en-USA National Newsletter for Veterans and their Health Care Providers WRIISC en-US en-US Advantage en-USA National Newsletter for Veterans and their Health Care Providers SUMMER 2018 INSIDE THIS ISSUE: Why BODY MOVEMENT and en-USPHYSICAL ACTIVITY matteren-US Learn about en-US en-US GULF WAR ILLNESSen-US FREE phone-based en-US en-US MEDITATION and YOGA CLASSESen-US en-US for Veterans Learn about the Gut and Brain en-USHEALTH CONNECTION U.S. Department of Veterans Aairs Oce of Patient Care Services Post-Deployment Health Services
en-USIn this edition of en-USWRIISC Advantageen-US, we cover topics important to improving Veterans en-US health including the eects of body movement and physical activity on health and what en-US is referred to as the gut and brain health connection. Read on and nd out about these en-US topics and much more!DIRECTORS' CORNER en-USMen-USany of you may have been hearing about Veterans en-US Health Administrations (VHA's) recent focus on en-US whole health. We are happy to report that our WRIISC en-US model of care falls in line perfectly with this focus. Every en-US WRIISC patient interaction supports Veterans in achieving en-US their greatest overall well-being. Working with our team, Veterans identify what matters most en-US in their lives and learn new approaches to live optimally, working to resolve any obstacles en-US standing in the way. Central to the idea of whole health is what an individual Veteran can do on en-US their own to manage their symptoms and thus live a better life. At the WRIISC we introduce and en-US en-US next steps on the path to wellness.en-US en-USKeeping a focus on whole health remains our trademark!2 | SUMMER 2018en-USWes Ashford, MD, PhDen-USDirector, CA WRIISCen-USDrew Helmer, MD, MSen-USDirector, NJ WRIISCen-USMatt Reinhard, PsyDen-USDirector, DC WRIISC en-USLateral or bending and moving side-to-side. en-USForward-backward bouncing, rebounding, and jumping. en-USIncreasing or decreasing the angle en-US of a joint (exion/extension). en-USMoving a body part towards or away from en-US the center of the body (abduction). en-USShaking of the entire body or a specic part of the body. en-USVibrational or left to right movement within the body. Resistance or using external force to increase muscular strength/bone density. Aerobic or increasing heart rate/oxygen intake and nurturing the cardiovascular system. en-US Most of these movements happen while doing daily chores like house and yard work and leisurely activities including gardening, golng, and playing with children or grandchildren. e negative health eects for inactivity can include a number of unpleasant symptomsfurther discomforts in body movement, weight gain, musculoskeletal injuries, cardiovascular disease, psychological disorders such as depression and anxiety among other conditions. All of this makes it so important for a person to keep moving! It's generally recommended an adult participate in one to two hours of continuous physical activity throughout the day. Participating in aerobic exercise, strength training, and stretching are all good ways to make sure that your body movements are reaching all the parts of your body. Age and other health factors will be important when choosing physical activities, body movements, or exercise programs that are suitable for you. BODY MOVEMENT and PHYSICAL ACTIVITY MATTER!OFTEN VETERANS h ear about the importance of exercise and the associated health and wellness benets whether it be from a doctor, the news, or another source. Physical activity and movement can positively impact physical and internal movements important to body function and can also improve sleep, energy levels, strength, body weight, and even mood. Physical activity and body movement also play a crucial role in preventative health for diseases related to the heart, bones, digestive system, and immune system. ere are many dierent types of body movements and each one is important to practice on a daily basis to keep a person healthy. ese movement types include:
