Gulf War Syndrome
Gulf War syndrome
Approximately 697,000 U.S. service members were deployed to the Persian Gulf from January to March 1991 as part of a multinational effort to stop Iraq's attack against Kuwait. And while the war itself was short, a long battle has been taking place ever since by veterans, the government and scientists to determine what has caused "Gulf War Syndrome," a mysterious collection of symptoms reported by as many as 70,000 U.S. men and women who served in the war. They are joined by British veterans in their health complaints, and in smaller numbers by Canadians, Czechs, and Slovaks.
Gulf War Syndrome is a complex array of symptoms, including chronic fatigue, rashes, headaches, diarrhea, sleep disorders, joint and muscle pain, digestive problems, memory loss, difficulty concentrating, and depression. A small percentage of veterans have had babies born with twisted limbs, congestive heart failure, and missing organs. The veterans blamed these abnormalities on their service in the Gulf. The U.S. Environmental Protection Agency (EPA) has also found high rates for brain and nervous system cancers among these veterans, up to seven to 14 times higher than among the general population, depending on the age group. Considering that most soldiers and veterans are younger and in better physical shape than the general population, researchers find such figures more than surprising.
Collectively, these ailments suggest that neurological processes may have been altered, or immune systems damaged. While no single cause has been identified, various analyses of the Gulf War experience point to low-level exposure of chemical weapons, combined with other environmental and medical factors, as key contributors to the health problems triggered years after exposure.
The war was unique in the levels of physical and emotional stresses created for those who served, as well as for their families. A significant portion of troops were from the reserves, rather than active enlistees. Deployment occurred at unprecedented speed. Most troops were given multiple vaccinations that singularly do not have adverse effects; their combined effects were not tested before distribution. Detectors often signaled the presence of chemical weapons during the conflict, but were mostly ignored as inaccurate. The soldiers worked long hours in extreme temperatures, lived in crowded and unsanitary conditions where pesticides were used indiscriminately to rid areas of flies, snakes, spiders, and scorpions, and breathed and had dermal exposures to chemicals from the continuous oil fires—burning trash, feces, fuels, and solvents. Blazing sun, blowing sand and biting sandflies further increased the discomfort and stress of military life in the desert . Exposures to the various fumes often exceeded federal standards and World Health Organization health guidelines; these alone could have caused "permanent impairment," according to a 1994 National Institutes of Health report.
The U.S. military now admits it was inadequately prepared for chemical and biological warfare, which it knew Iraq had previously used. Three of four reserve units, for example, didn't have protective gear. The drug pyridostigmine bromide (PB, 3-dimethylaminocarbonyloxy-N-methylpyridium bromide) was given to almost 400,000 troops before and during the Gulf War to combat the effects of nerve gas, even though it is approved by the Food and Drug Administration (FDA) only for treatment of the neurological disorder myasthenia gravis. The FDA agreed on the condition that commanders inform troops what they were taking and what the potential side effects were. One survey, however, found that 63 of 73 veterans who had taken the drug did not receive such information. Records were not kept on who took which drugs or vaccines, as required by FDA and Defense Department guidelines.
While the Defense Department and other government agencies have spent more than $80 million to try to identify the cause of veterans' ailments, a privately funded team of toxicologists and epidemiologists may have discovered an explanation for at least some problems experienced by Gulf War veterans. Researchers treated chickens in 1996 with nonlethal doses of three chemicals veterans were exposed to: DEET (N,N-diethyl-m-toluamide) and chlorpyrifos (O,O-diethyl O-3,5,6-trichloropyridinyl phosphorothioate), used topically or sprayed on uniforms as insecticides, and the anti-nerve gas drug pyridostigmine bromide. They found that simultaneous exposure to two or more of the insecticides and drugs damaged the chickens' nervous system, even though none of the chemicals caused problems by itself. The range of symptoms the chickens developed is similar to those the veterans describe. A similar study by the Defense Department found that the chemicals were more toxic to rats when given together than individually. Follow up studies are underway to determine if this also holds for humans.
The researchers hypothesize that multiple chemicals overwhelmed the animals' ability to neutralize them. The enzyme butyrylcholinesterase, which circulates in the blood, breaks down a variety of nitrogen-containing organic compounds, including the three substances tested. But the anti-nerve gas drug, in particular, can monopolize the enzyme, preventing it from dealing with the insecticides. Those chemicals could then sneak into the brain, and cause damage they would not produce on their own.
