Ask the Doctor: #43. The battle goes on.

Mr. S was 61 year old when his family doctor referred him to me several years ago. He was a veteran of the Korean war and his left leg had been smashed when the military vehicle he was on hit a mine field. After several surgeries to clean up the metal fragments from his flesh and a metal plate and screws to put together the broken leg bones, he was still hurting, many years after the injury. When we admitted him to my unit for a 4 day intense interdisciplinary (team) approach, not only did we find out he had damaged a nerve in his leg, but he also had a “broken” spirit. Mr. S. was still suffering from Post Traumatic Stress Disorder (PTSD), a serious mental condition that occurs frequently after a person witnesses a seriously psycho-traumatic event. Mr. S. was haunted by nightmares of the truck explosion and flashbacks of his friends’ scattered bodies who were not so lucky, as he put it. “I only hurt a leg”, he told us, “but they lost their lives”.

Ms. B. was only 29 years old. She came from a military family with a long tradition. When referred to us, she had been to Afghanistan twice and come back alive (“in body only”) as she told my colleague who saw her in consultation in our outpatient pain clinic. She was told she had suffered some brain injury when her group was ambushed. Apart from problems with foggy memory, poor concentration, difficulty finding her words and dreadful dreams, her whole body was aching and she had fallen into deep depression. This was quite obvious as she never stopped crying during the lengthy interview with the doctor of our team.

The 2008-2009 Force Health Protection (FHP) Health and Lifestyle information survey showed that 41% per cent of Canadian Force members reported some type of pain problems “The Canadian Forces Physical Medicine and Rehabilitation Program” (March 2, 2009). Multiple orthopaedic trauma is the most common type of injury, often associated with peripheral nerve injury, spinal injuries, amputations and soft-tissue injuries. Much more common are problems similar to those experienced by civilians, such as low back pain, sprains and strains, osteoarthritis and overuse injuries. The Canadian Forces provide initial care to our injured soldiers at the site of injury, and depending on the severity of the injury they may be transferred to a combat-support facility, usually part of a large base, or later on the Landstuhl Regional Medical Center, a U.S. Army facility in Germany, which is also home to a smal, highly professional Canadian medical contingent. Once they return home, our injured personnel is treated in civilian facilities providing rehabilitation.

Preliminary information collected through questionnaires completed by returning troops from Afghanistan showed an incidence of 6.4% for concussion and 5.9% for PTSD and/or major depression (as some personnel had experienced symptoms of both mental disorders)

One of the most important recent news on our military is the creation of The Canadian Institute for Military and Veteran Health Research which opened just last month in the Kingston Ontario campus of Queen’s University to address the gap in veteran health research in Canada. Dr. Alice Aitken, the institute director stated that not only research done in the institute will “feed back to the military” but military research done in the battlefield will come back to the civilian world as well (Medical Post, October 6, 2011). Areas of study are numerous. Dr. Aitken stated that female partners of military personnel have a 25% increased risk of being diagnosed with breast cancer. The Institute will be able to look at possible causes: Is it because there is no continuity of care or because they are under excessive stress, Dr. Aitken questioned. Dr. Aitken’s own research will be focusing on creating guidelines for physicians who treat special populations like the military. It is expected that this type of research will be applicable to “first responders” as well, such as firefighters and the police.

As a front liner clinician and a researcher, I can not tell you how excited I am with the launching of this long overdue Institute, which is now engaging researchers from around the country to work in issues that affect our military. Long overdue!


Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)

Director, Comprehensive Pain Program,

Senior Investigator, Krembil Neuroscience Centre

Toronto Western Hospital,

Chair ACTION Ontario