WRIISC Advantage | 3en-USMindfulness movement is an excellent way you can practice en-US full body movement and also reduce the physical and en-US emotional eects of stress. Research has also shown health en-US benets including increased strength and exibility, better en-US balance and coordination, improved reaction times, better en-US lung function, heightened cardiovascular conditioning, and en-US weight loss. Types of mindfulness movement include: 1. en-USQIGONG en-USis a Chinese practice using movement, en-US armations, breath work, visualizations, and en-US meditation to improve the ow of "qi" or life force. 2. en-USYOGAen-US includes stretching and strengthening en-US poses, breathing exercises, focused attention, and en-US meditation practices which also improve the en-US ow of prana, the yogic term for life force. Yoga en-US practice operates on the nadis similar to the way en-US acupuncture works on the meridian system.en-US en-US View our WRIISC Star-Well Kit for more information en-US on Qigong or Yoga and getting started:en-US en-US https://www.WarRelatedIllness.va.gov/en-US education/STAR/index.asp. en-USACTUALLY, ANY TYPE OF REGULAR EXERCISE IS IMPORTANT. If you have numerous aches and pains, particularly in large joints, non-impact exercise is important. Another type of excellent exercise is swimming. e VA develops programs with the YMCA and the US Master Swimming Association to encourage Veterans to take up swimming as a regular form of exercise: http://www.usms.org. You should consult with your doctor before beginning any exercise/body movement program. en-USGut and Brain Health Connection en-USVen-USeterans might be surprised to learn en-US that the type, amount, and makeup en-US of bacteria in the human digestive en-US system or gut (referred to as gut en-US microbiome) hugely aect the way en-US that the human brain works. Have en-US you ever gone with your gut en-US when making a choice or had en-US butterflies in your stomach en-US when anxious or excited? This en-US is a result of what scientists en-US are now calling a second brain en-US or the enteric (gut) nervous system en-US (ENS). The ENS is not like the big en-US brain we know of, but instead en-US located in the lining of the stomach. en-US It significantly impacts digestion, en-US mood, health, and even the way en-US one thinks! The Gut-Brain Axis en-US or GBA is the term that describes the relationship en-US between gut microbiome/ENS/brain. en-US The gut/brain connection is especially important when a en-US Veteran experiences unpleasant gastrointestinal symptoms en-US with no obvious physical causecommonly referred to as en-US Irritable Bowel Syndrome or IBS. Recent research supports en-US that psychological or emotional stress can trigger unhealthy en-US bacteria in the gut of IBS patients to act up causing en-US unpleasant symptoms. IBS symptoms can be dierent based en-US on the individual and change over time, and can include en-US abdominal pain, constipation, diarrhea, indigestion, gas, en-US bloating, fatigue, and headaches. Treatments for IBS have en-US evolved in recent years, focusing more on the gut/brainen-US Âƒ en-USen-USReducing stress: relaxing en-US breath, biofeedback, en-US yoga, meditation. Âƒ en-USen-USHypnosis. Âƒ en-USen-USCognitive Behavioral en-US Therapy (CBT). Âƒ en-USen-USAcupuncture which en-US relieves bloating. Âƒ en-USen-USExercise which helps en-US bowel regularity and en-US reduces stress. Âƒ en-USen-USIncrease fiber intake. Âƒ en-USen-USIncrease of foods that en-US contain friendly bacteria en-US such as yogurt. Âƒ en-USen-USSmall, frequent meals. Âƒ en-USen-USAnti-inflammatory diet en-US (include lots of fruits/en-US vegetables/whole en-US grains/plant-based en-US proteins (like beans and en-US nuts), fatty fish, fresh en-US herbs, and spices). Âƒ en-USen-USAvoid trigger foods. Âƒ en-USen-USKeep a food diary if en-US symptoms still persist. Âƒ en-USen-USHydration (drinking en-US water). Âƒ en-USen-USPeppermint oil. Âƒ en-USen-USTurmeric. Âƒ en-USen-USCarob powder en-US for diarrhea.en-US For more information about IBS or the related treatments visit: Âƒ en-USen-USVA Center for Integrated Healthen en-US https://www.mirecc.va.gov/cih-visn2/Documents/en-US Patient_Education_Handouts/Irritable_Bowel_en-US Syndrome_Information_for_Patients_Version_3.pdf Âƒ en-USen-USNational Institute of Healthen en-US https://nccih.nih.gov/sites/nccam.nih.en-US gov/files/IBS_11-18-2015.pdfen-US en-USen-USconnection and how to successfully reduce or even en-US eliminate symptoms. Keeping a healthy gut microbiome en-US is a key to how a Veteran with IBS functions and feels on en-US a day to day basis. The latest tips for increasing good gut en-US bacteria and improving the symptoms of IBS include:
Gulf War Illness 4 | SUMMER 2018en-USSen-USince the Gulf War in 1990-1991, there has been en-US much discussion in the Veteran community en-US and in the media about Gulf War Illness (GWI). en-US GWI refers to a group of unexplained or ill-en-US dened chronic symptoms found in Veterans deployed en-US to the Persian Gulf during Operation Desert Storm/en-US Operation Desert Shield. GWI falls under the umbrella en-US of what is referred to as Chronic Multisymptom Illness en-US (CMI). Symptoms of GWI vary by individual which make en-US it challenging for healthcare providers to recognize and en-US treat it. Here are the most common symptoms of GWI: en-USFatigue en-USMuscle and joint pain en-USCognitive diculty en-USSkin rashes en-USHeadaches en-USShortness of breath en-USSleep disturbances en-USAbdominal (belly) en-US discomfort/en-US bowel changesen-US Despite much research, the cause of GWI is en-US unclear. A number of possible causes include: en-USImmune dysfunction en-USNerve dysfunction en-USMitochondrial (the part of your cells en-US involved in energy) dysfunction en-USA genetic and environmental exposure interaction en-USDeployment related exposures en-USA combination of these factorsen-US Many Gulf War Veterans have concerns that en-US exposure to chemicals such as low dose nerve agents, en-US pyridostigmine bromide (taken in pill form to prevent en-US eects from exposure to nerve agents) and smoke en-US from oil well res caused GWI. ere have been no en-US clear or consistent links found. Veterans can work with en-US a healthcare provider or see an environmental health en-US clinician or expert in occupational and environmental en-US exposures if they have specic exposure concerns.en-US As noted above, GWI falls under a broad term for a group en-US of chronic, unexplained symptoms called Chronic Multi-en-US Symptom Illness (CMI). In 2014, the VA and Department en-US of Defense (DoD) released guidelines for healthcare en-US providers caring for Veterans with CMI. ese guidelines en-US can also help healthcare providers identify, manage, and en-US treat GWI. Veterans with concerns about GWI can learn en-US more about the guidelines for treatment of CMI by visiting: en-USen-US en-USPATIENT SUMMARYen en-US https://www.healthquality.va.gov/guidelines/MR/en-US cmi/VADoDCMICPGPatientSummary2014.pdfen-USen-US en-USFAQen en-US https://www.healthquality.va.gov/guidelines/MR/en-US cmi/CMIFAQSheetFinal.pdfen-US While there are no specic treatments for GWI, en-US there are many things that can help a Veteran en-US manage their symptoms. e focus of treatment is en-US improving quality of life and functioning. Treatment en-US without medicine, or non-pharmacological en-US treatment, is usually tried rst. It can include: en-USGraded exercise en-US programs en-USYoga en-USAcupuncture en-USCognitive-behavioral en-US therapy en-US ere are some medications which may help reduce en-US symptoms. Care for symptoms should be tailored to en-US the individual. What works well for one person may not en-US work well for someone else. Care coordination is a central en-US part of managing chronic conditions such as GWI. It is en-US important for Veterans to work with their healthcare en-US team to check their response to any treatment.en-US VA continues to look for the best approaches en-US to Veteran care. ey also will continue to do en-US more research about GWI and CMI. en-US SEVERAL STUDIES SHOW THAT ABOUT ONE-THIRD OF GULF WAR VETERANS HAVE GWI. ITS IMPORTANT TO NOTE THAT DEPLOYED GULF WAR ERA VETERANS DO NOT HAVE HIGHER RATES OF DEATH COMPARED TO GULF WAR ERA VETERANS WHO DID NOT DEPLOY. FOR GULF WAR VETERANS en-US:en-US en-US Participation in the VAs en-USGulf War Registry Health Examen-US helps en-US identify health issues related to GWI and can assist in getting an appropriate specialty evaluation. It also en-US assists the VA in understanding and responding to these health problems more eectively. For more en-US information, go to https://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp.