Many veterans believe that, while the drugs and pesticides may have played a role in their ailments, so have chemical weapons. Troops could have been subjected to much more low-level exposure of chemical weapons than previously believed, either directly or via air plumes, because 75% of Iraq's chemical weapons production capability, along with 21 chemical weapons storage sites, were destroyed by allied air raids.
In addition, U.S. battalions blew up an Iraqi arms dump soon after the war was over, before many troops had left the Gulf. Khamisiyah, an enormous ammunition storage site, covered 20 mi2 (50 km2) with 100 ammunition bunkers and other storage facilities. Two large explosions were set off, one on March 4 and a second on March 10, 1991. Smaller demolition operations continued in the area through most of April 1991.
While the site was not believed to have contained chemical weapons at the time, the Defense Department admitted in June 1996 that the complex had included nerve and mustard gases. The Central Intelligence Agency also admitted in April 1997 that it knew in 1986 that thousands of mustard gas weapons had been stored at the Khamisiyah depot, but the agency failed to include it on a list of suspected sites provided to the Defense Department before the 1991 war, which led troops to assume it was safe to blow it up.
Weather data shows that upper-level winds in the gulf were blowing in a southerly direction during and after the bombing. Thus, vapors carried by these winds could have contaminated troops hundreds of miles away. A 1974 report, Delayed Toxic Effects of Chemical Warfare Agents, found that chemicals weapons plant workers suffer as many chronic symptoms as those now suffered by Gulf War veterans, including neurological, gastrointestinal and heart problems, loss of memory and a greater risk of cancer ; exposure to these chemicals may also create birth effects in children. A 1995 study by a British medical researcher found many of the same symptoms in Third World people exposed to organophosphate insecticides, like DEET used in the Gulf War, which are diluted versions of chemical weapons.
While British, Canadian and Slovak veterans have reported similar ailments, albeit in smaller numbers, no French veterans have complained of such illnesses, despite extensive publicity. This is also providing valuable clues to the U.S. veterans' maladies, in several ways. For example, the French did not use many of the vaccines that the British and Americans used, including pyridostigmine bromide. French camps were not sprayed with insecticides as a preventive measure, rather only when needed to control pest populations. When they did spray, they did not use organophosphates. Finally, the French were nowhere near the Khamisiyah munitions depot when the destruction occurred.
In February 1997, a series of study results established the most definitive links between Gulf War syndrome and chemicals to date. The research identifies six "syndromes," or clusters of like symptoms in discrete groups of veterans, and associates each with distinct events during the war. Troops who reported exposure to chemical weapons, for example, are likely to suffer from confusion, balance problems, impotence and depression. Other sets of symptoms correspond to the use of insect repellants and anti-nerve gas drugs. While not conclusive, these findings will likely spur further research into the effects of low-level exposure to certain chemicals.
Such research was advocated by the presidential advisory committee, a 12-member panel of veterans, scientists, and health care and policy experts established in 1995. The committee held 18 public meetings between August 1995 and November 1996 to investigate the nature of Gulf War veterans' illnesses, health effects of Gulf War risk factors, and the government's response to Gulf War illnesses. While the committee's final report in January 1997 concluded that no single, clinically recognizable disease can be attributed to Gulf War service, it recommended additional research on the long-term health effects of low-level exposures to chemical weapons, on the synergistic effects of pyridostigmine bromide with other Gulf War risk factors, and on the body's physical response to stress.
While the debate continues, the Veterans Affairs and the Defense Departments are providing free medical help to any veteran who believes he or she is suffering from Gulf War Syndrome. In January 1997, President Clinton proposed new regulations that would extend the time available to veterans to prove their disabilities are related to Gulf War service from two to 10 years. He also initiated a presidential review to ensure that in any future deployments the health of service men and women and their families is better protected.
Definitive answers as to the causes and treatments for veterans' ailments may be years away. What is clear is that the complex biological, chemical, physical and psychological stresses of the Persian Gulf War appear to have produced a variety of complex adverse health effects. No single disease or syndrome is apparent, but rather multiple illnesses with overlapping symptoms and causes. If what had been considered acceptable trace levels of chemical agents in the war environment are found to be harmful, the U.S. military will have to revamp the way it protects its forces against even those tiny amounts. Tragically, that would mean that not only did "friendly fire" account for nearly 25% of the 146 U.S. deaths, but also that allied actions were responsible for the war's most persistent and haunting pain.
