How to Get a 20% VA Rating for Your Back Disability
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Many veterans have back disabilities as a result of their military service. Unfortunately, proving that you have pain in your back from an injury is not necessarily sufficient to get a rating from VA.
VA has particular rules that determine the correct VA rating for back disabilities. Understanding these rules can help improve your chances of receiving the correct rating.
VA uses the term “thoracolumbar spine” to refer to what most people would call their back. This articles will focus on VA’s rules for rating disabilities of the thoracolumbar spine.
Many veterans have back disabilities as a result of their military service. Unfortunately, proving that you have pain in your back from an injury is not necessarily sufficient to get a rating from VA.
VA has particular rules that determine the correct VA rating for back disabilities. Understanding these rules can help improve your chances of receiving the correct rating.
VA uses the term “thoracolumbar spine” to refer to what most people would call their back. This articles will focus on VA’s rules for rating disabilities of the thoracolumbar spine.
What is the thoracolumbar spine?
The thoracolumbar spine is what most people refer to as their back. Think of it as your middle and lower back.
It is actually composed of two parts of the spine:
- The thoracic spine which is made up of twelve vertebral bodies
- The lumbar spine which is made up of five vertebral bodies
The other part of your spine is what we would commonly call your neck. VA uses medical terminology and refers to your neck as your “cervical spine”. Look for me to discuss how VA rates cervical spine disabilities in future articles.
The thoracolumbar spine is what most people refer to as their back. Think of it as your middle and lower back.
It is actually composed of two parts of the spine:
- The thoracic spine which is made up of twelve vertebral bodies
- The lumbar spine which is made up of five vertebral bodies
The other part of your spine is what we would commonly call your neck. VA uses medical terminology and refers to your neck as your “cervical spine”. Look for me to discuss how VA rates cervical spine disabilities in future articles.
How to get a 20 percent VA disability rating for your thoracolumbar spine
VA has two methods from rating thoracolumbar spine disabilities. The most common way that VA rates thoracolumbar spine disabilities is a range of motion formula. VA looks at the flexion that you have at your waist and whether is is limited as a result of your back disability.
A 20 percent rating requires your flexion to be pretty limited. VA defines it as forward flexion greater than 30 degrees but less than 60 degrees. So, if your back disability significantly limits your ability to bend at the waist, you could qualify for a 20 percent rating or higher. VA will often looks to the examinations from your doctors or physical therapists to determine whether and how much your range of motion is limited.
VA has two methods from rating thoracolumbar spine disabilities. The most common way that VA rates thoracolumbar spine disabilities is a range of motion formula. VA looks at the flexion that you have at your waist and whether is is limited as a result of your back disability.
A 20 percent rating requires your flexion to be pretty limited. VA defines it as forward flexion greater than 30 degrees but less than 60 degrees. So, if your back disability significantly limits your ability to bend at the waist, you could qualify for a 20 percent rating or higher. VA will often looks to the examinations from your doctors or physical therapists to determine whether and how much your range of motion is limited.
Are there other ways to get a 20 percent VA rating for the thoracolumbar spine?
Sometimes, I find that veterans with signficant back disabilities have pretty good range of motion. So, they do not qualify for a 20 percent rating under VA’s range of motion rules.
VA does provide three other ways to get a 20 percent thoracolumbar VA rating.
- Combing range of motion of the thoracolumbar spine not greater than 120 degrees
- Muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis
- Intervertebral disc syndrome with incapacitating episodes of at least 2 weeks but less than 4 weeks in the last year
Sometimes, I find that veterans with signficant back disabilities have pretty good range of motion. So, they do not qualify for a 20 percent rating under VA’s range of motion rules.
VA does provide three other ways to get a 20 percent thoracolumbar VA rating.
- Combing range of motion of the thoracolumbar spine not greater than 120 degrees
- Muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis
- Intervertebral disc syndrome with incapacitating episodes of at least 2 weeks but less than 4 weeks in the last year
What does VA mean by combined range of motion?
Combined range of motion focuses on range of motion other than your forward flexion. The doctor should measure forward flexion, extension back, your lateral, which is again the side to side bending, and then rotation which is twisting on an axis.
The doctor should take measurements of each of those. If the measurements add up to be not greater than 120 degrees total, then that would also qualify you for a 20 percent rating.
Combined range of motion focuses on range of motion other than your forward flexion. The doctor should measure forward flexion, extension back, your lateral, which is again the side to side bending, and then rotation which is twisting on an axis.
The doctor should take measurements of each of those. If the measurements add up to be not greater than 120 degrees total, then that would also qualify you for a 20 percent rating.
How can I qualify for a 20 percent rating for an abnormal gait or abnormal spinal contour?
Some veterans have good range of motion but have an abrnormal gait or abnormal spinal contour from muscle spasm or guarding. These veterans can also qualify for a 20 percent rating.
If your back disability affects how you walk, you might certainly qualify for this rating. Also, diagnostic testing performed by your doctor may demonstrate scoliosis, reversed lordosis, or abnormal kyphosis.
Some veterans have good range of motion but have an abrnormal gait or abnormal spinal contour from muscle spasm or guarding. These veterans can also qualify for a 20 percent rating.
If your back disability affects how you walk, you might certainly qualify for this rating. Also, diagnostic testing performed by your doctor may demonstrate scoliosis, reversed lordosis, or abnormal kyphosis.
What does VA mean by incapacitating episodes?
As I mentioned above, veterans can also qualify for a 20 percent VA rating by showing at least 2 weeks of incapacitating episodes in the last year. This applies most often to veterans who have periods where their back flares up or goes out, and they simply are unable to do much of anything. This really takes a toll on veterans and should be factored in by VA.
Fortunately, VA does factor that in. It’s another way to rate a spinal condition. Having back pain or some limitations alone will not be enough to qualify for the 20 percent VA rating since VA defines incapacitating episodes.
In VA’s rules, incapacitating episodes means signs and symptoms that your doctor says require bedrest that your doctor orders. The good news is that the episodes do not have to be two weeks in a row. You just have to have a total of at least two weeks in the last year.
VA’s rules also provide that VA should use whichever method of rating your thoracolumbar spine which provides you with the higher rating. So, if you qualify for a ten percent using range of motion and a 20 percent using incapacitating episodes, then VA should assign you a 20 percent rating.
As I mentioned above, veterans can also qualify for a 20 percent VA rating by showing at least 2 weeks of incapacitating episodes in the last year. This applies most often to veterans who have periods where their back flares up or goes out, and they simply are unable to do much of anything. This really takes a toll on veterans and should be factored in by VA.
Fortunately, VA does factor that in. It’s another way to rate a spinal condition. Having back pain or some limitations alone will not be enough to qualify for the 20 percent VA rating since VA defines incapacitating episodes.
In VA’s rules, incapacitating episodes means signs and symptoms that your doctor says require bedrest that your doctor orders. The good news is that the episodes do not have to be two weeks in a row. You just have to have a total of at least two weeks in the last year.
VA’s rules also provide that VA should use whichever method of rating your thoracolumbar spine which provides you with the higher rating. So, if you qualify for a ten percent using range of motion and a 20 percent using incapacitating episodes, then VA should assign you a 20 percent rating.
Can I get a rating higher than 20 percent if my back disability is more severe?
Yes. You can qualify for a VA rating between 40 percent and 100 percent depending on how severe your disability is. I discuss thoracolumbar VA ratings of 40 percent or higher in this article.
Yes. You can qualify for a VA rating between 40 percent and 100 percent depending on how severe your disability is. I discuss thoracolumbar VA ratings of 40 percent or higher in this article.
What if I have more questions about my VA claim?
I understand you want your VA claim to be done as quickly as possible. But remember the ultimate goal – to win your VA disability compensation claim.
You may eventually get there on your own, but it may be after a series of decisions by the Regional Office and Board of Veterans Appeals. Sometimes claims are appealed and remanded several times, which can cause a claim to drag on for years. If you are interested in avoiding unnecessary delay in your claim and want to do everything you can to maximize your chances of success, it is probably a good ida for you to consult with an accredited veterans disability attorney.
We would be happy to talk to you. If you would like a free consultation with one of Perkins Law Firm’s veterans disability attorneys just click here or give us a call to set one up.
I understand you want your VA claim to be done as quickly as possible. But remember the ultimate goal – to win your VA disability compensation claim.
You may eventually get there on your own, but it may be after a series of decisions by the Regional Office and Board of Veterans Appeals. Sometimes claims are appealed and remanded several times, which can cause a claim to drag on for years. If you are interested in avoiding unnecessary delay in your claim and want to do everything you can to maximize your chances of success, it is probably a good ida for you to consult with an accredited veterans disability attorney.
We would be happy to talk to you. If you would like a free consultation with one of Perkins Law Firm’s veterans disability attorneys just click here or give us a call to set one up.