WRIISC Advantage | 5en-USNJ WRIISC's MINDFULNESS MEDITATION CLASSES en-US(twice a month)en-USSCHEDULE:en-USAugust October 2018 dates: Âƒ en-USen-USAugust 3en-USrden-US and 10en-USthen-USMindful Breathing Âƒ en-USen-USSeptember 7en-USth en-USand 14en-USthen-USMindful Body Scan Âƒ en-USen-USOctober 5en-USthen-US and 12en-USthen-USMindful Movementen-USTIME: Âƒ en-USen-US11am 12pm, Eastern Standard Time (EST) Âƒ en-USen-US10am 11am, Central Standard Time (CST) Âƒ en-USen-US9am 10am, Mountain Standard Time (MST) Âƒ en-USen-US8am 9am, Pacic Standard Time (PST)en-USHOW TO PARTICIPATE: en-USCall 1-800-767-1750, then en-US enter Access Code 54220#.en-USFor more information about this class, please visit: https://en-US www.WarRelatedIllness.va.gov/education/local-oerings/en-US support/Mindfulness-Meditation-Class-flyer.pdf.en-US Research Matters en-USWRIISC continues to be involved in GW research. Below is a study recently published by the WRIISC research team: PUBLICATION TITLE: en-USAbnormal rheological en-US properties of red blood cells as a potential marker en-US of "Gulf War Illness: A preliminary study"en-USKey Points:en-USQUESTION:en-US en-US Are red blood cell (RBC) properties en-US aected in Veterans with Gulf War Illness?en-USFINDINGS: en-USIn comparison to Veterans without en-US GWI, RBCs of Veterans with GWI are more en-US deformable (able to change shape). In addition, en-US the size and shape of RBCs are more diverse in en-US Veterans with GWI versus those without GWI.en-USMEANING: en-USIn this preliminary study, we observed en-US increased deformability along with increased size en-US and shape of RBCs in Veterans with GWI, which en-US may contribute to the origination of symptoms en-US of GWI or a clue about the underlying cause of en-US GWI. Further research is required to conrm our en-US ndings and the role of RBC monitoring in GWI.en-USADDITIONAL INFORMATION: en-USis research en-US appears in the journal Clinical Hemorheology en-US and Microcirculation, 2018, Volume 68. Authors en-US are from the NJ WRIISC (Michael Falvo, Yang en-US Chen, Jacquelyn Klein-Adams, Duncan Ndirangu) en-US and VA New Jersey (Michael Condon). en-US Phone-Based Meditation Classes for Veterans WRIISC CONTINUES TO LOOK FOR WAYS en-US en-USto support Veterans and provide en-US easy access to our education for all Veterans registered in the VA Nationwide. en-USCA WRIISC's YOGA SLEEP (iRest) MEDITATION CLASSES en-US (weekly)en-USSCHEDULE: en-USWeekly, each ursdayen-USTIME: Âƒ en-USen-US2pm 3pm, Eastern Standard Time (EST) Âƒ en-USen-US3pm 4pm, Central Standard Time (CST) Âƒ en-USen-US4pm 5pm, Mountain Standard Time (MST) Âƒ en-USen-US5pm 6pm, Pacic Standard Time (PST)en-USHOW TO PARTICIPATE: en-USCall 1-800-767-1750, then en-US enter Access Code 24953#.en-USFor more information about this class, please visit: https://en-US www.WarRelatedIllness.va.gov/clinical/integrative-health/en-US ca/WRIISC-What-is-Yoga-Nidra-Meditation.pdf. en-USen-USA Veteran can take any en-US or all of the classes listed en-US by calling a en-US en-US toll-free number en-US from the comfort en-US of their home!
