“Veterans Affairs Research Supports CDC Recommendation to Screen Baby Boomers for Hepatitis C”

The families of the estimated
51,000 infected veterans not diagnosed yet are in for 
 a rough ride.

The “Liver Meeting 2013” conference in DC ends tomorrow. The sponsor of the meeting, the American Association of the Study of Liver Diseases(AASLD), released a press release (11/3/13) on the research of Lisa Backus, M.D., Ph.d. from the VA. As the excerpt below states, the VA believes that 51,000 veterans have yet to be diagnosed with HCV. That’s a massive number.

Researchers at the Department of Veterans Affairs (VA) studied the health records of 5,500,392 veterans. Of those, 64.2 percent of baby boomers and 54.7 percent overall — or more than 2.9 million — had at least one VA screening for HCV. Of those screened, 9.9 percent of the baby boomers had HCV infection, compared with 1.7 percent of those born before 1945 and 1.1 percent of those born after 1965.

After extrapolating the infection data to the veterans not yet screened, researchers concluded that up to 51,000 more veterans of the baby boomer generation could be identified with HCV. The VA has been a leader in adopting new care models such as telehealth and Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN ECHO) in order to expand the VA capacity to take care of any additional veterans identified as having HCV infection through expanded screening.

The story was picked up today by AIDSMAP.  Although the accusation that thousands upon thousands of Vietnam-era veterans injected drugs continues to be repeated ad nauseam in the media, at least the AIDSMAP article mentions jet injectors (air guns) in the 2nd paragraph of this excerpt.

US military veterans of the baby-boom generation form a population at higher-than-average risk of hepatitis C. Hepatitis C prevalence is higher in adults born between 1945 and 1965 due to higher levels of injecting drug use and greater lifetime risk of exposure to blood transfusions containing hepatitis C compared to those born after 1965.

Veterans may be at especially high risk of hepatitis C infection due to high levels of injecting drug use among the population that served during the Vietnam War era and blood exposure in battle or medical settings. Tattooing and transmission through use of airguns for vaccination during military service are difficult to quantify as sources of infection, but many veterans – particularly those who did not see active service in Vietnam – believe these routes explain their infection with hepatitis C.

vietnam-soldiers-crater

Soldiers at the bottom of Hamburger Hill (Hill 937) in Vietnam 10-20 May 1969

Keith Alcorn’s article, Need for expansion of hepatitis C screening among veterans, ‘baby-boom’ generation and pregnant women highlighted, is welcome.  But repeating the IVDU canard is not. Accusation is not evidence. It’s a diversionary tactic to “explain” away the cluster of service-connected HCV infections.   Vietnam veterans were fulfilling their missions and trying to staying alive.  A shocking 58,286 died doing America’s hardest job–the work of war.  The Vietnam Veterans Memorial Foundation NJ) reminds us that many more have died as the result of the war from HCV, AO, emotional and physical injuries.  To accuse hundreds of thousands of veterans of spending their few hours of rest, giddily injecting drugs, is a grave insult to this much maligned group of heroes. 

Ed. note: An interesting side note is the plethora of draftees who were pulled into this against their will. Certainly, some of these were unsavory characters who may have engaged in the practice of IVDU but their presence in a shot line using a pneumatic air injection device is all it would take to propagate the hepatitis C virus. No study of troops based on a subset of basic training has ever been accomplished nor will it ever occur.

Having been to VA medical centers, I can tell you first hand the queer looks I get when I mention my HCV. Reiterating the history of the infection via a transfusion for a GSW is greeted with the rolling of the eyeballs. I no longer try to set the record straight. Of course, I no longer go to the VAMC anymore either so it is a moot point.

Posted in Guest authors, HCV Health, HCV Risks (documented) | Tagged , , , , , , , , , , , , , , , , , | 4 Comments

Hepatitis C replication increased during pregnancy according to recent study

 An abstract of a study just published in Nature signals  

pregthat mainstream medical associations, like the American Congress of Obstetricians and Gynecologists (ACOG), should become proactive by screening for HCV routinely rather than by known risk-factors. 

