HAMPTON ROADS, VA.   December 16, 2004

Other Substances, Many Possibilities

CHAPTER 6: PART OF THE MIX

After more than a decade, there are still more questions than answers about the cause of illnesses suffered by veterans of the 1991 Persian Gulf War.

 

 Photo
Oil fires suspect.
Oil fires suspect.
AP PHOTO

Defective suits.
Defective suits.
FILE PHOTO BY WIN MCNAMEE / AP

 Stories
VA list of other possible causes of Gulf War illness

 Photo
Blowing up a tank.
Blowing up a tank.
PHOTO COURTESY OF MATT ROHMAN

 THE SERIES

Part One: Looking for a cause, looking for a cure

Part Two: From the nose to the brain

Part Three: The silver bullet

Part Four: The battlefield at home

Part Five: The best test
 
BY BOB EVANS
247-4758

December 16, 2004

Stress. Pyridostigmine bromide. Bug spray. Permethrin. Sarin. Sand.

Depleted uranium.

Matt Rohman was exposed to all of them.

It happened in the 1991 Persian Gulf War, after Rohman enlisted and left his home in York County.

Now he's left to wonder whether one of those suspected dangers, several of them - or none of them - are why his once-strong body has been falling apart ever since.

The pain and problems began when he was 28, just back from battle. He hasn't been able to work since age 33. Now he's 40, unable to feel anything in his hands or feet, unable to breathe without drugs and unable to play ball with his young son.

Rohman's not alone. More than 183,000 veterans of the Gulf War are on some form of disability, and many of them have no idea what made them sick.

The Pentagon and government wrote off the problem as "stress" until public complaints, a few scientists and members of Congress raised a fuss and brought a change in direction a few years ago. Since then, some serious science has taken place in labs spanning the nation, giving many people involved some hope of progress.

Researchers in Mississippi used high-tech brain-imaging equipment to identify a type of dysfunction that appears to be consistent among sick Gulf War veterans.

Scientists in San Francisco found that the veterans who had health problems had experienced reduced levels of a chemical necessary for good brain functioning.

Doctors at Duke and in Dallas learned that many of the sick veterans had naturally low levels of an enzyme that helps the body fight off the debilitating effects of nerve gas.

In New Mexico, scientists found two problems when rats breathed air containing tiny bits of depleted uranium dust. In one group of animals, the depleted uranium migrated to the brain. Tests on another group revealed genetic mutations thought to be indicative of cancer.

The particles that the animals breathed were similar to the pieces of black dust resulting from using depleted uranium "tank-killing" weapons. The dust is toxic, mildly radioactive and easily inhaled. But scientists disagree on whether it could be responsible for the neurological and physical problems suffered by so many veterans of the war.

Pentagon officials dismiss the notion that the dust can cause health problems. They say the weapons are important and give U.S. troops a big advantage on the battlefield.

Rohman suspects that depleted uranium might have played a role in the loss of his health, but he also considers exposure to nerve gas, the bug spray he was given and other chemicals issued by the Army to be possible sources of the evils he's suffered.

So do doctors and researchers.

And that's part of the problem.

According to a June report on the problems of sick Gulf War vets by the Government Accountability Office, or GAO, 21 research questions remain unresolved. This is despite $247 million in research since 1994.

New technology provides a new look at vets' brains

With so many possible alternatives for what happened and so little hard evidence of who was exposed to the suspected causes, researchers are scrambling for good data, Robert Haley says. He's an epidemiologist and researcher who serves on a Department of Veterans Affairs advisory panel for Gulf War illnesses.

He and Duke University researcher Mohamad B. Abou-Donia say they don't even have an answer for simple questions, such as which drugs were given to which soldiers and where those soldiers were during the war.

Haley says a research effort to finally get a handle on the basic data of exposure is being prepared now and should begin in January. It should have been done years ago, he says.

Government officials almost started the project, but Haley and other researchers saw the questionnaire that they were going to use and recognized it wasn't adequate. It lacked a number of basic questions that will help researchers establish what hazards veterans might have come in contact with during the war.

Among the deficiencies, he says, were questions that would have helped define possible exposure to depleted uranium.