[Sally Cole-Misch ]
RESOURCES
PERIODICALS
Abou-Donia, M.B., et. al. "Increased Neurotoxicity Following Concurrent Exposure to Pyridostigmine Bromide, DEET and Chlorpyrifos." Fundamental and Applied Toxicology 34, no. 190 (1996): 201–.222.
Barry, J., and R. Watson. "Scent of War." Newsweek, September 30, 1996, 38–39.
Cary, P., and M. Tharp. "The Gulf War's Grave Aura." U.S. News & World Report, 121, no. 2, July 8, 1996, 38–39.
Cowley, G., and M. Hager. "Poisoned in the Gulf?" Newsweek 127, no. 18, April 29, 1996, 74.
——. "A Gulf War Cover-up?" Newsweek, November 11, 1996, 48–49.
"Darkness at Noon." The Economist 342, no. 7999 (January 1, 1997): 71–74.
National Institutes of Health Technology Assessment Workshop Panel. "The Persian Gulf Experience and Health." Journal of the American Medial Association 272, no. 5 (August 3, 1994): 391–395.
Pennisi, E. "Chemicals Behind Gulf War Syndrome." Science 272, no. 5261 (April 26, 1996): 479–480.
Shenon, P. "CIA Says It Knew of Iraq Chemicals." Detroit Free Press, April 10, 1997, 1–3A.
Thompson, M. "The Silent Treatment." Time, 148, no. 28, December 23, 1996, 33–37.
Waldman, A. "Credibility Gulf." The Washington Monthly, 28, no. 12, December 1996, 28–35.
Gulf War Syndrome
Gulf War syndrome
Definition
Gulf War syndrome describes a wide spectrum of illnesses and symptoms ranging from asthma to sexual dysfunction that have been reported by U.S. and U.S. allied soldiers who served in the Persian Gulf War in 1990–91.
Description
Between 1994 and 1999, 145 federally funded research studies on Gulf War-related illnesses were undertaken at a cost of over $133 million. Despite this investment, and the data collected from over 100,000 veterans who have registered with the Department of Defense and/or Veterans Administration as having Gulf War-related illnesses, there is still much debate over the cause and nature of Gulf War Syndrome. Veterans who have the illness experience a wide range of debilitating symptoms that elude a single diagnosis. They are tired, have trouble breathing, have headaches, sleep poorly, are forgetful, and cannot concentrate. Similar experiences among Gulf War veterans have been reported in the United Kingdom and Canada.
Causes & symptoms
There is much current debate over a possible causative agent for Gulf War Syndrome other than the stress of warfare. Intensive efforts by the Veterans Administration and other public and private institutions have investigated a wide range of potential factors. These include chemical and biological weapons, the immunizations and preventive treatments used to protect against them, smoke from oil well fires, exposure to depleted uranium, and diseases endemic to the Arabian peninsula. So far investigators have not approached a consensus. They even disagree on the likelihood that a specific agent is responsible, as a combination of these risk factors may have negative health consequences. There is, however, a likelihood that sarin and/or cyclosarin (nerve gases) were released during the destruction of Iraqi munitions at Kharnisiyah, Iraq, and that these chemicals might be linked to the syndrome.
In October 1999, the U.S. Pentagon released a report that hypothesized that an experimental drug known as pyriostigmine bromide, or PB, might be linked to the physical symptoms manifested in Gulf War Syndrome. The experimental drug was given to U.S. and Canadian troops during the war to protect soldiers against the effects of the chemical nerve agent soman.
Statistical analysis shows that the following symptoms are about twice as likely to appear in Gulf War veterans than in their non-combat peers: depression , post-traumatic stress disorder (PTSD), chronic fatigue , cognitive dysfunction (diminished ability to calculate, order thoughts, evaluate, learn, and remember), bronchitis , asthma, fibromyalgia , alcohol abuse, anxiety , and sexual dysfunction. PTSD is the modern equivalent of shell shock (term used in World War I) and battle fatigue (World War II). It encompasses most of the psychological symptoms of war veterans, not excluding nightmares, panic at sudden loud noises, and inability to adjust to peacetime living.
