Lingering Casualties Even The Victors Suffer Gulf War Vets Afflicted By Painful Symptoms, Official Indifference

David Achtemeier was treated like a hero when he returned from the Persian Gulf in 1991.

Wounded in a mine explosion, the former Airborne medic came home to the thanks of a grateful nation that had just waged one of its most successful wars.

After the accolades faded, Achtemeier and a small but significant number of Gulf War veterans found they were paying an unexpected price for their service.

Stomach pains. Nausea. Headaches. Debilitating fatigue. Pains deep in the muscles. Insomnia. Strange rashes that form bumps like hard bubbles and last for months.

Since leaving the Army in 1992, Achtemeier has looked for answers, and often met with skepticism or indifference. His physician in Colville was stumped. Veterans Affairs doctors suspected stress or psychological problems.

Last December, wracked with pain and bone weary, the 30-year-old Achtemeier was desperate for answers.

“I’ve had every test done two or three times to me,” he said. “The biggest thing we’re fighting is denial. I was repeatedly told there was nobody else, that we’re all alone.”

One VA doctor even told him there was little anyone could do and compared him to a used car. “He said to get used to it, that I’d never be like new again.”

By some estimates, more than 80,000 gulf veterans - about one-tenth of all the American forces sent to the Middle East for the war - have reported medical problems now known as Gulf War syndrome. In Washington state alone, more than 1,550 veterans have requested medical exams to put them on the nation’s Persian Gulf War Registry.

Although veterans don’t have to be sick to receive a registry exam, nearly all those who ask for the tests have some symptoms, said Ric Price of the Washington state Veterans Affairs Department. The healthy ones don’t bother.

Veterans are asked to describe their medical problems and remember what toxic substances they may have encountered during the war. But a top medical researcher now suspects the information is so vague that it will be useless in finding the causes of veterans’ problems.

Gulf War syndrome was originally dismissed by the Defense Department and doubted by some VA medical experts. Now a growing number of researchers in and out of government say it exists, even if they disagree what caused it, how big a problem it is and how to treat it.

“I believe there is indeed significance and substance to Gulf War syndrome,” said Dr. Mimi Fields, the Washington state health officer and a physician in the Air National Guard. “Whatever it is, it is real.”

For former Army medic Achtemeier of Evans, Wash., and other gulf veterans, that recognition is a giant leap forward.

Questions and tests

Achtemeier made it through the initial questionnaire for his Gulf War Registry Exam before he had to excuse himself to vomit.

A clerk asked a long list of questions about what he could have been exposed to in the Middle East: Oil field smoke? Chemical weapons? Solvents? Pesticides? Vaccinations? Medications? Yes to all.

What about symptoms: Headaches? Joint pain? Fatigue? Memory loss? Rashes? Again, yes to all, plus some others that weren’t even on the form.

As the clerk finished the last of the questions on the exam form, Achtemeier turned pale and dashed for the rest room.

Nausea is a constant problem. The strain of the two-hour drive from their home north of Colville the previous day and the anticipation of the exam may have exacerbated his problems, said his wife, Lydia.

After her husband followed a physician’s assistant into an examining room, she waited anxiously in the medical center cafeteria and talked with Joseph Manley, the center’s director, and Ron Porzio, the assistant director.

She told them of her husband’s struggle to have his problems recognized as a true medical condition, and related the doctor’s comment comparing him to a used car.

The administrators winced, and Manley apologized, promising to personally check Achtemeier’s chart and talk to the physician. “If any of our doctors said that, he was wrong,” Manley said.

Lydia Achtemeier said she was anxious to have tests done on herself and her children under a separate VA program for relatives of gulf veterans. A week earlier, she had called a toll-free number to get information and was told to sign up at the nearest VA center. But when she asked a medical clerk at the center about the program, she was told to call the toll-free number.

Manley apologized for the confusion, and offered to find her a slot in the program. It means a trip to Seattle, the closest facility that conducts the exams, but if she can arrange to go, he promised to pay for the trip.

Her husband’s exam was more on her mind. After waiting weeks to get a slot, she said, they just hope it can shed light on the cause of his problems and suggest some treatment.

But that’s not the purpose of the exam, Manley told her. It’s strictly to provide information for the nation’s Gulf War Registry, a database for research into the mysterious collection of medical problems veterans have.

Internet fills the void

Recognition of Gulf War syndrome grew rapidly last year. Clinical tests on suffering veterans were completed and the results were submitted to scientific review. Researchers began suggesting causes - and debating conflicting studies.

A presidential commission held hearings around the country and at every stop heard stories of debilitating illnesses that plagued people who said they were healthy before going to war.

After years of denying that any troops were exposed to chemical warfare agents, the Defense Department was forced to admit that some soldiers could have been affected when an Iraqi weapons bunker was destroyed. Over several months of admissions, the number of troops who may have been exposed to nerve gas grew from 150 to 15,000.