Haley is a former official at the national Centers for Disease Control and Prevention and now is chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas. He says some of the most important recent research was made possible by brain-imaging equipment invented after the vets came home sick and weak from the 1991 war.

Armed with this technology, researchers now can get pictures of what's happening in the veterans' brains.

Those pictures show that veterans who had the characteristic problems that some people label "Gulf War illness" consistently have lower levels of NAA. NAA is a chemical in neurons, the switches in the brain that permit thinking and processing, including muscle movement, strength and fatigue.

NAA is an indicator of how well neurons are functioning. The sick veterans had about 20 percent less NAA than veterans who didn't have health complaints.

Anyone who'd had such low levels of NAA before the war would have been noticeably impaired and wouldn't have been allowed to serve, Haley says. So it's relatively safe to think that this change happened during their service.

That doesn't prove what caused the NAA level to go down though.

Haley and many others think the most likely candidate for the cause of the illnesses is the nerve gas sarin. The Iraqi army used it against Iran in an earlier war and had stockpiles in 1991, the Central Intelligence Agency, GAO and other U.S. government agencies reported.

After U.S. troops went to Iraq and Kuwait in 1990 and 1991, their chemical-weapons alert systems frequently indicated that sarin was present, the GAO says. But that equipment was often unreliable to prove exposure and prone to false alerts.

Government officials later found that many of the chemical-protection suits given to soldiers were also defective, the GAO says.

Even if the Iraqis didn't intend to use sarin, many experts say they're sure that it was in the air - probably because our own troops put it there.

The GAO says CIA and Pentagon officials have acknowledged that several Iraqi munitions dumps thought to contain sarin were destroyed by the U.S. military during the war. The troops involved didn't know what they were dealing with, the GAO says, and the explosions put an untold amount of sarin gas into the air each time.

'WE PUT THEM IN A BIG CIRCLE AND BLEW THEM UP'

Rohman says that he participated in operations to destroy equipment at some of the sites identified by the CIA and that he worked near others. He also spent about three months blowing up Iraqi munitions and equipment in other places.

"In one incident, we found a convoy in Iraq, several hundred vehicles filled with rockets and ammunition," he says. U.S. Air Force A-10 "Warthog" aircraft firing depleted uranium weapons had attacked the convoy and scattered the vehicles. "We put them in a big circle and blew them up."

In another operation, Rohman says, he and others lined up Iraqi rockets and other munitions in a mile-long stack like firewood and blew them up.

The effort to destroy all those munitions and equipment went too fast to examine the individual items to determine what they were, he says. His unit was moving, moving, moving - ordered to find all that it could and blow it up before the Army had to leave Iraq after combat stopped and diplomats took over.

Now he thinks it's quite likely that some of those shells contained poison gas. But he doesn't know for sure.

Some scientists dismiss the sarin theory, saying there simply weren't the deaths and classic symptoms that the chemical is known for.

But others say the expected reactions didn't happen because the chemical was dispersed in those explosions and resulted in small doses over a large area. They say the chemical still got into the soldiers' blood through the skin, nose and mouth and did its damage, then disappeared from the bloodstream before testing could find it.

The human body has an enzyme that attacks sarin and staves off the effects, Haley says. Some people naturally have more of it, and some have less, but the level that someone has in their body doesn't change over time, and it can't be added later to rid the body of a toxin that's caused damage.

If the sarin from exploded munitions went into the air, it then fell on the soldiers in minute quantities for days, Haley says. He theorizes that soldiers with lower levels of the protective enzyme started experiencing weakness and reduced neurological functions that were barely noticeable, then continued to get worse. Other soldiers, with high levels of the enzyme, went home fine.

This would help explain why veterans with nearly identical experiences came home with totally different health prospects, Haley says.

Rohman and other veterans say their problems did begin with weakness, followed by more debilitating problems as time went on.

ONE TYPE OF PESTICIDE LINKED TO PROBLEMS, IF DOSES HIGH

Sarin is a chemical known as an organophosphate, which simply means that it's an organic derivative of phosphoric or similar acids. Agent Orange, the now-infamous weed killer that caused problems for veterans of the Vietnam War, is also an organophosphate.

Organophosate pesticides were also used during the Persian Gulf War to ward off sand fleas and other biting and infectious bugs in the desert. Soldiers frequently doused themselves, their tents and the sand around them with the chemicals.