“Loss of immune escape mutations during persistent HCV infection in pregnancy enhances replication of vertically transmitted viruses” 

A few quotes from the abstract:

  • Globally, about 1% of pregnant women are persistently infected with the hepatitis C virus (HCV). Mother-to-child transmission of HCV occurs in 3–5% of pregnancies and accounts for most new childhood infections

  • HCV-specific CD8+ cytotoxic T lymphocytes (CTLs) are vital in the clearance of acute HCV infections, but in the 60–80% of infections that persist, these cells become functionally exhausted or select for mutant viruses that escape T cell recognition

  •  Importantly, the viruses transmitted perinatally were those with enhanced fitness due to reversion of escape mutations. Our findings indicate that the immunoregulatory changes of pregnancy reduce CTL selective pressure on HCV class I epitopes, thereby facilitating vertical transmission of viruses with optimized replicative fitness.

Medical societies know that HCV is contagious, serious, and can be passed on from mother-to-baby.  But pregnant women are only screened routinely for hepatitis B.  If they are HIV-positive, HCV screening is ordered.  But the current risk factor based screening is a flawed concept.  That HCV infects babies is a terrible reality. Screening is easy and fast with the OraQuick HCV test.

The VA could take a national leadership role in this area due to changing veteran demographics:

Women are now the fasting growing subgroup of U.S. Veterans. The number of women Veterans is expected to increase dramatically in the next 10 years, and VA health care is expected to be in high demand by the women Veterans of Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn.

baby va

Please test my mom
for HCV

Specialty care for women includes these conditions and much more: 

  • Management and screening of chronic conditions includes heart disease, diabetes, cancer, glandular disorders, osteoporosis, and fibromyalgia as well as sexually transmitted diseases such as HIV/AIDS and hepatitis.
  • Reproductive health care includes maternity care, infertility evaluation and limited treatment; sexual problems, tubal ligation, urinary incontinence, and others.

 Let VA help–yes, please do. 

Update: Link to a lay article discussing the 

Nature article in plain language. 

Posted in Guest authors, HCV Health | Tagged , , , , , , , , , , , , , , , , | Leave a comment

Apps for veterans (# 1): Twitter

twitter-bird-white-on-blue

Tweet out

The VA is using Twitter. To follow their micro-posts, sign up for a free account.  (Check out ASKNOD’s Twitter feed too.)  Information on how to use Twitter is on the HELP page. 

Official VA Twitter accounts: Department: https://twitter.com/DeptVetAffairs (122+K followers)

Administration:

VBA:  https://twitter.com/VAVetBenefits (24+K followers)

VHA:  https://twitter.com/VeteransHealth (32+K) followers)

NCA:  https://twitter.com/VANatCemeteries (3+K)

Don’t read OIG feed
if you feel like this.

Many VA medical centers, programs, and staff, also have Twitter accounts.  If your blood pressure is under control, I recommend perusing VA Office of the Inspector General Twitter feed: https://twitter.com/VetAffairsOIG

A few non-VA sites: https://twitter.com/cdchep;

https://twitter.com/HepatitisCTrust;

https://twitter.com/Hep_Alliance; https://twitter.com/InjectionSafety.

Article: New York Times (10/23/13) Twitter Illiterate? Mastering the @BC’s

Intrigued? Read Twitter’s blog: https://blog.twitter.com/

The company will be going public soon so it will become an even bigger social media player.  Do you tweet? 

 

Posted in All about Veterans, Guest authors | Tagged , , , , , , , | Leave a comment

SOFOSBUVIR HITS 85% IN SVR24 TRIALS

downloadNow we’re talking, ladies and gentlemen. When I entered this arena in 1995, less than 33% were achieving any kind of success and some relapsed years after. The pegylated Interferon (PegIntron) of the early to mid 2000s again only hit about 50%+ in repeated trials. Genotypes 2 and 3, which were always the ones most expected to achieve sustained Viral Response (SVR) have been coming out on the skinny end in 12 week trials that are Interferon-free. Enter the new, 24 week regimen.