7 Costly Mistakes To Avoid When Filing For Veterans Disability Benefits
MISTAKE #1: Failing to learn how the Department of Veterans Affairs decides whether to give you benefits. Many veterans think they simply fill out forms – send them in – and wait for their check. But the bureaucracy involved with getting your disability claim approved is much more complicated. The VA awards benefits only when you can prove that (1) you are eligible to receive VA benefits, (2) you have a current disability, (3) you have proof that something happened to you while you were in the service, (4) you have medical evidence linking your disability to something that happened in the service, and (5) you have medical evidence demonstrating the severity of your condition. Proving these five points is difficult. This is one reason the VA denies most first-time claims.
MISTAKE #2: Failing to hire a lawyer after you’ve been denied. Most veterans who deserve disability benefits do not understand the fine points in the law. It’s nearly impossible for you to win VA disability benefits unless you hire an experienced veterans disability lawyer.
MISTAKE #3: Failing to submit detailed statements from your friends and family members. It is important to document your symptoms and how they have affected your life. Many veterans fail to obtain sworn statements from service buddies, friends, or family members who personally witnessed the symptoms of their disability.
MISTAKE #4: Overstating the impact of your disability. Some veterans think they must exaggerate their symptoms to convince the VA that their disability is serious. This causes the VA to question their entire claim. And, in the end, all they do is hurt themselves. While you need to explain your case thoroughly, make sure what you present is accurate. The VA doesn’t like to accept what a veteran says. When there are inconsistent statements in your file, you give the VA an easy way to discredit you and conclude that they should not believe what you say.
MISTAKE #5: Failing to obtain a medical opinion linking your disability to your service. One of the biggest reasons why VA denies claims is the absence of medical evidence linking your disability to your service. If all you have are your own statements claiming the problem is related to your service, the VA will almost certainly deny your claim.
MISTAKE #6: Relying on the VA compensation and pension examiner. Don’t assume that the C&P examiner will say something favorable to your claim. You must take the responsibility to make sure your file contains a well-written, well-reasoned medical opinion from your doctor (preferably a private doctor). This can be of tremendous value in persuading the C&P examiner to write a favorable opinion.
MISTAKE #7: Failing to pursue your claim and, instead, just giving up. The appeal process is long and cumbersome. Add to that your disability and the financial hardship, and you may decide “It’s just not worth it.” Please don’t give up. If you meet the VA’s requirements, you have earned the right to receive disability benefits. In addition, a finding of service connection is required to secure other VA benefits such as healthcare. Hiring a veterans disability lawyer to represent you can make the appeal process much easier on you – and greatly increase your chances of success. Over the years I have seen that success comes to those veterans who continue to fight for their benefits
Soldiers get shorter, an unexpected and painful result of carrying a heavy load of gear
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BY JEREMY OLSON PIONEER PRESS
After 16 months in Iraq, Minnesota National Guard members who came home this summer expected aches and pains.
They did not expect to shrink.
Brian Hesse figures he lost an inch or so – a consequence of the heavy body armor and the gear he toted on convoy and security missions. The armor alone weighed more than 30 pounds. And then there was the 4-pound helmet, the 7.5-pound loaded M-4 rifle, the 10 pounds of extra ammunition and other necessities.
“I shrunk,” the 25-year-old from Minnetonka said, “and got a bit wider. It’s like my body said, ‘OK, I need a wider base.’ ”
It’s no myth. Some returnees and their doctors agree they did get shorter – if at least temporarily. The 60 to 90 pounds of gear around their torsos, shoulders and heads likely caused their spinal discs to compress, making the soldiers shorter and causing back pain.
Guard officials expected the 2,600 members of the state’s returning 1st Brigade Combat Team to suffer from a host of physical ailments. While less dramatic than gunshot wounds or brain injuries caused by blast exposures, musculoskeletal injuries are easily the most common health problems for Iraq returnees.
“A good chunk of what we’re seeing is actually overuse that we would really anticipate would get better in a short period of time,” said Dr. Michael Koopmeiners, who directs community clinics for the Minneapolis VA Medical Center.
The key question , now that returnees have been home for three months, is how many are in fact developing chronic problems and how many are getting better.
The answer will become clearer over the next month as Guard members report to Camp Ripley in central Minnesota to complete a post-deployment reassessment. A questionnaire asks soldiers about physical injuries and their risks of combat stress or traumatic brain injury.
The reassessment is a follow-up to one the soldiers completed either in their final days in Iraq or when they reached Fort McCoy in Wisconsin en route home. The questions are identical, but history shows that returning soldiers either don’t recognize their symptoms during the first survey or don’t want to admit any problems.
About 1,300 Minnesota National Guard members returned home from Iraq and Afghanistan before the return of the 1st Brigade Combat Team. Of those, 716 were referred for health care services after completing their reassessments, according to the Minnesota National Guard. The majority reported “nagging injuries” to their joints and muscles, the Guard reported.
Nationwide, more than 96,000 National Guard members and reservists have completed reassessments since October 2006, and 49 percent reported health problems unrelated to combat wounds, according to the U.S. Defense Department.
Low back problems are most common, Koopmeiners said, followed by neck, shoulder, knee and ankle injuries.
MINNESOTANS AT GREATER RISK
The risk appears even greater for the 1st Brigade Combat Team, whose 16-month deployment in Iraq is the longest of any U.S. military unit. Research has shown that deployment length increases injury risk.
“The longer they’re deployed,” Koopmeiners said, “the more likely that they have injuries, especially to the musculoskeletal system.”
Hesse and his girlfriend, Ashley Ekstrom, a sergeant who also served in Iraq in the Minnesota National Guard, are both showing signs of wear.
Ekstrom, 24, also of Minnetonka, said her initial assessment revealed she was an inch shorter, too. She has sought physical therapy and chiropractor treatments for shooting pains in her back and neck that make it hard to sleep.
Ekstrom said her pains grew steadily from the weight of the body armor and the long convoys on bumpy roads in Iraq.
Hesse, a staff sergeant, isn’t much of a complainer, nor does he want to place blame on the military or his Iraq service. He goes to the gym, hopeful that stretching and exercising on his own will help his back and reduce his occasional pain.
“It slows me down from what I used to be (before Iraq),” he said, “but that was also two years ago, when I was a little bit younger and a little bit more mobile.”
HEAVY LOADS
The high number of returnees with joint and muscle pain poses two questions for military leaders.
First, there’s the age-old question of combat load: Body armor and weapons may be getting lighter, but the net weight isn’t changing much. Many soldiers are now wearing extra armor plates to protect their sides, throats and groins.
A 2004 study of an Army unit in Afghanistan estimated that riflemen were carrying equipment that equaled 36 percent of their body weight during combat and 55 percent of their body weight during patrols. The recommended load is no more than 30 percent of body weight.
Some soldiers using mortars or heavy weapons carried nearly 100 percent of their body weight at times, the study found.
“Can you imagine walking around carrying yourself, all the time, day in and day out?” asked Charles Dean, a retired Army colonel who led the study. “It would definitely have an impact.”
Second, there’s the question of lasting injury: Will muscle and joint pains heal with time? Or will they become chronic?
Guard officials are hoping the health screenings and reintegration events persuade returnees to confront physical problems before they are aggravated. Even if pain goes away, it could resurface in the future.
“That’s one of those things we’re going to notice again five or 10 years down the line,” said Maj. Gen. Larry Shellito, adjutant general to the Minnesota Guard. “That’s why I would like for us to deal with it up front.”
PAIN BEGETS INJURY
Wartime operations put soldiers in awkward positions, said Michelle Peterson, a physical therapist at the Minneapolis VA. Patients include machine-gunners who sat in uncomfortable turrets atop vehicles and infantrymen who pointed their weapons in ready positions for hours.
VA therapists also speculate that Iraq’s sandy, loose terrain contributed to back problems because it was poor footing for the weighed-down soldiers.
Peterson has treated many soldiers who ignored their pain and injuries while in Iraq. She understands their thinking – not wanting to be held back from duty while their buddies and units are fighting – but said the choice can have a toll.
“When you’re active duty, you might view pain as a weakness,” she said. “So you don’t admit to having pain, and by doing that, you further injure yourself.”
HOW TALL NOW?
Ekstrom’s height was measured again in late November when she went to Camp Ripley for her reassessment. To her relief, she had gained back the lost inch of height. Chiropractic treatments have relieved some of her pain, and some of the associated headaches aren’t as intense.
A big challenge now is adjusting to work at a retail clothing store, where interaction with hectic customers is a bit different from life in the structured military.
Hesse, on the other hand, has felt more back pain in recent weeks. He’s sacrificed his exercise regimen while working in shipping for Comcast and taking night classes to earn an engineering degree.