In high doses, they've been proven to cause neuromuscular disorders. Scientists aren't sure whether smaller doses cause serious harm as well.

Haley says studies have found that farmers and pesticide workers who use organophosphates have higher-than-expected rates of the neuromuscular disease ALS, commonly known as Lou Gehrig's disease.

So have Gulf War veterans. According to the Veterans Affairs Department, they have a much higher rate of ALS at early ages than that of the general population. Haley says that gives some credence to the theory the organophosphates might play a role in Gulf War vets' problems.

Other researchers say chemicals troops used to prevent insect bites, and ate to ward off the possible effects of chemical weapons (including pyridostigmine bromide and permethrin) might be the problem. In the rush to battle after the Iraqi invasion of Kuwait, Pentagon planners began worrying about the possibility of a chemical war and realized that they had only experimental drugs to give troops. A decision was made to give the drugs out anyway, and some caused severe reactions.

Pyridostigmine bromide pills gave many vets sudden, violent reactions.

"When I started taking those pills, my hands went completely numb," Rohman says. "I couldn't hold things. So I just quit taking them."

The U.S. government maintains that soldiers didn't get a high enough dose of any of those pills to be harmed.

Haley, Abou-Donia and others say a mounting body of evidence about toxic chemicals shows the problem might not be that simple.

Scientists have known for years that a person under psychological or physical stress is much more susceptible to illnesses of many kinds than someone who isn't under stress, Abou-Donia says.

The sandstorms and extremely fine sand of the Persian Gulf region add to that stress on the body by irritating the eyes, breathing and other bodily functions.

Add the mixture of chemicals that the soldiers were exposed to, and the result could be demonstrable neurological problems from what might otherwise be insignificant doses of chemicals, Abou-Donia and Haley say.

Abou-Donia and other researchers demonstrated that principle in a scientific paper published earlier this year. They found that the combination of several of those chemicals, coupled with stress and exposure to silica from sand, resulted in measurable changes to important parts of the brain in laboratory animals.

The study included exposing the animals to high-strength DEET, a bug repellent used by many troops in the war. Products containing DEET are the most commonly used bug repellents in the United States. In low and limited doses, DEET is recommended to prevent various diseases from ticks, mosquitoes and other pests.

Abou-Donia's experiment involving DEET and other chemicals didn't include exposing animals to depleted uranium. But he says he thinks the weapons' dusty residue on the battlefield is a likely suspect in the parade of toxins that soldiers were exposed to - and which caused them to come home sick.

"I would think it is part of the mix," he says.

Area veteran tried for years to get depleted uranium test

Even though much more is now known about the nature of their illnesses and possible causes, Gulf War veterans still are having trouble getting adequate attention to their needs, say leaders of the American Legion and the National Gulf War Resource Center Inc., a veterans rights group.

Steve Robinson, executive director of the resource center, says doctors and clinicians at military bases and Veterans Affairs hospitals all over the country haven't been properly trained or educated about possible exposure to depleted uranium. The information that those clinicians are given doesn't include research later than 1999, he told Congress earlier this year, and what they're taught is often biased. As a result, he says, many veterans' problems are being ignored.

Rohman's medical records show he's had that problem at the Hampton VA Medical Center.

He says he's been trying to get officials there to give him a test for depleted uranium for years. Many of his medical records have been misplaced, lost or destroyed by the government agencies that handled them, but his own copies demonstrate that he told VA physicians about his exposure at least as early as 1998.

Kay Reid, who runs the Gulf War program at the Hampton VA hospital, says that should have been enough to trigger an examination for exposure to depleted uranium - and, given Rohman's description of his war experiences, a urine test.

She says she's not sure why it didn't happen then. Just as she doesn't know why it didn't happen this spring, when a doctor at the hospital put a note in Rohman's medical records March 9 that said Rohman "had requested a uranium exposure test."

The medical records show that messages were supposed to be sent from the doctor, notifying Reid that Rohman was in need of evaluation. Reid says she never got that message.

Rohman says he was given Reid's name and office telephone number to set up an appointment for the test. He says he called several times and left messages but never got a response.