The latest news with 24 week regimens shows an 85% SVR among Genotype 3 HCV sufferers with most exhibiting SVR by week 12. When I “volunteered” for Project 404 in July of 1970, I wasn’t allowed to ask many questions about the assignment until after I had acquiesced and signed on the line. No, this isn’t about Obamacare but it parallels it in some respects. One question I pointedly asked was what the casualty rate was. They mentioned 35-40%. Being 19 and incredibly optimistic, this young airman converted that into a chance of coming out unscathed at 60-65% which is what incredibly optimistic, testosterone-infused young servicemen tended to do in war.

I consider an 85% chance of conquering HCV to be incredibly good odds. Conversely, a 15% failure rate is almost immeasurable in the scheme of medical mishaps. This is, in the final instance, another Win or Die proposition so it is not up for debate. Left untreated, I die. I have an 85% chance of success if I press on. In my book, that’s  incredibly good odds compared to 45 years ago. Where do I sign up?

Posted in HCV Health | Tagged , , , , , , , , , , , , , , , , | 4 Comments

NEW WIDGET

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An Khe chopper revetments

Here’s a great addition to the widget bar above. Sent in by Tip of the Spear Bruce McCartney (4 tour combat medic 68-72). It will bring back that hot sticky air and pungent aroma of decaying vegetation. I think there’s a picture of dang near every airpatch in country and at least 40 I never went near in the far south. Camp Evans, Camp Bikini, they’re all there. Enjoy. 

80871924

Dak To Airpatch (Khontum)

Nape strike at Can Tho 1968

Nape strike at Can Tho 1968

Home of 7th Tactical Air Control Center (7th TACC) my boss

Home of 7th Tactical Air Control Center (7th TACC) my boss

USO Saigon

USO Saigon

 

Posted in From the footlocker, Vietnam War history | Tagged , , , , , , , , , | Leave a comment

DRV ANGLES FOR MORE MONEY FROM UNCLE SUGAR

Chuck Hagel, John KerryHaving lived on the Indochinese Peninsula for several years off the grid during the Vietnamese Misunderstanding, I can safely say the following article link represents subtle bargaining at a high level. I had much occasion to barter on the local economy for foodstuffs and other “essentials” and was quite adept at it by the time I left. Milo Minderbinder had nothing on me. Who do you know who could convert a $12 bottle of Johnnie Walker Black into $52 in the blink of an eye? Or a whole case for that matter.  One thing I took away from this was the innate love of the orientals to haggle for the mere sake of haggling. The price was immaterial. Both sides knew that going in. For argument’s sake, the object had a street value that was non negotiable. For a roundeye like myself, it was axiomatic that I hold my own in one of these arguments or lose massive face if I paid the initial asking price. 

Similarly, the eight man delegation headed up by Senior Lieutenant General Nguyen Chi Vinh, set the price of four new excavations for our soldiers’ remains as their opening gambit. We, in turn, are expected to bid two no trump and so on around the table. The Democratic Republic of Vietnam ( DRV or formerly Hanoi Jane’s playground) is feeling a little troubled by all the neighbors looking for what Hitler referred to in WW II as lebensraum   . China and others in their neck of the woods are all expanding their economic horizons and find themselves cramped for room. Our former enemies now view us as their possible allies if a territorial squabble busts loose.

We are already spending vast quantities of bucks excavating and cleaning up our former bases and their associated POL dumps. POL stands for Petroleum, Oil and Lubricants-i.e. anything of or having to do with oil. It tends to really screw up shallow water tables as they are coming to find out back at Camp Pour Le Jeune Garçons Et Filles in North Carolina.

