the new U-M site offers information on the kinds of symptoms that might occur, the types of activities and therapies that may help ease them, and the history of war-related syndromes and knowledge on the lasting effects of stress.

The list of symptoms includes pain in specific areas such as the lower back and neck or “all over”; fatigue or lack of energy; mood difficulties such as depression or irritability; gastrointestinal problems such as diarrhea, gas or bloating; problems with memory or ability to concentrate; rashes and other skin conditions; and disturbed sleep and insomnia.

The simplest preventive step that service members can take — and perhaps the most important — is trying to restore a sense of normalcy to life as soon as possible after they return from the war, during the initial readjustment to civilian life, Clauw says.

“That includes the same level of exercise or activity that they were doing before the war, and re-establishing social ties and connections,” he explains. “From our research, we know that all of those things seem to be extremely important, and that when they aren’t done, people seem to have some of the longer-term health consequences.”

If symptoms don’t fade over time, Clauw and his colleagues have found, there may be options that service members can do for themselves, or that health care providers can recommend. These include a structured exercise program, better attention to “sleep hygiene” via good habits that encourage sleep, avoiding alcohol, memory-building tricks, stress management and relaxation techniques, medications, and “talk therapy” with a mental health professional.

Clauw helped lead a national study that was published in the Journal of the American Medical Association this spring, showing that veterans of the first Gulf War who had war-related illnesses had improvement in their symptoms if they exercised or took part in group cognitive behavioral therapy sessions, or both. That study was conducted in veterans who had had symptoms for years, but Clauw and others feel that earlier intervention could help more.

Just being aware that symptoms can occur in the first six to 12 months after the war may help, too, researchers feel. “If returning service members and their families know that there may be an adjustment period and some symptoms, and that this doesn’t mean they were necessarily exposed to a nerve gas or other agent in the war, but is rather a natural consequence of going to war, then they won’t worry as much. And that will help them get their lives back to the way it was before,” or make a decision to seek help if the symptoms continue.”

That decision to seek help may be one that a service member has trouble making, because he or she isn’t sure that anything can be done, or that the health care providers available will understand what’s happening.

But Clauw urges service members to take part in not only the post-service health screening that the Department of Defense is offering, but also the medical and mental health care offered to most active-duty and reserve personnel, and veterans, through their military or Veterans Administration benefits.

As awareness grows among physicians and other health care professionals of the strong scientific evidence behind the stress-based theory of post-war illness, more veterans and military personnel will get the help they need when they need it.

In the meantime, Clauw and his colleagues hope that health care providers who take care of those returning from the recent Iraq war will visit their new Web site, too. “The military spends a great deal of time training people on how to go to war,” he says, “but we don’t quite understand yet exactly how we should be training people to go home.”

Information on post-war illness:

• Many veterans of every war in American history have been affected by long-term illnesses that begin shortly after their service. What was known as “shell shock” after World Wars I and II, “post traumatic stress disorder” after the Vietnam War, and “Gulf War Syndrome” after the 1991 war in Iraq, are probably all related.
  
• Being in a war, just like other experiences ranging from car crashes to life-threatening infections, can put stress on the body and brain that can cause lasting effects.
  
• Carefully balanced systems of brain chemicals and hormones can get thrown “out of whack” by major stresses, and in susceptible people those changes can be long-term.
  
• The effects of war-related stress are not “all in your head” — they’re real, and so are the symptoms they cause.
  
• Symptoms can include pain, fatigue, rashes, and problems with mood, memory, the digestive system and sleep.
  
• Many people who experience symptoms soon after war or other major stressful events will recover if they return to a normal routine, including exercise and social contacts. Others will need to pay special attention to their exercise, relaxation and sleep habits, or get help that might include medication, talk therapy or stress-management.

Information on the U-M Gulf War Health Web site:

• The site is located at www.med.umich.edu/gulfwarhealth
  
• The site was created independently by the U-M Chronic Pain and Fatigue Research Program, without input or oversight from the Department of Defense or Veterans Administration. The U-M team received DoD and VA funding for research projects.
  
• The site has three sections: for service members returning from war, for the family members, and for health care providers caring for service members.
  
• Anyone may use the site; it is not intended as a gateway to care at any specific health facility or treatment but rather as a public resource.
  
• As the site grows and develops, more sections and information will be added, including issues suggested by visitors to the site.

Written by Kara Gavin

E-mail this information to a friend

Recent Press Releases