His health reassessment at Camp Ripley is next month. Proud of his Guard service, Hesse said he would likely check “unsure” on the survey when it asks if he relates any physical problems to his deployment. Those long rides in the gunner’s turret probably didn’t help, though, he admits.
As for his height? Hesse returned home at 5-foot-7, an inch shorter than when he was deployed. But at least his old clothes fit. The reassessment will tell him if he’s grown back.
BY JEREMY OLSON PIONEER PRESS
After 16 months in Iraq, Minnesota National Guard members who came home this summer expected aches and pains.
They did not expect to shrink.
Brian Hesse figures he lost an inch or so – a consequence of the heavy body armor and the gear he toted on convoy and security missions. The armor alone weighed more than 30 pounds. And then there was the 4-pound helmet, the 7.5-pound loaded M-4 rifle, the 10 pounds of extra ammunition and other necessities.
“I shrunk,” the 25-year-old from Minnetonka said, “and got a bit wider. It’s like my body said, ‘OK, I need a wider base.’ ”
It’s no myth. Some returnees and their doctors agree they did get shorter – if at least temporarily. The 60 to 90 pounds of gear around their torsos, shoulders and heads likely caused their spinal discs to compress, making the soldiers shorter and causing back pain.
Guard officials expected the 2,600 members of the state’s returning 1st Brigade Combat Team to suffer from a host of physical ailments. While less dramatic than gunshot wounds or brain injuries caused by blast exposures, musculoskeletal injuries are easily the most common health problems for Iraq returnees.
“A good chunk of what we’re seeing is actually overuse that we would really anticipate would get better in a short period of time,” said Dr. Michael Koopmeiners, who directs community clinics for the Minneapolis VA Medical Center.
The key question , now that returnees have been home for three months, is how many are in fact developing chronic problems and how many are getting better.
The answer will become clearer over the next month as Guard members report to Camp Ripley in central Minnesota to complete a post-deployment reassessment. A questionnaire asks soldiers about physical injuries and their risks of combat stress or traumatic brain injury.
The reassessment is a follow-up to one the soldiers completed either in their final days in Iraq or when they reached Fort McCoy in Wisconsin en route home. The questions are identical, but history shows that returning soldiers either don’t recognize their symptoms during the first survey or don’t want to admit any problems.
About 1,300 Minnesota National Guard members returned home from Iraq and Afghanistan before the return of the 1st Brigade Combat Team. Of those, 716 were referred for health care services after completing their reassessments, according to the Minnesota National Guard. The majority reported “nagging injuries” to their joints and muscles, the Guard reported.
Nationwide, more than 96,000 National Guard members and reservists have completed reassessments since October 2006, and 49 percent reported health problems unrelated to combat wounds, according to the U.S. Defense Department.
Low back problems are most common, Koopmeiners said, followed by neck, shoulder, knee and ankle injuries.
MINNESOTANS AT GREATER RISK
The risk appears even greater for the 1st Brigade Combat Team, whose 16-month deployment in Iraq is the longest of any U.S. military unit. Research has shown that deployment length increases injury risk.
“The longer they’re deployed,” Koopmeiners said, “the more likely that they have injuries, especially to the musculoskeletal system.”
Hesse and his girlfriend, Ashley Ekstrom, a sergeant who also served in Iraq in the Minnesota National Guard, are both showing signs of wear.
Ekstrom, 24, also of Minnetonka, said her initial assessment revealed she was an inch shorter, too. She has sought physical therapy and chiropractor treatments for shooting pains in her back and neck that make it hard to sleep.
Ekstrom said her pains grew steadily from the weight of the body armor and the long convoys on bumpy roads in Iraq.
Hesse, a staff sergeant, isn’t much of a complainer, nor does he want to place blame on the military or his Iraq service. He goes to the gym, hopeful that stretching and exercising on his own will help his back and reduce his occasional pain.
“It slows me down from what I used to be (before Iraq),” he said, “but that was also two years ago, when I was a little bit younger and a little bit more mobile.”
HEAVY LOADS
The high number of returnees with joint and muscle pain poses two questions for military leaders.
First, there’s the age-old question of combat load: Body armor and weapons may be getting lighter, but the net weight isn’t changing much. Many soldiers are now wearing extra armor plates to protect their sides, throats and groins.
A 2004 study of an Army unit in Afghanistan estimated that riflemen were carrying equipment that equaled 36 percent of their body weight during combat and 55 percent of their body weight during patrols. The recommended load is no more than 30 percent of body weight.
Some soldiers using mortars or heavy weapons carried nearly 100 percent of their body weight at times, the study found.
“Can you imagine walking around carrying yourself, all the time, day in and day out?” asked Charles Dean, a retired Army colonel who led the study. “It would definitely have an impact.”
Second, there’s the question of lasting injury: Will muscle and joint pains heal with time? Or will they become chronic?
Guard officials are hoping the health screenings and reintegration events persuade returnees to confront physical problems before they are aggravated. Even if pain goes away, it could resurface in the future.
“That’s one of those things we’re going to notice again five or 10 years down the line,” said Maj. Gen. Larry Shellito, adjutant general to the Minnesota Guard. “That’s why I would like for us to deal with it up front.”
PAIN BEGETS INJURY
Wartime operations put soldiers in awkward positions, said Michelle Peterson, a physical therapist at the Minneapolis VA. Patients include machine-gunners who sat in uncomfortable turrets atop vehicles and infantrymen who pointed their weapons in ready positions for hours.
VA therapists also speculate that Iraq’s sandy, loose terrain contributed to back problems because it was poor footing for the weighed-down soldiers.
Peterson has treated many soldiers who ignored their pain and injuries while in Iraq. She understands their thinking – not wanting to be held back from duty while their buddies and units are fighting – but said the choice can have a toll.
“When you’re active duty, you might view pain as a weakness,” she said. “So you don’t admit to having pain, and by doing that, you further injure yourself.”
HOW TALL NOW?
Ekstrom’s height was measured again in late November when she went to Camp Ripley for her reassessment. To her relief, she had gained back the lost inch of height. Chiropractic treatments have relieved some of her pain, and some of the associated headaches aren’t as intense.
A big challenge now is adjusting to work at a retail clothing store, where interaction with hectic customers is a bit different from life in the structured military.
Hesse, on the other hand, has felt more back pain in recent weeks. He’s sacrificed his exercise regimen while working in shipping for Comcast and taking night classes to earn an engineering degree.
His health reassessment at Camp Ripley is next month. Proud of his Guard service, Hesse said he would likely check “unsure” on the survey when it asks if he relates any physical problems to his deployment. Those long rides in the gunner’s turret probably didn’t help, though, he admits.
As for his height? Hesse returned home at 5-foot-7, an inch shorter than when he was deployed. But at least his old clothes fit. The reassessment will tell him if he’s grown back.
Weight of War: Gear that protects troops also injures them
Military studies acknowledge that combat soldiers are carrying too much weight — often more than 100 pounds. These loads have contributed to soaring numbers of injuries, and higher costs in disability payments.
Military studies acknowledge that combat soldiers are carrying too much weight — often more than 100 pounds. These loads have contributed to soaring numbers of injuries, and higher costs in disability payments.
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Before venturing out on patrol in Iraq, Spc. Joseph Chroniger would wrap his upper body in armor, then sling on a vest and pack that contained batteries for his radio, water, food, flashlight, ammunition and other gear. With his M4 rifle, the whole get-up weighed 70 to 80 pounds — and left him aching.
His body hurt the most when his squad came under attack and he tried to run or dive on the ground. His neck and shoulders would burn as if on fire.
Since returning to Western Washington 2 1/2 years ago, Chroniger has been diagnosed with bone spurs in the vertebrae of his neck caused by a degenerative arthritic condition. Sometimes, the pain is intense, and he dreads getting out of bed in the morning.
Before venturing out on patrol in Iraq, Spc. Joseph Chroniger would wrap his upper body in armor, then sling on a vest and pack that contained batteries for his radio, water, food, flashlight, ammunition and other gear. With his M4 rifle, the whole get-up weighed 70 to 80 pounds — and left him aching.
His body hurt the most when his squad came under attack and he tried to run or dive on the ground. His neck and shoulders would burn as if on fire.
Since returning to Western Washington 2 1/2 years ago, Chroniger has been diagnosed with bone spurs in the vertebrae of his neck caused by a degenerative arthritic condition. Sometimes, the pain is intense, and he dreads getting out of bed in the morning.
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“This is ridiculous,” Chroniger said. “I’m only 25 years old. Arthritis is supposed to happen when you get old. What’s it going to be like when I’m 50 or 60?”
Chroniger’s injury is a symptom of the overloaded U.S. combat forces that have served in the long wars in Afghanistan and Iraq.
In 2001, an Army Science Board study, noting that weight carried by soldiers could decrease mobility and increase fatigue and injury, recommended no soldier carry more than 50 pounds for any length of time. The Army chief of staff hoped to approach that goal by 2010.