Chronic fatigue syndrome has a specific medical definition that attempts to separate common fatigue from a more disabling illness in hope of finding a specific cause. Fibromyalgia is another newly defined syndrome, and as such it has arbitrarily rigid defining characteristics. These include a certain duration of illness, a specified minimum number of joint and muscle pains located in designated areas of the body, sleep disturbances, and other associated symptoms and signs. One study comparing unexplained symptoms in Gulf War veterans with symptoms in control subjects found that over half the veterans with unexplained muscle pain met the criteria for fibromyalgia, and a significant portion of the veterans with unexplained fatigue met the criteria for chronic fatigue syndrome.
As of 2001, amyotrophic lateral sclerosis (ALS), which is also known as Lou Gehrig's disease , has been added to the list of illnesses that occur more frequently in veterans of the Gulf War. Gulf War veterans are twice as likely as other veterans to develop ALS, which is a disease that causes wasting of muscle tissue and kills its victims within three to five years. About 40 Gulf War veterans have been diagnosed with ALS; most have already died.
Researchers have identified three distinct syndromes and several variations in Gulf War veterans. Type one patients suffer primarily from impaired thinking. Type two patients have a greater degree of confusion and ataxia (loss of coordination). Type three patients are the most affected by joint pains, muscle pains, and extremity paresthesias (unnatural sensations like burning or tingling in the arms and legs). In each of the three types, researchers found different but measurable impairments on objective testing of neurological function. The functioning of the nervous system is much more complex and subtle than other body systems. Measuring it requires an equally complex effort. The tests used in this study carefully measured and compared localized nerve performance at several different tasks against the same values in normal subjects. Brain wave response to noise and touch, eye muscle response to spinning, and caloric testing (stimulation of the ear with warm and cold water, which causes vertigo) were clearly different between the normal and the test subjects. The researchers concluded that there was "a generalized injury to the nervous system." Another research group concluded their study by stating that there was "a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems."
Diagnosis
Until there is a clear definition of the disease, diagnosis is primarily an exercise in identifying those Gulf War veterans who have an undefined illness in an effort to learn more about them and their symptoms. Both the Department of Defense (DoD) and the Veterans Administration (VA) currently have programs devoted to this problem. Both the DoD's Comprehensive Clinical Evaluation Program and the VA's Persian Gulf Registry provide free, in-depth medical evaluations to Gulf War veterans and their families. In addition to providing individual veterans with critical medical care, these organizations use the cumulative data from these programs to advance research on Gulf War syndrome itself.
Treatment
Specific treatment awaits specific diagnosis and identification of a causative agent. Meanwhile, veterans can benefit from the wide variety of supportive and nonspecific approaches to this and similar problems. The key to working successfully with people living their lives with Gulf War syndrome is long-term, ongoing care, whether it be hypnotherapy, acupuncture, homeopathy, nutrition , vitamin/mineral therapy, or bodywork.
Allopathic treatment
There are many drugs available for symptomatic relief. Psychological counseling by those specializing in this area can be immensely beneficial, even life-saving, for those contemplating suicide. Veterans' benefits are available for those who are impaired by their symptoms.
Expected results
The outlook for war veterans is unclear, but will hopefully improve as more information is gathered about the illness. Gradual return to a functioning life may take many years of work and much help. However, even in the absence of an identifiable and curable cause, recovery is possible.
Resources
BOOKS
Isselbacher, Kurt, et al., ed. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1998.
"Posttraumatic Stress Disorder." Treatments of Psychiatric Disorders. 3rd ed. Ed. Glen O. Garbbard. Washington, DC: American Psychiatric Press Inc., 2001.
PERIODICALS
Bourdette, Dennis N., et al. "Symptom Factor Analysis, Clinical Findings, and Functional Status in a Population-Based Control Study of Gulf War Unexplained Illness." Journal of Occupational and Environmental Medicine 43 (December 2001): 1026–1040.
Haley, R. W., et al. "Evaluation of Neurologic Function in Gulf War Veterans. A Blinded Case-Control Study." Journal of the American Medical Association. 277 (January 15, 1997): 223–230.