In addition, just having a Naval ship or two sitting at at anchor in the harbor at Cam Ranh Bay can express a thousand words to casual observers. And as assuredly as word travels at the speed of light, that information is telegraphed to the four corners of the East China Sea.

To the uninitiated, this may seem like a warm, fuzzy get together with noble aspirations down at Fort Fumble but it is nothing more than Asian posturing and bartering for an upper hand. I do hope Messieurs Kerry and Hagel are smart enough to recognize the signs and signals. I’d sure hate to see Americans refurbishing  and refortifying CRB and Vung Tau in a few years.

data=VLHX1wd2Cgu8wR6jwyh-km8JBWAkEzU4,wek-UW_atADNJV4i368PMeWd7QK2ftapweYIj6LLLML0DuMWJCvmPut-QS7gUPtrY88Wa_UDEq8RklZrX5v12UMfONrPsBYSan2OG4u0Nkr7uBYJXGy2TZxe-Di2gD0JAoTBt2MSFLvcRs_s-KQ0mONGDneTpYxn67fVZ_xoTh1gCCEQXwt5KFzB

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VA–NOD FORMS OR NOTHING

downloadVA just published their proposed changes to Part three of 38 CFR and will soon only be accepting Form 21-0958 Notice of Disagreement instead of any old piece of paper you have lying around that doesn’t have too many coffee stains on it. The good old days of using the Tickle Me Elmo stationary to voice your imminent desire for appellate review are soon going to be history.

Here’s the article link to the Federal Register discussion. What’s next? Our way or the highway?

VA retiring Tickle me Elmo Form

VA retiring Tickle me Elmo Form

Posted in Uncategorized | Tagged , , , , , , , , | 6 Comments

VA TO CONGRESS– IT WILL JUST CONFUSE VETS

download (2)When you go to any government entity and request their services (which, incidentally, you pay for), are you ever taken aback at the ennui and lack of desire to be helpful? I certainly don’t write this to imply anything about anyone but I am constantly stupefied at the litany of excuses trotted out in response to a genuine “How come you don’t do it this way?” The amount of research time and dollars expended to prove it is infeasible is often more excessive that compliance in most cases.

Once again, the go-to, signature Agency entrusted with  He Who Shall Have Borne The Battle is once again bemoaning the idea of accountability. Let’s delve deeper.

imagesHistorically, the VA, even in all it’s prior iterations, was always a cush, backwater government job with little heavy lifting and a massive medical mission. Every once in a while a war would come along and there would be a lump in the compensation python. With advances in medical science, people started living longer. Surprisingly, Vets eagerly followed suit. With each succeeding war, the odds of survival went up due to new innovations in medicine as well as warfare. Enter the Huey.

Vietnam was the first war where you could be in Tachikawa AB hospital over in Japan  less than 6 hours after losing your legs (and many of your buddies) to a bouncing Betty. The miracle of medicine also guaranteed you could be fitted with a colostomy bag and live to a ripe old age as well. Vets like this didn’t need a lot of evidence to win their claims but life in the service lane is never that simple. Due to sloppy record keeping, the military’s records were pretty spotty until the 80s. Absent medical proof of what you were claiming was anathema to your claim, unless you could wave your Purple Heart or Bronze Star and get a  38 USC 1154(b) Combat “enhancement” that gave your lay testimony the semblance of the truth. Many is the Vet who lost any hope of remuneration due to this brain fart in adjudication logic. Perhaps worse was the July 13th, 1973 records bonfire at the sprinkler-challenged NPRS records warehouse in St. Louis. In some strange Back To The Future scenario, Veterans from the 80’s are discovering that their records, too, were somehow burned up in that fateful 1973 conflagration. VA has yet to reveal how they do this prestidigitation but one day it will come out. Rumor has it they bought a souped up DeLorean with a hyperdrive motivator.

The VA metamorphosed again in 1961 with the inception of the modern Board of Appeals. Even so, the cabal of judges were at the beck and call of the VA Grand Poobah (our future Secretary). This was an arm of the military run out of Fort Fumble until 1988 and the inauguration of the modern day Department of Vet Affairs. All this time, the VA honchos had been pretty much left to their own devices.