When the Daily Press contacted Reid in July, she said she didn't know about his calls. She promised to follow up. Reid phoned Rohman that day to begin screening him for a test. Rohman says he still hasn't been tested, however.

Rohman's problems getting testing are similar to other veterans' experiences, based on a 2000 report by the GAO, the investigative arm of Congress.

The study found that more than 14 percent of the veterans selected for a depleted uranium testing program hadn't received testing because VA officials hadn't processed the referrals and made appointments.

The steps for screening vets who want a DU test

Reid says that as of Nov. 12, 603 men and women from southeastern Virginia and eastern North Carolina had been placed in a nationwide registry of veterans who served in the Persian Gulf region from 1991 to the present. The government began the registry in the early 1990s as an attempt to track health trends among the veterans, after persistent complaints about undiagnosed health problems. Nationwide, 86,000 veterans are in the registry.

Over the years, eligibility for the registry has changed, Reid says. Now anyone who served in the Persian Gulf region since 1990 - regardless of their health or whether they were there when a shot was fired - can ask to be included. As of mid-November, five people who served in the more recent fighting there have been placed in the registry by the Hampton hospital, though others are being evaluated and tested and will likely join them, she says.

Between 20 percent and 25 percent of the local veterans in the registry have health problems that are observable but not diagnosed, which mirrors the nationwide average, she says.

When veterans enter the registry and ask for a depleted uranium test, they first see a VA clinician like Reid. She says she goes through a 10-page questionnaire with each vet to get an idea about their exposures and experiences.

Then they're examined by a nurse practitioner, who makes a referral to a doctor, if that's called for, Reid says. At the Hampton hospital, Reid is the nurse practitioner who usually does the exams.

Reid says about half the veterans from the Persian Gulf War whom she's put into the registry in Hampton have asked for a test for depleted uranium.

"They think they may have been exposed to depleted uranium," she says, "but after we go over the criteria, they change their mind."

Reid says she asks people what jobs they had in the war and what kind of contact they had with enemy and allied tanks and armored vehicles struck by depleted uranium. If they weren't on or near the tanks very soon after a weapon struck, they're not likely candidates for exposure, she says.

If they were around a tank three days later, she says, there would be no exposure or minimal exposure - unless they went in the tank for extended periods.

"It's not something that's just floating in the air," she says. "You have to be around the tank within an hour of it being hit."

The Army's Environmental Policy Institute told Congress that bits of depleted uranium have been found as far as 400 meters (1,320 feet) downwind from experimental explosions.

The Canadian military's testing found that the particles can be suspended in the air for hours after an explosion.

U.S. military training programs say anyone going within 50 meters of a vehicle struck by a depleted uranium weapon should wear protective clothing and a breather mask, no matter how long after the explosion.

Ultimately, Reid says, she decides to give the tests to only 1 percent or 2 percent of the vets. If they insist, they can get the test, anyway.

Of those tested through her office, "We have not identified anyone here who actually had depleted uranium in their system," she says.

'If you don't look, you won't find'

Pentagon officials say the vast majority of the samples that they get don't contain enough total uranium, depleted or otherwise, to warrant further examination to determine whether depleted uranium is present. The military's testing program is also incapable of identifying small quantities of depleted uranium in veterans' urine samples and can never be used as a definitive test of exposure - only a test of what the military has deemed potentially unhealthy exposure.

Labs in Britain and Germany have developed methods much more capable of detecting depleted uranium, but the U.S. military isn't interested in copying them. Robinson and other critics of the military's handling of exposure issues say this is an important part of the problem.

The military has been telling people for years that the tests showed no exposure to depleted uranium when all that can be said for sure is that the tests chosen by the U.S. government are unable to detect it.

"If you don't look, you won't find," Robinson says.

Robinson and other veterans advocates say the problem is being repeated in the current war, with inadequate testing of troops before and immediately after deployment. This means scientists will once again be lacking important data if health problems arise a year or more from now, they say.

Rep. Christopher Shays, R-Conn., is chairman of the subcommittee on national security, veterans affairs and international relations of the House Committee on Government Reform. He says the Pentagon failed to set up the testing and health assessments that Congress demanded after realizing what happened during the Persian Gulf war.