But the loads combat soldiers typically carry remain far above that goal.
That weight has helped fuel an avalanche of musculoskeletal injuries that are eroding the combat-readiness of the military. Long after the fighting ends, injuries such as Chroniger’s will remain a painful and expensive legacy of these wars.
• Nearly one-third of all medical evacuations from Iraq and Afghanistan from 2004 through 2007 resulted from musculoskeletal, connective-tissue or spinal injuries, according to a study led by a Johns Hopkins University researcher. That was more than double the number of evacuations from combat injures.
• The number of soldiers medically retired from the Army with at least one musculoskeletal condition increased nearly 10-fold from 2003 to 2009, according to Army statistics.
• The heavy loads contribute to rising numbers of Afghanistan and Iraq war veterans retiring with degenerative arthritis, cervical strains and other musculoskeletal injuries. Disability benefits paid for these injuries by the Department of Veterans Affairs (VA) exceed $500 million annually, according to estimates done by The Seattle Times. That figure is expected to grow as tens of thousands of new veterans apply to the VA for compensation.
Weighing the gear
For years, the Army only had an estimate of how much weight foot soldiers carried in combat.
In 2003, Col. Charles Dean, a military-equipment expert, formed a seven-man team to conduct a detailed study of weight worn in the combat zones of eastern Afghanistan. “What we were proposing was highly irregular, and my chain of command had to pass this all the way to the generals to get approval,” Dean said.
Dean, who is now retired, wanted his team to share an infantry soldiers’ life, packing the same loads and facing the same dangers.
In Afghanistan, the team joined soldiers of the 82nd Airborne Division. Their missions typically began with a helicopter ride, followed by multiday foot patrols. Before each mission, team members pulled out a digital scale and weighed weapons, ammunition, night-vision goggles, sleeping bags, eating utensils and every other item carried by soldiers, down to ID cards.
The team stayed in Afghanistan for three months, collecting data from more than 750 soldiers with a range of different jobs.
Dean said many soldiers had no idea how much weight they were carrying.
“They were very interested in helping out,” Dean said. “If anybody could help ease the burden to them, that was great news.”
When soldiers headed out on extended foot patrols, their average load ranged from 87 pounds to 127 pounds. When they came under attack and dropped their rucksacks, most of their fighting loads still exceeded 60 pounds.
In his final report, Dean sounded an alarm.
“If an aggressive … weight-loss program is not undertaken by the Army,” Dean wrote in his report, “the soldier’s combat load will continue to increase and his physical performance will continue to be even more severely degraded.”
Back in the United States, Dean said “jaws dropped,” when he disclosed his findings to Army leaders.
The Army launched new programs to develop lighter gear. But at the same time the Army was looking at ways to lighten the load, it also focused on trying to reduce casualties by beefing up body armor and other measures.
It’s unclear if any headway was made in reducing the overall weight during the next six years. A 2009 study by a team of Army advisers indicated some soldier loads had increased by 25 percent or more compared with 2003.
The Army isn’t alone in its struggle.
A 2007 study by a Navy research-advisory committee found Marines typically have loads from 97 to 135 pounds. The committee, citing information from the VA, stated that an increasing number of disabilities due to lower-back problems were a “direct result” of carrying excessive loads for long periods.
“Many of these injuries reflect troops carrying far more weight than what medical experts say is reasonable,” said Norman Polmar, a Naval analyst and historian who served on the committee.
“You just… suck it up”
For foot soldiers, muscle and bone injuries always have been an occupational hazard. But piling too much weight on soldiers for prolonged periods can intensify the injury cycle, aggravating old muscle tears or cervical strains, and triggering new ones that never heal.
Noncommissioned officers — seasoned leaders who often have shouldered loads through three or four tours in a combat zone — may be hard-hit by these injuries. But many of these leaders feel burdened by responsibility and are unwilling to cede their place in a war zone to less experienced soldiers who may have fewer injuries.
“I had a choice. But I couldn’t leave my squad behind just before they were being deployed,” said Staff Sgt. James Knower, a wiry, 155-pound soldier from Joint Base Lewis-McChord who served in Afghanistan for a year despite injuries to his arm and rotator cuff.
Carrying loads in Afghanistan, Knower’s injuries worsened. On patrols through the Arghandab Valley in southern Afghanistan, his right arm often went numb.
“Basically, it comes down to: If you want to do your job — and you take pride in what you do — you’ve just got to suck it up,” said Knower, 29.
A rail-thin staff sergeant in the same platoon, 130-pound Kenneth Rickman, patrolled with armor and gear that typically weighed between 80 and 90 pounds.
Earlier in his Army career, Rickman suffered a pinched nerve while carrying his gear in Iraq and then a cracked vertebra in his spine while back in the United States. While in Afghanistan, he fell off a roof with all his gear on and injured his shoulder.
As the months wore on, Rickman described the pain as a kind of bone-on-bone grinding. So he gradually began to shed some of his gear. He ditched some of his extra batteries, three of his seven ammo magazines and switched to a lighter rifle.
Finally, he headed back to Washington state several weeks early on a flight filled with other injured soldiers. There, he underwent a spinal-fusion operation and the removal of a ruptured disc.
“I told them I had had enough. I was done,” said the 35-year-old Rickman.
Rising narcotics use
To help soldiers cope with the pain of musculoskeletal injuries, medical providers often prescribe opiates.
“Primary-care providers … have had very limited tools in their toolbox. It’s medications for the most part, and maybe physical therapy, but very little to offer in addition to that,” said Col. Diane Flynn, chief of the department of pain management at Madigan Army Medical Center.
Through the war years, the use of these drugs has escalated. A 2010 Army report found 14 percent of soldiers had prescriptions for opiates. The Army also is concerned the availability of pain drugs through medics widens the potential for abuse.
A 26-year-old Army veteran who lives in Seattle said a medic provided him with Vicodin, Dilaudid and morphine to help him through a series of deployments in Afghanistan and Iraq. Some of the worst pain came in 2003 on duty in the steep terrain of eastern Afghanistan as he labored up hills with his body armor, pack and a bulky automatic weapon that sometimes pushed his total load to more than 100 pounds.
“My lower back would just start aching from running up the hills. It would just break me,” said the veteran who requested anonymity.
For some soldiers suffering from post-traumatic stress disorder (PTSD) and other mental wounds, the combination of chronic pain and opiates to treat their physical injuries can help push them deeper into despair.
Orrin Gorman McClellan, a veteran of the war in eastern Afghanistan, returned to his family home in Whidbey Island with severe PTSD. He took an opiate he obtained online, but it failed to relieve his muscle and back pain. In May 2009, he committed suicide at the age of 25.
McClellan’s mother believes the physical pain contributed to his suicide.
“One of the things that he was angry about was that he always hurt. He never really got a break,” Judith Gorman said.
Since his return from Iraq, Chroniger also has struggled with PTSD, which helped him gain an early discharge from the Army that goes into effect this week. But most days, Chroniger said his neck injury causes him the biggest problems.
He has been prescribed an opiate, Percocet, which he can take up to three times a day. Yet it often fails to quell the pain.
“The neck hurts so bad, sometimes you can’t concentrate on anything other that,” Chroniger said.
Rethinking treatment
In recent years, the military has been searching for ways to improve treatment of musculoskeletal injuries.
The Army has created teams of physical therapists and other specialists to serve with infantry brigades in combat areas, and it stepped up screening for serious injuries at clinics. But some soldiers complain these injuries still may be discounted by physician assistants, who often act as gatekeepers to more extensive workups by doctors at military hospitals.
While training for his 2009 deployment to Afghanistan with the 5th Stryker Brigade, an Army sergeant complained of a sore back. A physician assistant at Madigan Army Medical Center dismissed the complaint as muscle pain.
Shortly before his deployment, the sergeant, who requested not to be named in this story, paid out of his own pocket for an MRI that indicated a herniated disc. He opted to deploy and then seek treatment upon his return to Washington state in summer 2010.
The sergeant said medical staff are rightfully on the lookout for “sick-call warriors” who constantly complain of problems when there is nothing wrong. But, he said, “the problem is, now they treat most everyone like they are faking it.”
Medical officials say attitudes are changing.
“The faster you can address some of those issues at the clinic level, the less likely the soldier is to need hospital-level care … in the theater (or need) to be evacuated,” said Col. Stephen Bolt, Madigan Army Medical Center’s chief of the department of anesthesia and operative services.
The Army also is trying to reduce the use of opiates for pain. An Army report recommended the increased use of alternatives, including chiropractic care, massage, meditation and acupuncture.
At Madigan, Shashi Kumar, a doctor trained in acupuncture, says these treatments have helped many patients substantially reduce pain and narcotics use.