Enter Senator Alan Cranston. I suspect the VA had shortchanged some of the Senator’s friends and fellow Veterans back in California. Cranston was an enlisted man in WW2 and was staunchly pro Vet. When debate began on a revised Veterans administration with full cabinet status in 1988 (the inception of the VJRA), Cranston was very critical of the VA. He felt they were finally dragging the VA out of some dark corner and finally getting a good look at a nasty problem. He was right.

images (1)Ever since then the tenor of the argument has remained at this high level of animosity. The VA Secretary feels he is being put upon if they so much as have to adjudicate a Veteran’s claim in less than three years-with a computer no less. Towards meeting that mandate and entering the paperless world, numerous computer programs, .pdfs and electrons have been engaged in the project of putting the VA Humpty Dumpty back together again.

Now the good Congressmen are actually requesting that VA be honest up front on claims and tell Veterans when they can expect to get a decision. Whoa. Hold the phone Congressman Miller!  On top of that injustice, they are asking VA to prognosticate as to what the odds are of the Veteran actually winning this claim based on statistical data that VA currently possesses. As usual, the problem is far more complex than mere mortal, non-VA personnel lower than a GS-95 can absorb. Thus it behooves Congress to butt out. This is VA Rocket Science we’re talking about.

Here’s what the bill (S.1148) entails:

1) would require the VA to post information about the average processing times for disability claims

2) post processing times based on various formats in which a claim can be submitted

3) monitor and keep transparent the backlog of claims,

4) would establish within the VA a commission or task force to evaluate the backlog of veterans’ disability claims,

5) the same VA commission or task force would also evaluate the backlog of veterans’ disability claims, including the current process used to evaluate claims and appeals, the applicable laws and regulations and the appeals process.

6) the task force would also analyze possible improvements to the claims process and submit to the VA remedies and solutions for the backlog.

VA fall guy and designated Apologist-Queen-For-A-Day Robert Jesse rebutted the wish list by bringing the true reality of the problem into focus. His observations were not filled with Rainbows and Unicorns. Here’s his take:

1)  the VA thinks collecting and posting all of that information would be burdensome

2)  the VA thinks collecting and posting all of that information would  actually slow down processing.

3) the requirement that VA provide certain information to each claimant would require VA to revise a number of forms

4) The complexity of the data concerns VA

5) Some of the metrics outlined in the bill are not currently available in VA systems

6) VA generally does not routinely track grant rates for particular types of claims

7) VA generally does not routinely track whether claims are submitted in standard or non-standard paper form

8) the data could confuse claimants

9) Providing this type of information could be seen as directing claimants to file, or not file, certain types of claims

10) Providing this type of information could be seen as directing claimants to elect to use a particular type of representative

11) the data provided may not be the best indicator of the most appropriate course of action for the particular claimant

OIGSo, in a period of less than 90 minutes, Guru and soothsayer/prognosticator emeritus Samuel Jesse has identified eleven excellent reasons why this won’t work and that it will just confuse Vets further. Actually, I didn’t think confusing Vets further was attainable as it has been considered  a done deal for centuries.  It also sounds like a typical government response to a logical “What if?” to me. The major problem I see is in red above. Good Lord. Haven’t we learned anything in over 200 years of government? You never form a commission or task force to investigate a problem from within the organization you hope to repair. That’s Independent Investigation 101. Look at VA’s Hear no Evil, See no Evil, Seek out no Evil, and pretend you didn’t hear any Evil and give a good whitewash to any Evil discovered Office of Inspector General as an example of why that is inadvisable. If you don’t work for the VA and have done something wrong, your ass is grass. On the opposing hand, if you are an offending VHA employee, you will be counseled on how to avoid killing your patients in the future or (VBA) rewarded with a promotion, bonus and transferred to the Manchester RO.