6 | SUMMER 2018 en-USDC WRIISCen-USWhole Health Coaching now available! en-USWHOLE HEALTH en-US COACHINGen-US is en-US now applied in the en-US care of Veterans en-US who receive a en-US comprehensive en-US clinical evaluation at en-US DC WRIISC. During en-US an evaluation with en-US the DC WRIISC en-US clinical team, en-US several clinicians en-US with dierent backgrounds and expertise work closely en-US together to support Veterans with deployment-en-US related health concerns on their mission to achieving en-US better health. A majority of Veterans report that after en-US their evaluation they are universally happy with their en-US experience at DC WRIISC and feel that a brighter en-US health status moving forward is not only possible en-US but achievable. e application of whole health en-US coaching to clinical care at the DC WRIISC supports en-US the momentum expressed by these WRIISC Veterans en-US in their journey to improved health. rough this en-US approach to care, the DC WRIISC clinicians assist en-US these Veterans to develop personal goals related en-US to their care plan and identify what matters most en-US to them as individuals. is program also allows en-US DC WRIISC clinicians to provide advanced follow-en-US up support to Veterans after their onsite visit to en-US identify if the Veterans desired health outcomes en-US are achieved and if adjustments are needed. e en-US whole health coaches at the DC WRIISC provide en-US continued support to Veterans evaluated in the en-US development of their self-management strategies, en-US which are needed to make lifestyle changes or follow-en-US up with WRIISC recommendations thoroughly. en-US Whole health coaching paired with traditional en-US medical care at the DC WRIISC has the potential to en-US transform Veterans lives by assisting them in making en-US positive and long-term health outcomes a reality!en-USCA WRIISCen-USBenefits of Yoga: It only works if you do it.en-USCA WRIISC HAS en-US PROVIDEDen-US weekly yoga en-US classes for Veterans en-US since 2010 and en-US currently oers daily en-US classes about 50 en-US weeks out of the en-US year. Referrals to en-US the yoga program en-US have continued en-US to grow with nearly en-US 3000 yoga referrals since en-US 2010. In 2017, CA WRIISC en-US studied these yoga referrals more carefully. Data en-US about symptoms was gathered by phone from newly en-US referred Veterans and looked at to see if there was a en-US relationship between reasons for seeking yoga and en-US whether the Veteran attended class. Findings included: 3 en-USen-USVeterans who are referred to yoga by en-US their providers for mental health reasons en-US attend at higher rates than those who are en-US referred for chronic pain or fatigue. 3 en-USen-USVeterans who report they are coming to yoga for en-US sleep issues and the desire to improve strength and en-US exibility as well as post-traumatic stress disorder en-US (PTSD) symptoms attend at higher rates than en-US those who have no mental health symptoms. 3 en-USen-USSurprisingly, it appears that the Veterans who might en-US benet the most from yoga those with chronic en-US pain and fatigue are simply not attending. en-US ese important ndings will be presented en-US at an upcoming scientic meeting on en-US integrative medicine and health. en-US Veterans who do participate in yoga classes at en-US en-US CA WRIISC continue to express both patient satisfaction en-US and symptom improvement. For these reasons, en-US looking at barriers that stand in the way of Veteran en-US participation is an important new area of study for en-US CA WRIISC clinical yoga program and research. Around the WRIISC en-USNews A VETERAN RECEIVES en-USWHOLE HEALTH COACHING en-US FROM THEIR VA NURSE. en-US en-US DC WRIISC NOW PROVIDES en-US THIS SERVICE. en-USFor more en-US information about the en-US CA WRIISC Yoga Program en en-US and its upcoming class en-US schedule, visit:en-US https://www.WarRelatedIllness.en-US va.gov/clinical/integrative-en-US health/ca/index.asp