Knoke, James D., and Gregory C. Gray. "Hospitalizations for Unexplained Illnesses Among U.S. Veterans of the Persian Gulf War." Emerging Infectious Diseases 4 (April-June 1998): 211–219.
McDiarmid, Melissa, et al. "Surveillance of Depleted Uranium-Exposed Gulf War Veterans: Health Effects Observed in an Enlarged 'Friendly Fire' Cohort." Journal of Occupational and Environmental Medicine 43 (December 2001): 991–1000.
"Self-Reported Illness and Health Status Among Gulf War Veterans. A Population-Based Study. The Iowa Persian Gulf Study Group." Journal of the American Medical Association 277 (January 15, 1997): 238–245.
Spencer, Peter S., et al. "Self-Reported Exposures and Their Association With Unexplained Illness in a Population-Based Case-Control Study of Gulf War Veterans." Journal of Occupational and Environmental Medicine 43 (December 2001): 1041–1056.
Szegedy-Maszak, Marianne. "A Gulf War Legacy." U.S. News & World Report (December 24, 2001): 50.
ORGANIZATIONS
Office of the Special Assistant for Gulf War Illnesses. 5111 Leesburg Pike, Suite 901, Falls Church, Virginia, 22041. 703-578-8518. [email protected]. <http://www.gulflink.osd.mil>.
The American Legion. Gulf War Veteran Issues. <http://www.legion.org/veterans/vt_gulfvet_info.htm>.
Veterans Administration. Persian Gulf Medical Information Helpline. 400 South 18th Street, St. Louis, Missouri 63103-2271. (800) 749-8387.
Veterans Administration. Persian Gulf Registry. 800-PGW-VETS (800-749-8387). <http://www.va.gov>.
Gulf War News. Office of the Special Assistant for Gulf War Illnesses, 5113 Leesburg Pike, Suite 901, Falls Church, Virginia 22041. (703) 578-8518. [email protected].
OTHER
Joseph, Stephen C., and the Comprehensive Clinical Evaluation Program (CCEP). "A Comprehensive Clinical Evalutation of 20,000 Persian Gulf War Vetrans." Military Medicine 162 (March 1997). [cited October 2002]. <http://www.defenselink.mil/pubs/foi/clinic.pdf>.
Paula Ford-Martin
Rebecca J. Frey, PhD
Gulf War Syndrome
Gulf War Syndrome
Definition
Gulf War syndrome describes a wide spectrum of illnesses and symptoms ranging from asthma to sexual dysfunction that have been reported by U.S. and U.S. allied soldiers who served in the Persian Gulf War in 1990–1991.
Description
Between 1994 and 1999, 145 federally funded research studies on Gulf War-related illnesses were undertaken at a cost of over $133 million. Despite this investment and the data collected from over 100,000 veterans who have registered with the Department of Defense (DOD) and/or Veterans Administration (VA) as having Gulf War-related illnesses, there is still much debate over the origin and nature of Gulf War syndrome. As of early 2001, the DOD has failed to establish a definite cause for the disorder. Veterans who have the illness experience a wide range of debilitating symptoms that elude a single diagnosis. Common symptoms include fatigue, trouble breathing, headaches, disturbed sleep, memory loss, and lack of concentration. Similar experiences among Gulf War veterans have been reported in the United Kingdom and Canada.
Causes and symptoms
There is much current debate over a possible causative agent for Gulf War syndrome other than the stress of warfare. Intensive efforts by the Veterans Administration and other public and private institutions have investigated a wide range of potential factors. These include chemical and biological weapons, the immunizations and preventive treatments used to protect against them, smoke from oil well fires, exposure to depleted uranium, and diseases endemic to the Arabian peninsula. So far investigators have not approached a consensus. In its final report released in December 2000, the Presidential Special Oversight Board for Department of Defense Investigations of Gulf War Chemical and Biological Incidents cited combat stress as a possible causative factor, but called for further research. There is also a likelihood that U.S. and allied forces were exposed to low levels of sarin and/or cyclosarin (nerve gases) released during the destruction of Iraqi munitions at Kharnisiyah, Iraq, and that these chemicals might be linked to the syndrome. In July 1997, the VA informed approximately 100,000 U.S. servicemen of their possible exposure to the nerve agents.