Michael J. Kilpatrick, the Pentagon's deputy director for looking after the health of troops deployed to war, says the current system might not be perfect. But, he says, the military has made marked improvement in collecting data and keeping records that would prove beneficial to researchers if there's a repeat of the parade of ill, undiagnosed veterans from Operation Iraqi Freedom.

He says military officials routinely take measurements and test the air, water and soil of where troops are stationed and fighting. Health records are being computerized, he says, so shots, illnesses and other records can be tracked later.

But, Kilpatrick says, the realities of the modern battlefield don't make it possible to say where every soldier was and what the air, water and soil were like at that time. The equipment used for this work also isn't capable of detecting depleted uranium, except in very large quantities, he says.

One of the improvements in baseline health monitoring that Congress demanded in its 1998 law to protect servicemen and women involves a requirement that the Pentagon store blood samples taken from everyone before deployment. That's so researchers can examine the samples later to help compare before-and-after characteristics, in case there are health problems.

But the Pentagon surprised many sponsors of the bill by not doing what was expected.

Rep. Stephen E. Buyer, R-Ind., is a Gulf War vet who helped write the law. He's been critical of the military's response to the requirements. He says Congress spent a lot of time crafting a law to protect the troops and create a baseline of accurate medical information on every soldier deployed, only to see the Department of Defense, or DoD, water it down.

"We've got DoD going out there, doing their own thing," he said in a congressional hearing last year.

The most obvious deviation from the law's intent, Buyer and other members of Congress say, involves medical attention to troops before and after they deploy.

Buyer is chairman of the House Veterans Affairs Subcommittee on Oversight and Investigations. He says he and other members of Congress expected every soldier, sailor, Marine and airman to get a hands-on physical exam from a doctor when they mandated a "medical examination" for everyone before deployment.

Instead, the Pentagon decided that giving soldiers a two-page questionnaire, asking them to report any health problems, would be sufficient.

"The intent of Congress was an examination," said Rep. John R. Boozman, R-Ark., during a hearing last year. "And really, the reality is these young men and women basically got less than, you know, a cheerleader or a football player does every couple of years."

Buyer also pointed out that the law required "the drawing of blood samples to accurately record the medical condition of members before their deployment and any changes in their medical condition during the course of their employment."

The Pentagon used blood serum from the standard AIDS test, a part of the blood that doesn't allow doctors to do many before-and-after comparisons to see whether chemical exposures have affected someone.

PENTAGON BYPASSES $100 WHITE-BLOOD-CELL STORAGE

Kilpatrick says the Pentagon is doing everything the law requires.

He acknowledges that the blood serum being stored is of limited value and is only part of the blood taken in a sample. It doesn't contain parts of whole blood that would enable researchers to compare the rate of DNA mutations or many other important attributes with samples taken after the troops return from war.

Right now, he says, "there is no single blood test that would prove useful in screening all service members who have deployed." So the serum is all that's saved. Anything else isn't practical, Kilpatrick says.

Richard Albertini is a cancer researcher at the University of Vermont who's been part of the research into soldiers with depleted uranium shrapnel from the Gulf War. He says the Pentagon missed a chance to gather samples of white blood cells that could prove very important.

A few veterans with the shrapnel have shown increased rates of genetic mutations thought to be a warning sign of possible cancer, he says. To see whether this might be because of depleted uranium, researchers exposed rats to air with depleted uranium dust, and the rats showed the same type of mutations, he says. They also developed tumors.

But unless you can have a before-and-after sample of the veterans' white blood cells, you can't determine whether the change in mutations is the result of something that happened during their deployment or from some other factor, Albertini says. That would be one of the items that he'd identify as valuable, if keeping data for a baseline of health was the goal.

It isn't difficult and isn't very expensive to keep those white-blood-cell samples either, he says. "We do it all the time," he says, and it costs less than $100 a sample. Several members of Congress tried to put more specific requirements for blood samples into law this year, in response to the Pentagon's decisions. But a majority were concerned with putting too many mandates on the military in the midst of a war, so there was little specific guidance enacted for the blood-storage program.

Kilpatrick acknowledges that the system for protecting troops is evolving and isn't as good as it should be yet.

But when it comes to keeping records and data on health issues, he says, "we are light-years ahead," compared with the 1991 Persian Gulf War.