Veterans already were cynical of the Pentagon’s truthfulness about nerve gas attacks. Many recalled times during Desert Storm when warning devices sounded and they were ordered into special protective clothing.

“Has it soured veterans? Absolutely,” said Beau Bergeron, director of the Washington state Department of Veterans Affairs. “It’s Agent Orange deja vu.”

Congressional committees began vying for the franchise to look into veterans’ problems and question the military’s handling of its investigations and records.

But other groups were way ahead of them. The Internet flashed with theories linking medical problems to sinister plots. Anti-government groups tried recruiting angry gulf veterans, suggesting they were being sacrificed for money, population control or one-world government.

“We cannot let this issue become another tool to divide and confuse the public and vets with health problems,” U.S. Sen. Patty Murray, D-Wash., warned colleagues on the Veterans Affairs Committee.

After the Vietnam War, the VA and Pentagon were criticized for being slow to react to the possible consequences of chemical poisoning by a defoliant and the stress of combat on soldiers. Agent Orange and post-traumatic stress disorder, or PTSD, slowly worked their way into acceptance over more than a decade.

For several years, PTSD was blamed for the problems of Gulf War vets as well.

But there were two problems with that diagnosis. First, while all wars cause traumatic stress, the Gulf War was very different from Vietnam. Veterans spent far less time in combat, emerged victorious and returned to parades, not derision.

The second problem is that PTSD is, itself, a vague diagnosis. There is no standard definition and no agreed upon treatment.

Doctor offers hope

Achtemeier’s afternoon exam for the Gulf Registry got him a referral to another doctor, and another day of tests. His blood was screened for HIV and three strains of hepatitis; he had an electrocardiogram, chest X-rays and ultrasounds.

Although grateful for the attention after feeling dismissed for several years, “it really makes you feel like a guinea pig,” he said.

The tests didn’t reveal the cause of his problems, but Achtemeier did gather more information about Gulf War syndrome to show his private doctor in Colville. Among the most helpful suggestions was a report that a common antibiotic, doxycycline, helps with the inflammation of muscle and nerve tissues that often accompanies the syndrome.

Howard Platter, a staff physician with extensive experience in environmental medicine at the Spokane VA Center, reviewed Achtemeier’s chart a few days later. He was struck by the similarity between the symptoms of Gulf War syndrome and two other hard-to-understand diseases, chronic fatigue syndrome and fibromyalgia. He’s not sure of the connection, or even if there is one.

“We’re dealing with something that’s not discovered,” said Platter. “I’ve got a lot of patients who are not Persian Gulf veterans who are sick with this.”

Platter said he was willing to prescribe doxycycline and other drugs that sometimes work for chronic fatigue syndrome or fibromyalgia, as long as veterans realize the medicines can have side effects. He searched through a 4-foot-high stack of studies on those other conditions compiled by his wife, Elaine, a registered nurse who suffers from fibromyalgia.

“The first thing for treatment is a little TLC,” he said.

Word spread quickly through the veterans’ community that the Spokane VA had a doctor who seemed to understand Gulf War syndrome. By late January, assistant director Porzio said veterans who live in areas served by other VA centers were coming to see Platter, who already had a full schedule of patients with other problems.

VA rules don’t allow patients to choose their doctor.

“We’re trying to see as many as we can, but I don’t want to set up undue expectations,” Porzio said. “If the people in Seattle and Walla Walla (Washington’s two other VA centers) use some of the same approaches, they’ll see similar results.”

New worries

After about a month of taking doxycycline, Achtemeier was well enough to work on the cabin he and his family are building on 20 acres north of Colville.

Mark Mendez-Vigo, a Colville physician who searched for treatments for Achtemeier for nearly two years, agreed to try doxycycline after reading information the young veteran brought him.

“He started getting better. Why? I don’t know,” Mendez-Vigo said.

The antibiotic has been around so long that many strains of bacteria are resistant to it. But it also has some chemicals that reduce inflammation, and with it, pain. That may be a key, the doctor said.

Whatever the cause, the difference was remarkable, Achtemeier said last week. Once too tired to work for more than a few minutes at a time without fainting or vomiting, he can now work through the pain to finish the family home.

He and his wife research Gulf War syndrome and allow homeless veterans who are willing to help with construction to live with them. He works with Pointman Ministries, a group of veterans who minister to other veterans, talking to people who are giving up on themselves, their faith or their country.

Their son, Alex, 3, has developed a fever and the rash with its oozing sores spreading over his face. Ashley, 8, has the rash and is sensitive to certain chemicals. Lydia has the fever and nausea.

The children recently began taking antibiotics.

“It kills me watching my family,” Achtemeier said. “They have the same symptoms I did two years ago.”

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