In October 1999, the U.S. Pentagon released a report that hypothesized that an experimental drug known as pyriostigmine bromide (PB) might be linked to the physical symptoms manifested in Gulf War Syndrome. The experimental drug was given to U.S. and Canadian troops during the war to protect soldiers against the effects of the chemical nerve agent soman. It has also been suggested that botulinum toxoid and anthrax vaccinations administered to soldiers during the conflict may be responsible for some manifestations of the syndrome.
Some studies have shown that Gulf War veterans have a higher incidence of positive tests for Mycoplasma fermentans, a bacteria, in their bloodstream. However, other clinical studies have not found a link between the bacterial infection and Gulf War-related illnesses.
Statistical analysis tells us that the following symptoms are about twice as likely to appear in Gulf War veterans than in their non-combat peers: depression, posttraumatic stress disorder (PTSD), chronic fatigue, cognitive dysfunction (diminished ability to calculate, order thoughts, evaluate, learn, and remember), bronchitis, asthma, fibromyalgia, alcohol abuse, anxiety, and sexual discomfort. PTSD is the modern equivalent of shell shock (World War I) and battle fatigue (World War II). It encompasses most of the psychological symptoms of war veterans, including nightmares, panic at sudden loud noises, and inability to adjust to peacetime living. Chronic fatigue syndrome has a specific medical definition that attempts to separate common fatigue from a more disabling illness in hope of finding a specific cause. Fibromyalgia is another newly defined syndrome, and as such it has arbitrarily rigid defining characteristics. These include a certain duration of illness, a specified minimum number of joint and muscle pain located in designated areas of the body, sleep disturbances, and other associated symptoms and signs.
Researchers have identified three distinct syndromes and several variations in Gulf War veterans. Type one patients suffer primarily from impaired thinking. Type two patients have a greater degree of confusion and ataxia (loss of coordination). Type three patients were the most affected by joint pains, muscle pains, and extremity paresthesias (unnatural sensations like burning or tingling in the arms and legs). In each of the three types, researchers found different but measurable impairments on objective testing of neurological function. The business of the nervous system is much more complex and subtle than other body functions. Measuring it requires equally complex effort. The tests used in this study carefully measured and compared localized nerve performance at several different tasks against the same values in normal subjects. Brain wave response to noise and touch, eye muscle response to spinning, and caloric testing (stimulation of the ear with warm and cold water, which causes vertigo) were clearly different between the normal and the test subjects. The researchers concluded that there was "a generalized injury to the nervous system." Another research group concluded their study by stating that there was "a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems."
Diagnosis
Until there is a clear definition of the disease, diagnosis is primarily an exercise in identifying those Gulf War veterans who have undefined illness in an effort to learn more about them and their symptoms. Both the Department of Defense and the Veterans Administration currently have programs devoted to this problem. Both the DOD's Comprehensive Clinical Evaluation Program and the VA's Persian Gulf Registry provide free, in-depth medical evaluations to Gulf War veterans and their families. In addition to providing individual veterans with critical medical care, these organizations use the cumulative data from these programs to advance research on Gulf War Syndrome itself.
Treatment
Specific treatment awaits specific diagnosis and identification of a causative agent. Meanwhile, veterans can benefit from the wide variety of supportive and non-specific approaches to this and similar problems. There are many drugs available for symptomatic relief. Psychological counseling by those specializing in this area can be immensely beneficial, even life-saving for those contemplating suicide. Veterans' benefits are available for those who are impaired by their symptoms.
Alternative treatment
The symptoms can be worked with using many modalities of alternative health care. The key to working successfully with people living their lives with Gulf War syndrome is long-term, ongoing care, whether it be hypnotherapy, acupuncture, homeopathy, nutrition, vitamin/mineral therapy, or bodywork.
Experimental treatment with antibiotics is advocated by some healthcare professionals who believe that Gulf War illness is related to a Mycoplasma fermentans bacterial infection. However, a conclusive link has not been clinically proven.
Prognosis
The outlook for Persian Gulf War veterans is unclear, but will hopefully improve as more information is gathered about the illness. Gradual return to a functioning life may take many years of work and much help. It is important to note that even in the absence of an identifiable and curable cause, recovery is possible.
KEY TERMS
Ataxia— Lack of coordination.
Caloric testing— Flushing warm and cold water into the ear stimulates the labyrinth and causes vertigo and nystagmus if all the nerve pathways are intact.