“This has been more than what I hoped for,” Kumar said. “The pain-management outcome is fantastic.”
Chroniger is one of her patients. During his first treatment, she gently inserted the metal needles about a quarter-inch deep into his neck and shoulder muscles. Then she hooked the needles up to a machine that generated a small electrical current and bathed her patient in the warm glow of an infrared lamp.
After some 15 minutes, she took out the needles and helped the patient back to his feet.
Chroniger said he felt better, not so tight, and will undergo three more sessions. But at Madigan and elsewhere, the Army has few staff trained to offer these therapies, and military insurance does not pay for most of these alternative services from civilian providers.
“That’s really one of the things that’s holding us back,” said Flynn, the Madigan doctor who directs the pain center. “We have such limited access to other than what we call traditional medicine.”
The Army also has sought to prevent such injuries by improving the conditioning of soldiers.
While training, soldiers may exercise or run with full body armor and other gear. But even the most physically fit platoon member will be prone to injuries when carrying 100 pounds of gear through a year of combat.
So, the Army continues to pursue an elusive goal: Lightening the load.
“This is ridiculous,” Chroniger said. “I’m only 25 years old. Arthritis is supposed to happen when you get old. What’s it going to be like when I’m 50 or 60?”
Chroniger’s injury is a symptom of the overloaded U.S. combat forces that have served in the long wars in Afghanistan and Iraq.
In 2001, an Army Science Board study, noting that weight carried by soldiers could decrease mobility and increase fatigue and injury, recommended no soldier carry more than 50 pounds for any length of time. The Army chief of staff hoped to approach that goal by 2010.
But the loads combat soldiers typically carry remain far above that goal.
That weight has helped fuel an avalanche of musculoskeletal injuries that are eroding the combat-readiness of the military. Long after the fighting ends, injuries such as Chroniger’s will remain a painful and expensive legacy of these wars.
• Nearly one-third of all medical evacuations from Iraq and Afghanistan from 2004 through 2007 resulted from musculoskeletal, connective-tissue or spinal injuries, according to a study led by a Johns Hopkins University researcher. That was more than double the number of evacuations from combat injures.
• The number of soldiers medically retired from the Army with at least one musculoskeletal condition increased nearly 10-fold from 2003 to 2009, according to Army statistics.
• The heavy loads contribute to rising numbers of Afghanistan and Iraq war veterans retiring with degenerative arthritis, cervical strains and other musculoskeletal injuries. Disability benefits paid for these injuries by the Department of Veterans Affairs (VA) exceed $500 million annually, according to estimates done by The Seattle Times. That figure is expected to grow as tens of thousands of new veterans apply to the VA for compensation.
Weighing the gear
For years, the Army only had an estimate of how much weight foot soldiers carried in combat.
In 2003, Col. Charles Dean, a military-equipment expert, formed a seven-man team to conduct a detailed study of weight worn in the combat zones of eastern Afghanistan. “What we were proposing was highly irregular, and my chain of command had to pass this all the way to the generals to get approval,” Dean said.
Dean, who is now retired, wanted his team to share an infantry soldiers’ life, packing the same loads and facing the same dangers.
In Afghanistan, the team joined soldiers of the 82nd Airborne Division. Their missions typically began with a helicopter ride, followed by multiday foot patrols. Before each mission, team members pulled out a digital scale and weighed weapons, ammunition, night-vision goggles, sleeping bags, eating utensils and every other item carried by soldiers, down to ID cards.
The team stayed in Afghanistan for three months, collecting data from more than 750 soldiers with a range of different jobs.
Dean said many soldiers had no idea how much weight they were carrying.
“They were very interested in helping out,” Dean said. “If anybody could help ease the burden to them, that was great news.”
When soldiers headed out on extended foot patrols, their average load ranged from 87 pounds to 127 pounds. When they came under attack and dropped their rucksacks, most of their fighting loads still exceeded 60 pounds.
In his final report, Dean sounded an alarm.
“If an aggressive … weight-loss program is not undertaken by the Army,” Dean wrote in his report, “the soldier’s combat load will continue to increase and his physical performance will continue to be even more severely degraded.”
Back in the United States, Dean said “jaws dropped,” when he disclosed his findings to Army leaders.
The Army launched new programs to develop lighter gear. But at the same time the Army was looking at ways to lighten the load, it also focused on trying to reduce casualties by beefing up body armor and other measures.
It’s unclear if any headway was made in reducing the overall weight during the next six years. A 2009 study by a team of Army advisers indicated some soldier loads had increased by 25 percent or more compared with 2003.
The Army isn’t alone in its struggle.
A 2007 study by a Navy research-advisory committee found Marines typically have loads from 97 to 135 pounds. The committee, citing information from the VA, stated that an increasing number of disabilities due to lower-back problems were a “direct result” of carrying excessive loads for long periods.
“Many of these injuries reflect troops carrying far more weight than what medical experts say is reasonable,” said Norman Polmar, a Naval analyst and historian who served on the committee.
“You just… suck it up”
For foot soldiers, muscle and bone injuries always have been an occupational hazard. But piling too much weight on soldiers for prolonged periods can intensify the injury cycle, aggravating old muscle tears or cervical strains, and triggering new ones that never heal.
Noncommissioned officers — seasoned leaders who often have shouldered loads through three or four tours in a combat zone — may be hard-hit by these injuries. But many of these leaders feel burdened by responsibility and are unwilling to cede their place in a war zone to less experienced soldiers who may have fewer injuries.
“I had a choice. But I couldn’t leave my squad behind just before they were being deployed,” said Staff Sgt. James Knower, a wiry, 155-pound soldier from Joint Base Lewis-McChord who served in Afghanistan for a year despite injuries to his arm and rotator cuff.
Carrying loads in Afghanistan, Knower’s injuries worsened. On patrols through the Arghandab Valley in southern Afghanistan, his right arm often went numb.
“Basically, it comes down to: If you want to do your job — and you take pride in what you do — you’ve just got to suck it up,” said Knower, 29.
A rail-thin staff sergeant in the same platoon, 130-pound Kenneth Rickman, patrolled with armor and gear that typically weighed between 80 and 90 pounds.
Earlier in his Army career, Rickman suffered a pinched nerve while carrying his gear in Iraq and then a cracked vertebra in his spine while back in the United States. While in Afghanistan, he fell off a roof with all his gear on and injured his shoulder.
As the months wore on, Rickman described the pain as a kind of bone-on-bone grinding. So he gradually began to shed some of his gear. He ditched some of his extra batteries, three of his seven ammo magazines and switched to a lighter rifle.
Finally, he headed back to Washington state several weeks early on a flight filled with other injured soldiers. There, he underwent a spinal-fusion operation and the removal of a ruptured disc.
“I told them I had had enough. I was done,” said the 35-year-old Rickman.
Rising narcotics use
To help soldiers cope with the pain of musculoskeletal injuries, medical providers often prescribe opiates.
“Primary-care providers … have had very limited tools in their toolbox. It’s medications for the most part, and maybe physical therapy, but very little to offer in addition to that,” said Col. Diane Flynn, chief of the department of pain management at Madigan Army Medical Center.
Through the war years, the use of these drugs has escalated. A 2010 Army report found 14 percent of soldiers had prescriptions for opiates. The Army also is concerned the availability of pain drugs through medics widens the potential for abuse.
A 26-year-old Army veteran who lives in Seattle said a medic provided him with Vicodin, Dilaudid and morphine to help him through a series of deployments in Afghanistan and Iraq. Some of the worst pain came in 2003 on duty in the steep terrain of eastern Afghanistan as he labored up hills with his body armor, pack and a bulky automatic weapon that sometimes pushed his total load to more than 100 pounds.
“My lower back would just start aching from running up the hills. It would just break me,” said the veteran who requested anonymity.
For some soldiers suffering from post-traumatic stress disorder (PTSD) and other mental wounds, the combination of chronic pain and opiates to treat their physical injuries can help push them deeper into despair.
Orrin Gorman McClellan, a veteran of the war in eastern Afghanistan, returned to his family home in Whidbey Island with severe PTSD. He took an opiate he obtained online, but it failed to relieve his muscle and back pain. In May 2009, he committed suicide at the age of 25.
McClellan’s mother believes the physical pain contributed to his suicide.
“One of the things that he was angry about was that he always hurt. He never really got a break,” Judith Gorman said.
Since his return from Iraq, Chroniger also has struggled with PTSD, which helped him gain an early discharge from the Army that goes into effect this week. But most days, Chroniger said his neck injury causes him the biggest problems.
He has been prescribed an opiate, Percocet, which he can take up to three times a day. Yet it often fails to quell the pain.
“The neck hurts so bad, sometimes you can’t concentrate on anything other that,” Chroniger said.
Rethinking treatment
In recent years, the military has been searching for ways to improve treatment of musculoskeletal injuries.