Congress is naive if they think they can pass some high-handed law and effect change at the VA (again). The agency is intractable and staffed with hidebound lifers who refuse to budge even when the Ricster orders it. If you guys and gals think the Obamacare website has a few glitches, you need to view the Veterans Benefits Management System (VBMS) computer first hand. You almost can’t find it hidden behind all the bandaids and gauze. Hell, some of the VAROs have individualized patches in an attempt to keep them from crashing. Rumor has it that it is up and running in 18 VAROs presently on any given day with a slower speed than dial up. In order to maintain a reduction in claims, they are holding off introducing it into the larger VAROs in Oakland, St. Pete’s and Seattle. As for Waco and Winston-Salem? The forecast is still iffy. Very iffy. Like 2016 iffy. Much like the Healthcare.gov site, it wasn’t designed to handle more than 6 VAROs at one time. They’re working on it.

Meanwhile, the VA and the DoD are still in discussions on how to mate the DoD’s shiny new hyperspeed STRs computer to the VA’s pedantic, hopelessly outdated 1995 VISTA system. I’d pass a kidney stone to be a fly on the wall in that office.

veterans-photo1_0

Posted in VA BACKLOG, Veterans Law | Tagged , , , , , , , , | 2 Comments

NEW INFO ON THE ACA (OBAMACARE)

download (4)This just in from member Dave. Trust him to ferret out that which we absolutely have to know about healthcare. To view the new, improved site which has been repaired, go here…

What you need to know but were afraid to ask.

Obamacare subcontractors

Posted in Humor | Tagged , , , , , , , | 5 Comments

NEW VA OVERSIGHT IN CONFERENCE SPENDING

download (2)After it was divulged that VA Human Resources personnel were treated to not one, but two shindigs in Orlando involving millions of dollars, VA has admitted to taking steps that will curb about half the abuses cited. They did admit, however, wasteful spending of $762,000 but not a dime more. Relax. Denial is the first phase of a disease process. Eventually, they will embrace their shortcomings and by 2060 will be willing to incorporate some of the recommendations from an outside review panel. 

What was not negotiable, according to UnderSecretary for VA Bashes Allison “in Wonderland” Hickey, was the idea that anyone-Congress included- was going to tell her how to institute her version of Six Sigma training.

“We owe it to our Veterans to give them the very best. Sometimes this involves teaching our personnel in warm, southern locales with easy access to entertainment facilities. This isn’t an “all work-no play” game. VA employees need mindless entertainment like jello shots and Karaoke in order to unwind after a long day at the cheese and wine tastings. Tasking these employees with mind-numbing concepts that only a VA employee can grasp causes burnout and we can’t afford that. We have too much invested in them. Now that Congress has effectively neutered our bonuses, we have to segue into a new paradigm. We’re more than willing to meet Congress and Veterans halfway but taking Orlando, Bahamas or Jamaica off the table is non-negotiable. Besides, most VA employees make far less than their counterparts in the private sector so we have to offer a competitive wage.” said Hickey.

When queried as to who she was referring to in the private sector, she indicated GEICO Nationwide and other major insurance companies. A quick check revealed most GEICO employees were lucky to see a median wage of $49,000 a year with a no-frills medical policy. VA employees, on the other hand, appear to have a median wage of $94,000 annually with a generous medical/dental plan. VA’s PR flack, Bob, who declined to give his last name, was unable to rebut the reporter’s findings explaining that the work VA does is simply incomparable to the civilian sector.

“What you’re doing is comparing oranges to orangutans.” We’re the VA. We don’t have to answer to anyone. Congress doesn’t get it. They should be worrying about how to fix Obamacare and leave the heavy lifting of Veterans claims to people who know what they’re doing. We are unique in DC. Nobody knows how to do what we do.” said Bob.

Some would say they, too, do not know how to do what it is they are tasked with. Well, allow me to offer a codicil. They are well-versed in the art of denial.

images

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