Endemic— Always there.
Paresthesia— An altered sensation often described as burning, tingling, or pin pricks.
Syndrome— Common features of a disease or features that appear together often enough to suggest they may represent a single, as yet unknown, disease entity. When a syndrome is first identified, an attempt is made to define it as strictly as possible, even to the exclusion of some cases, in order to separate out a pure enough sample to study. This process is most likely to identify a cause, a positive method of diagnosis, and a treatment. Later on, less typical cases can be considered.
Resources
BOOKS
Wheelwright, Jeff. The Irritable Heart. New York: W.W. Norton & Co., 2001.
ORGANIZATIONS
The American Legion. Gulf War Veteran Issues. 〈http://www.legion.org/gulftoc.htm〉.
Office of the Special Assistant for Gulf War Illnesses. 5113 Leesburg Pike, Suite 901, Falls Church, VA, 22041. (703) 578-8518. 〈http://www.gulflink.osd.mil〉.
U.S. Department of Defense. Comprehensive Clinical Evaluation Program (CCEP). (800) 796-9699.
Veterans Administration. Persian Gulf Medical Information Helpline. 400 South 18th Street, St. Louis, Missouri 63103-2271. (800)749-8387.
Veterans Administration. Persian Gulf Registry. (800)PGW-VETS (800) 749-8387. 〈http://www.va.gov〉.
OTHER
Office of the Special Assistant for Gulf War Illnesses. Fourth Annual Report: Office of the Special Assistant for Gulf War Illnesses. Falls Church, VA: Office of the Special Assistant for Gulf War Illnesses, 2000. 〈http://www.gulflink.osd.mil/library/annual/4thannual_report_jan01.htm〉.
Gulf War Syndrome
GULF WAR SYNDROME
Gulf War syndrome, or Gulf War illness, refers to a group of poorly understood symptomatic illnesses afflicting veterans of the 1990–1991 Persian Gulf War. The most characteristic symptoms are fatigue, musculoskeletal complaints, and psychiatric complaints of emotional distress, anxiety, and cognitive problems. To date, no specific underlying physical abnormalities have been identified, which links Gulf War illness to other medically unexplained syndromes such as chronic fatigue syndrome and multiple chemical sensitivity. In fact, substantial proportions of ill Gulf War veterans have complaints consistent with these other conditions.
Medically unexplained symptoms have been common in soldiers who have returned from previous deployments. The symptoms among Gulf War veterans are somewhat different from those noted after previous conflicts, however. Further, complaints of contemporary soldiers who were not deployed to the Persian Gulf are similar in character, though the symptoms occur at substantially greater rates, and with greater severity, among those deployed to the Gulf.
Specific causes for Gulf War illness are unknown. The presence of similar complaints in those not deployed to the Gulf suggests that a unique Gulf War exposure is not the sole cause. While individuals with complaints report higher rates of exposure to various toxins in the Gulf, including pesticides, anti-nerve gas pills, immunizations, and exploding missiles, these associations are not regarded as definitive at this time, with recall and information bias being very problematic. Because of this uncertainty, prevention efforts have been nonspecific and aimed at a reduction of various stressors and an improvement in risk communication with at-risk soldiers. Further research is ongoing.
Howard M. Kipen
(see also: Multiple Chemical Sensitivities; War )
Bibliography
Fukuda, K.; Nisenbaum, R.; Stewart, G.; Thompson, W. W.; Robin, L.; and Washko, R. M. et al. (1998). "Chronic Multisymptom Illness Affecting Air Force Veterans of Gulf War." Journal of the American Medical Association 280(11):981–988.
Fulco, C. E.; Liverman, C. T.; and Sox, H. C., eds. (2000). Gulf War and Health, Vol. 1: Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines. Committee on Health Effects Associated with Exposures During the Gulf War. Division of Health Promotion and Disease Prevention. Institute of Medicine.
Hodgson, M. J., and Kipen, H. M. (1999). "Gulf War Illnesses: Causation and Treatment." Journal of Occupational and Environmental Medicine 41(6):443–452.
Hyams, K. C.; Wignall, F. S.; and Roswell, R. (1996). "War Syndromes and Their Evaluations: From the U.S. Civil War to the Persian Gulf War." Annals of Internal Medicine 125(5):398–405.