The Army has created teams of physical therapists and other specialists to serve with infantry brigades in combat areas, and it stepped up screening for serious injuries at clinics. But some soldiers complain these injuries still may be discounted by physician assistants, who often act as gatekeepers to more extensive workups by doctors at military hospitals.
While training for his 2009 deployment to Afghanistan with the 5th Stryker Brigade, an Army sergeant complained of a sore back. A physician assistant at Madigan Army Medical Center dismissed the complaint as muscle pain.
Shortly before his deployment, the sergeant, who requested not to be named in this story, paid out of his own pocket for an MRI that indicated a herniated disc. He opted to deploy and then seek treatment upon his return to Washington state in summer 2010.
The sergeant said medical staff are rightfully on the lookout for “sick-call warriors” who constantly complain of problems when there is nothing wrong. But, he said, “the problem is, now they treat most everyone like they are faking it.”
Medical officials say attitudes are changing.
“The faster you can address some of those issues at the clinic level, the less likely the soldier is to need hospital-level care … in the theater (or need) to be evacuated,” said Col. Stephen Bolt, Madigan Army Medical Center’s chief of the department of anesthesia and operative services.
The Army also is trying to reduce the use of opiates for pain. An Army report recommended the increased use of alternatives, including chiropractic care, massage, meditation and acupuncture.
At Madigan, Shashi Kumar, a doctor trained in acupuncture, says these treatments have helped many patients substantially reduce pain and narcotics use.
“This has been more than what I hoped for,” Kumar said. “The pain-management outcome is fantastic.”
Chroniger is one of her patients. During his first treatment, she gently inserted the metal needles about a quarter-inch deep into his neck and shoulder muscles. Then she hooked the needles up to a machine that generated a small electrical current and bathed her patient in the warm glow of an infrared lamp.
After some 15 minutes, she took out the needles and helped the patient back to his feet.
Chroniger said he felt better, not so tight, and will undergo three more sessions. But at Madigan and elsewhere, the Army has few staff trained to offer these therapies, and military insurance does not pay for most of these alternative services from civilian providers.
“That’s really one of the things that’s holding us back,” said Flynn, the Madigan doctor who directs the pain center. “We have such limited access to other than what we call traditional medicine.”
The Army also has sought to prevent such injuries by improving the conditioning of soldiers.
While training, soldiers may exercise or run with full body armor and other gear. But even the most physically fit platoon member will be prone to injuries when carrying 100 pounds of gear through a year of combat.
So, the Army continues to pursue an elusive goal: Lightening the load.
Soldiers: Serving your country is killing your back
- Reduce the amount of weight carried.
- This is the most obvious way to change this problem. If possible reduce the amount of weight you carry. Make purses, bags, and etc. lighter. Soldiers, look for options to reduce your load, or exchange items with lighter options.
- Evenly distribute and support extra weight
- When carrying extra weight always evenly distribute the weight on your body. Use two straps, one on both shoulders. Try to keep the weight as high up on the back as possible to reduce the stress on the low back. When possible use hip straps/support to help distribute the weight.
- Always maintain correct posture when carrying excess weight.
- When carrying excess weight it is crucial to stay in proper posture. Allowing your self to go into incorrect postural position increases the stress on the muscles that protect your spine. Too much stress and these muscles give out and your spine takes the damage.
Rehabilitation
- Strengthen your spinal postural muscles
- Do core exercises to strengthen the postural muscles that support the spine. Planking is an excellent exercise. Lay with your chest on the floor. Support your body weight on your toes and your elbows/forearms. Lift your body off the ground and maintain this position as long as possible.
- Lose excess body fat.
- Reducing extra body weight removes stress from the spine and pressure from the vertebral discs.
Spinal Alignment
- Spinal distraction
- This is a great therapy that can be done at home to help relieve the stress on the vertebral discs. Lay with your upper body on a bed or soft surface. Let your legs hang off. The surface needs to be high enough that your knees don’t touch the ground. Allow gravity to pull your lower body down, which will expand the space between the vertebrae and allow the discs to return to a normal position.
Soldiers: Serving your country is killing your back
Soldiers serving their country in places such as Iraq and Afghanistan routinely carry between 50 and 100 pounds of gear such as body armor, weapons, flack vests, rucksacks, and ammo. This weight is directly affecting their spine and increasing spine related problems for military men and women. Carrying gear weighing over 10% of a persons body weight is known to cause damage to the spine and vertebral discs. It is no surprise that the main complaint from soldiers returning home would be neck & back pain, followed by hip and knee problems. The VA has seen over 396,000 veterans already for these musculoskeletal problems, which is roughly 31% of the returning soldiers. It is assumed many more have not sought medical care or have gone to private medical center.
Your spine has a maximum load restriction
The spine is designed to hold a person up right, and to allow freedom of movement and function. Just like any structure there are “maximum load restrictions”. When we increase the weight placed on the spine by more than 10% of our normal body weight it begins to stress and degenerate the vertebral discs that act like the shock absorbers between the spinal vertebrae. If these discs become worn and degenerated the spine can no longer function correctly. Compensation and adaptation sets into the spine and other structures such as the hips, knees, and muscles of the back.
Posture Distortion Patterns degenerate the Spine and cause back pain.
Additionally when we have this excess amount of weight on our spines we are often put into compromising postural positions to balance this weight. This causes the postural distortions patterns, which are known to degenerate the spine and cause back pain. Soldiers are trained to handle extreme situations. They are “mentally tough” and physically fit, however the spine can’t be trained to withstand these extreme loads. Forcing ones body to maintain extreme stress and weight bearing begins to slowly deteriorate the spine.
Soldier or Civilian carrying excess weight will damage your spine
Although the soldier may be tough enough to deal with the pain and stress during their younger years, as they age and become more elderly, these traumas to the spine often debilitate this once mighty soldier, often reducing them to canes, wheel chairs, and in some cases in ability to even get out of bed. The pain is traumatic and the damage is done. Soldiers often experience the most extreme situation in excess weight bearing, however, many of our population is suffering from the same thing. According to the Center for Disease Control 70% of adults are overweight with 35% being considered obese. This excess weight in the form of fat is placing the same stress on societies spines as well.
Anyone carrying 15 pounds or more is prone to an increased chance of spinal disease. This could be a backpack, military gear, or body fat. Carrying excess weight for long periods of time damages the spine. To know for sure if you are developing these postural distortion patterns get a Posture Diagnosis Online from the American Posture Institute.
6 Tips to Stop Killing Your Spine
Habits
- Reduce the amount of weight carried.
- This is the most obvious way to change this problem. If possible reduce the amount of weight you carry. Make purses, bags, and etc. lighter. Soldiers, look for options to reduce your load, or exchange items with lighter options.
- Evenly distribute and support extra weight
- When carrying extra weight always evenly distribute the weight on your body. Use two straps, one on both shoulders. Try to keep the weight as high up on the back as possible to reduce the stress on the low back. When possible use hip straps/support to help distribute the weight.
- Always maintain correct posture when carrying excess weight.
- When carrying excess weight it is crucial to stay in proper posture. Allowing your self to go into incorrect postural position increases the stress on the muscles that protect your spine. Too much stress and these muscles give out and your spine takes the damage.
Rehabilitation
- Strengthen your spinal postural muscles
- Do core exercises to strengthen the postural muscles that support the spine. Planking is an excellent exercise. Lay with your chest on the floor. Support your body weight on your toes and your elbows/forearms. Lift your body off the ground and maintain this position as long as possible.
- Lose excess body fat.
- Reducing extra body weight removes stress from the spine and pressure from the vertebral discs.
Spinal Alignment
- Spinal distraction
- This is a great therapy that can be done at home to help relieve the stress on the vertebral discs. Lay with your upper body on a bed or soft surface. Let your legs hang off. The surface needs to be high enough that your knees don’t touch the ground. Allow gravity to pull your lower body down, which will expand the space between the vertebrae and allow the discs to return to a normal position.
Mycoplasma - Often Overlooked In Chronic Lyme Disease
June 1, 2009 in Science/Research by Scott Forsgren
Those of us with chronic Lyme disease are quite familiar with the names of the better known Lyme co-infections. Babesia, Bartonella, and Ehrlichia have become everyday words. As much as we would like to rid ourselves of these illness-producing pathogens, they have become a part of our daily struggle to regain a sense of health and wellness. Unfortunately, these are not the only co-infections seen in chronic Lyme disease. For some reason,Mycoplasma infections are not only lesser known by patients, but seemingly often overlooked by doctors as well. It is important for us, as patients, to educate ourselves on the topic of Mycoplasma and to ask our practitioners how we are being evaluated and treated for these infections.