en-USWRIISC AdvantageSUMMER en-USProduced by theen-US en-US War Related Illness and Injury Study Centeren-USEditor:en-US en-US Susan L. Santos, PhD, MSen-US Assistant Editor:en-US en-US Christina Rumage-Miller, MSPHen-US WRIISC Directors:en-US en-US Wes Ashford, MD, PhD, CA WRIISCen-US en-US Drew Helmer, MD, MS, NJ WRIISCen-US en-US Matt Reinhard, PsyD, DC WRIISCen-US Graphic Artist:en-US en-US Florence B. Chua, MSen-US Contributors:en-US Steven Greer, mS-EP-Cen-US Drew A. Helmer, MD, MSen-US Walt Jachimowicz, MSN, RN, CNLen-US Louise Mahoney, MS, RYTen-US Christina Rumage-Miller, MSPHen-US Susan L. Santos, PhD, MSen-US Serena M. Satcher, MD, FAAPMRen-US DC WRIISC: 1-800-722-8340en-US en-US War Related Illness and Injury Study Centeren-US en-US Department of Veterans Aairsen-US en-US Washington, DC VA Medical Centeren-US en-US Room 3B 203, Mail Stop 127en-US en-US 50 Irving St., NWen-US en-US Washington, DC 20422-0002en-US CA WRIISC: 1-888-482-4376en-US en-US War Related Illness and Injury Study Centeren-US en-US Department of Veterans Aairsen-US en-US Palo Alto Health Care Systemen-US en-US 3801 Miranda Ave.en-US en-US Mail Code 151Yen-US en-US Palo Alto, CA 94304-1290en-US NJ WRIISC: 1-800-248-8005en-US en-US War Related Illness and Injury Study Centeren-US en-US Department of Veterans Aairsen-US en-US New Jersey Health Care Systemen-US en-US 385 Tremont Ave.en-US en-US Mail Stop 129, 11en-USthen-US flooren-US en-US East Orange, NJ 07018-1023en-US For comments or concerns regarding this en-US newsletter, please contact us at:en-US en-US 1-800-248-8005 or email@example.com. W en-USRIISC Advantage | 7 Around the WRIISC News NJ WRIISC en-USVeteran Feedback Reinforces Successful Work by Clinical Teamen-USTHE NJ WRIISC CLINICAL TEAMen-US en-USremains highly en-US committed to improving the life of each Veteran en-US medically evaluated. When a Veteran reports that en-US health is improved through a WRIISC evaluation or by en-US WRIISC recommendations, it means the world to the en-US team and illustrates the impact of a job well done.en-US Recent feedback included comments directly from en-US Veterans such as:en-USATTENTION READER:en-US en-USDo you prefer to receive the en-US WRIISC Advantage newsletter electronically? en-US en-US Email us at firstname.lastname@example.org with your full en-US name and preferred email address. T en-UShe level of expertise en-US you all presented and en-US the compassion you en-US showed were amazing! [the clinical evaluation en-USsta] members exceeded en-US anything I was expecting and en-US I felt that my concerns were en-US being acknowledged and en-US addressed comprehensively en-US for the first time. All WRIISC team members remain focused on en-USmaking a positive dierence in the lives of our en-US Veterans and their health and wellness by providing en-US the care that our Veterans truly deserve.en-US Your team exceeded en-USmy expectations en-US of professionalism, en-US thoroughness, and empathy. en-US I was just an old worn out en-US soldier, but your team took en-US care of me as if I was the most en-US important person on earth The nightmare of my en-USillness slowly became en-US a dream of recovery, all en-US thanks to a wonderful en-US team of doctors who en-US changed my destiny.
This newsletter contains a minimum of en-US30% post-consumer waste. U.S. Department of Veterans Aairs Oce of Patient Care Services Post-Deployment Health Services en-USAccess our training by visiting: en-UShttps://www.TRAIN.orgen-US (public) or en-UShttps://www.TMS.va.goven-US (VA-internal)en-USand search for "WRIISC" On-demand post deployment training en-US for providers now available en-US on TRAIN (public) and TMS (VA-internal) with accreditation:en-USDepartment of Veterans Affairs (VA)en en-US New Jersey Health Care Systemen-US 385 Tremont Ave., Mail Stop 129en-US East Orange, NJ 07018en-US 1-800-248-8005en-US www.WarRelatedIllness.va.gov