In 1987, Dr. Garth Nicolson, PhD was a professor at the University of Texas at Houston when his wife, an instructor at Baylor College of Medicine, became seriously ill and nearly died. She was diagnosed with aMycoplasma infection, treated, and later recovered. A few years later, their daughter, who had served in the Gulf War, returned from active duty quite ill. Not only was she sick, but the symptoms that she exhibited were very similar to those that Dr. Nicolson's wife had expressed years earlier.
At that point, Dr. Nicolson had the idea that his daughter's illness could be the result of an infection and started to investigate his theory further. As his work progressed, he looked at Brucella, Borrelia, Ehrlichia, and other chronic intracellular infections that have the potential to cause illness and present with overlapping signs and symptoms. In Gulf War veterans that were being evaluated, approximately 45% of those that were ill had Mycoplasma infection. It was found that the infection was a particular type of Mycoplasma, namely a peculiar species called Mycoplasma fermentans.
Very little was known about this particular species of Mycoplasma at the time except that the Armed Forces Institute of Pathology and the Army had been doing research on the organism. Once this likely causative agent of Gulf War Illness (GWI) had been identified in about one-half of the GWI cases, Dr. Nicolson recommended that the Mycoplasma-infected Gulf War veterans be treated with Doxycycline. He then found himself the target of vicious attacks for making the connection between the illness and M. fermentans. Dr. Nicolson shared that "even talking about this organism was highly discouraged." In fact, until the Gulf War, the military's own medical school had been teaching about the dangers of M. fermentans for years.
Background
Just years earlier in Texas, prisons emerged in which many of the inmates and guards came down with neurodegenerative conditions at rates that were far from ordinary. In Huntsville, where three large State prisons are found, there were about 70 cases of ALS, numerous cases of Multiple Sclerosis, and highly unexpected numbers of Rheumatoid Arthritis cases. At that time, the term "Mystery Disease" was used to identify the unusual illnesses that so many seemed to have acquired.
Dr. Nicolson started testing prison guards and their family members and found that very high numbers of these people were testing positive for Mycoplasma fermentans. Furthermore, this appeared to be a weaponized version of the organism called M. fermentans incognitus, a specific strain of Mycoplasma that had been altered to cause more severe symptoms, to be more virulent, and to be more survivable than the naturally occurring M. fermentans. Dr. Nicolson believed that biological weapons experiments had been carried out on inmates in the Texas prison system for years in which humans had been used as guinea pigs.
As time progressed, these illnesses did not remain confined to the prisoners. Soon after the prisoners unknowingly became a part in these experiments, the prison guards became ill. Their illnesses gradually became those of their families. It was not long before these Mycoplasma-based illnesses became a broader part of the surrounding Huntsville, Texas landscape.
The Texas prisoners that came down with Amyotrophic Lateral Sclerosis (ALS) later died. In the state of Texas, at the time, the state law dictated that all prisoners that died were later to be autopsied at University of Texas at Galveston. However, that was not what was happening to the prisoners who had died as a result of this horrific experimentation, according to Dr. Nicolson. Through one of his former students who at the time was responsible for the autopsy service at UT Galveston, Dr. Nicolson learned that none of the bodies had been sent there. Dr. Nicolson had discovered that at least six private autopsies a week were being performed on deceased prisoners at a US Army base. The bodies were then sent to a private crematory at a secret location in central Texas. Additionally, prisoner records were destroyed. All of this, according to Dr. Nicolson, violated state law.
Though much of the evidence of this experimentation had been destroyed, a document was found in the basement of an Austin building that was viewed as the "smoking gun". The document indicated that the Texas Prison Board, Baylor College of Medicine, and the Department of Defense were all a part of the experiments involving the Texas prisoners - experiments that later resulted in the death of many of the inmates. According to Dr. Nicolson, some of the experiments used Mycoplasma while others utilized various "cocktails of microbial agents" such asMycoplasma, Brucella, and DNA viruses such as Parvovirus B19. This project later became the topic of a book by Dr. Nicolson entitled Project Day Lily.
Dr. Nicolson believes that Mycoplasma fermentans is a naturally occurring microbe. However, some of the strains that exist today have been weaponized. Dr. Nicolson's research found unusual genes in M. fermentans incognitus that were consistent with a weaponized form of the organism. Weaponzing of an organism is done in an attempt to make a germ more pathogenic, immunosuppressive, resistant to heat and dryness, and to increase its survival rate such that the germ could be used in various types of weapons. Genes which were part of the HIV-1 envelope gene were found in these Mycoplasma. This means that the infection may not give someone HIV, but that it may result in some of the debilitating symptoms of the HIV disease. Indicators of a weaponized organism were evident in the prison guards in Huntsville as well as in military personnel that were likely exposed to the infections both through military vaccinations as well as through weapons used in the Gulf War.
The unfortunate reality according to Dr. Nicolson is that "once these things get out, you can't put the genie back in the bottle". Once these germs have been released, they are airborne infections that slowly penetrate into the population. In the case of Mycoplasma fermentans, Dr. Nicolson believes that this is exactly what happened. It may be this weaponized form of Mycoplasma that has led to the significant increases in neurodegenerative and autoimmune diseases over the last several years. Those patients with weaponized strains of these organisms are generally very sick. They may experience 60-75 signs and symptoms and are even at risk of their diseases becoming fatal.
In looking at the source of infection in the Gulf War veterans who were contracting Mycoplasma, Dr. Nicolson suggests that vaccinations appear to be the most likely mechanism through which the veterans became infected. Many military personnel that later became ill were far from the battlefields or had received the vaccinations and were never deployed. However, biological weapons sprayers were known to have been deployed by the Iraqis in the Gulf War and were used to spray the sand in Iraq and Kuwait. Gerald Schumacher, a Special Forces colonel in charge of biological weapons detection, blew the whistle on this after he retired. During the Gulf War, his group was not allowed to deploy their biological weapons detectors which led to reports that no such weapons were detected or used.
The Iraqis received a great deal of assistance on biological warfare from the United States during the Iran-Iraq Conflict. Both chemical and biologic weapons were given to them from the United States. After the Gulf War, rather than taking inventory of these weapons, they were blown up. Dr. Nicolson indicates that some of his patients have taken videos standing next to crates with Hazardous Materials tags from the United States. In the same videos, the crates are opened and weapons are clearly striped as having originated from the United States and being both chemical and biological weapons.
There were clear indicators that Iraq had offensive weapons in their arsenal. In Kuwait, many people had become quite ill. It was estimated that 25% of the population after the Gulf War had signs and symptoms which matched the symptoms of those infected with weaponized Mycoplasma. There were also a number of other chemical exposures and thus, there was never a clear indicator as to whether or not the Iraqi illnesses were caused by biologic or chemical agents.
When asking Dr. Nicolson how much he personally has been harassed for bringing much of this information to light, he shared that it has been "a horrific time". After Dr. Nicolson exposed the Huntsville prison experiments, the University of Texas educational system attempted to fire him from his tenured and highly respected position. Dr. Nicolson shared that a tremendous amount of pressure was put on the University of Texas system to "shut him up and close his laboratory". He was threatened on an almost daily basis with closing his lab as he continued to do his research on Mycoplasma. This became a major subject in the book Project Day Lily. Fortunately, for many of us struggling with chronic illnesses, Dr. Nicolson's experience and knowledge continue to be a benefit in that we understand so much more than we otherwise would about this formidable foe called Mycoplasma.
Symptoms
The signs and symptoms of Mycoplasma infection are highly variable and thus it is not uncommon for a diagnosis to be entirely missed. A partial list of symptoms includes chronic fatigue, joint pain, intermittent fevers, headaches, coughing, nausea, gastrointestinal problems, diarrhea, visual disturbances, memory loss, sleep disturbances, skin rashes, joint stiffness, depression, irritability, congestion, night sweats, loss of concentration, muscle spasms, nervousness, anxiety, chest pain, breathing irregularities, balance problems, light sensitivity, hair loss, problems with urination, congestive heart failure, blood pressure abnormalities, lymph node pain, chemical sensitivities, persistent coughing, eye pain, floaters in the eyes, and many others. On Dr. Nicolson's web site at http://www.immed.org, a full list of signs and symptoms and an illness survey form can be found.
It doesn't take long to see that the symptoms of Mycoplasma infections are very similar to the symptoms of Borrelia infections in chronic Lyme disease. Dr. Nicolson has looked at some of the more common neurodegenerative diseases and the infections that are associated with each. Mycoplasma is commonly found in patients with ALS, Multiple Sclerosis, Autism, Chronic Fatigue Syndrome, Rheumatoid Arthritis, Chronic Asthma, Lyme disease, and many other chronic disease conditions.
Characteristics
Mycoplasma are pleomorphic bacteria which lack a cell wall and, as a result, many antibiotics are not effective against this type of bacteria. There are over 100 known species of Mycoplasma, but only a half dozen or so are known to be pathogenic in humans. The pathogenic species are intracellular and must enter cells to survive. Once they are inside the cells, they are not recognized by the immune system and it is difficult to mount an effective response.
They stimulate reactive-oxygen species (ROS) which damage cell membranes. They release toxins into the body. Infected cells can be stimulated to undergo programmed cell death which may result in ALS or other severe neurological presentations. 90% of ALS patients evaluated were found to have Mycoplasma infections, whereasMycoplasma was found in 100% of ALS patients with Gulf War Syndrome, almost all of which were weaponizedM. fermentans incognitus.
They are thought of as "borderline anaerobes", meaning that they generally prefer low oxygen environments. Dr. Nicolson has found that airline employees are much more susceptible to these types of infections and that symptoms worsen with frequent long flights at low oxygen tension. Mycoplasma also have some characteristics of viruses.
Mycoplasma tend to be slow growing infections and they are usually transmitted slowly. Dr. Nicolson states that "Mycoplasma can be sexually transmitted, but the infection is usually passed through far less intimate contact.Mycoplasma can be obtained through fluid exchange, and it is easily transmitted through the air." In Gulf War veterans, the first person besides the veteran to become ill was the spouse and, later, other members of the household also became ill. Not everyone is equally susceptible to Mycoplasma infections, especially those with strong immune systems who can resist infection.
As already discussed, Mycoplasma fermentans produces numerous symptoms. Those infected are rarely found to be asymptomatic. In North America, M. pneumoniae is the most common Mycoplasma seen in various diseases. In Europe, M. hominis is far more prevalent and the incidence of M. fermentans is much lower than in North America.
The potential genetic factors involved in Mycoplasma illnesses are not known. Those with immune deficiencies and other illnesses, such as cancers and degenerative diseases, are at far greater risk of infection.
Prevalence
In one study looking at Mycoplasma in patients with Chronic Fatigue Syndrome, Dr. Nicolson has observed some interesting patterns in his research. Generally, the majority of CFS patients have Mycoplasma infections. However, CFS patients infected with Borrelia burgdorferi, the punitive agent in Lyme disease, had an even higher overallMycoplasma infection rate. As many as 75% of Lyme disease patients appear to have Mycoplasma infections, and yet Mycoplasma is often overlooked in the diagnosis and treatment of chronic Lyme disease, neurodegenerative diseases, and many other chronic illnesses lacking clear origins.
Even more startling was the finding that of the patients infected with Borrelia, over 50% of the patients had the M. fermentans infection. Approximately 23% carried M. pneumoniae. Chronic Fatigue patients that did not test positive for Borrelia had much more of a mixture of various species ofMycoplasma. Only 28% of the group not co-infected with Lyme disease had the M. fermentans infection. In normal, healthy controls, only 1.7% were found to have M. fermentans and at a total Mycoplasma infection rate of 5% compared to the 75% group mentioned earlier.
Dr. Nicolson notes that these findings are consistent with the fact that it is the Mycoplasma fermentans species that is more often isolated in ticks collected from the environment. The same tick that serves as the vector for Borrelia burgdorferi often also transmits M. fermentans simultaneously. Once a patient is multiply co-infected, the duration and severity of their illness both increase.
In his experience, Dr. Nicolson has found that Mycoplasma is the number one Lyme coinfection. The rate of infection with Mycoplasma in patients with Lyme disease surpasses that of Bartonella (25-40%) slightly and that ofBabesia (8-20%) significantly.
According to Dr. Nicolson, a healthy immune system can generally clear M. pneumoniae infections though will have a harder time eradicating M. fermentans on its own. Healthy people can often hold these infections in check - essentially having the infection but not expressing symptoms.
Testing
Dr. Nicolson noted that Mycoplasma infections in chronic Lyme disease are often overlooked by most doctors because they simply don't test for it. He states that those that do test for it find a much higher number of infected patients. Dr. Richard Horowitz, MD in New York finds a high incidence of M. fermentans, according to Dr. Nicolson.
Sadly, however, even if patients are tested for Mycoplasma, a similar problem exists here as the one that almost all Lyme doctors and patients are aware of - namely that reliable tests do not exist. Dr. Nicolson notes that once a laboratory gets a reliable test in place, the laboratory is often shutdown. There are only a few labs left that test forMycoplasma as a result.
In testing ticks for various microbial species, Dr. Nicolson has found a very high incidence of Mycoplasma fermentans. However, other Mycoplasma species have also been found such as M. pneumoniae and M. hominis. The incidence of these other species is far lower. "Far and away", it is the M. fermentans species that is seen in ticks, and this probably reflects the high incidence of M. fermentans coinfections in Lyme disease.
In terms of laboratory testing, Dr. Nicolson generally recommends Viral Immune Pathology, formerly known as RedLabs. He has found that the usefulness of any given lab in testing for Mycoplasma changes regularly. In the past, Dr. Nicolson used Medical Diagnostic Laboratories (MDL) for testing, but later he and other physicians found that the testing was no longer reliable. As a result, he no longer recommends MDL.
Dr. Nicolson finds that laboratories testing for Mycoplasma are highly scrutinized by federal agencies and that may affect the way the labs test and report this type of infection.
Autoimmunity
Thomas McPherson Brown, MD studied Mycoplasma at the Rockefeller Institute just before World War II. He was able to isolate bacteria from the joint fluid of a person with autoimmune arthritis and believed that the infection could have been the trigger for her disease. At the time, the organisms were too small to identify precisely, but it was later determined to be Mycoplasma.
Even then, Dr. Brown believed that Mycoplasma was very common and not easy to eradicate. He suggested using tetracycline drugs as an effective treatment for the disease. He later found that Doxycycline and Minocycline were effective at dealing with Mycoplasma. Though he garnered praise from his patients, he was generally regarded by the medical community as misguided and a trouble-maker. He died in 1989 prior to being fully vindicated. Fortunately, his work was validated through an NIH-sponsored study called MIRA or "Minocycline in Rheumatoid Arthritis".
Due to many of the characteristics of Mycoplasma, they may be responsible for the triggering of numerous autoimmune responses. As Mycoplasma replicate within cells and are eventually released, they capture antigens from the surface of the host cell and incorporate these antigens into their own membranes. This makes it almost impossible for the body to tell the difference between good and bad, between human and microbe, or between us and them. As a result, the immune system may begin to respond to these antigens now incorporated into the cell walls of the bacteria and create a condition of self-attack, or autoimmunity.
The microorganisms can produce mimicry antigens that mimic the natural host surface antigens and trigger an immune response to these antigens which may also result in autoimmune conditions through cross-reactivity. Additionally, Mycoplasma may cause cell death of host cells through a process known as apoptosis or programmed cell death.
Treatment
Though various strains of Mycoplasma have their own unique characteristics and drug responses, treatment tends to be quite similar. The variations in the strains do not appear to be a factor in a successful treatment response.
Dr. Nicolson suggests that in-vitro differences have been found but that it is not possible to easily extrapolate these findings to an in-vivo environment. Various factors including drug targeting, drug clearance, and the ability for the drug to cross into various body compartments are important considerations in treatment that cannot be examined in-vitro. Dr. Nicolson believes that, like many other coinfections of Lyme disease, Mycoplasma cannot be fully eradicated, but that once infected, treatment becomes an ongoing "management approach". He notes that this is a commonly understood fact and that the same is true of other organisms such as Chlamydia and Borrelia.
Dr. Nicolson recommends that the physician adopt an initial 6-month course of treatment with no break followed by several 6-week on, 2-week off antibiotic cycles. Candidate antibiotics include: Doxycycline, Ciprofloxacin (Cipro), Azithromycin (Zithromax), Minocycline, or Clarithromycin (Biaxin). He notes that antibiotic combinations may be required if there is a limited response to single drug, and most patients require switching antibiotics at least once during their treatment. Some patients may find the addition of Flagyl to be a benefit to treatment.
In Gulf War patients, once effectively treated, the majority of patients recovered. For civilians, six months is the minimum recommended treatment length, and some patients require much longer treatment in order to recover.Given that Mycoplasma have some characteristics of viruses, some physicians have suggested that Famvir or Ganciclovir may be added to the antibiotic therapy.
Herxheimer reactions do occur when treating Mycoplasma
Dr. Nicolson has seen evidence that Mycoplasma-specific transfer factors such as those from Chisholm Labs and others can be beneficial in some patients. He says that many natural options help in some patients, but that his experience has been that the antibiotic treatment results in the best outcomes. In many, recovery requires a push and pull between conventional and alternative treatments.
One of the hallmark signs of Mycoplasma infection is fatigue. The infections lead to oxidation in the body that leads to damage of the cell membranes. Oxidation accelerates the damage to the lipids in cell membranes which impacts mitochondrial function. This leads to less energy in the cell and ultimately to a fatiguing of the larger organism due to the fact that there is less energy to support necessary cellular functions. In patients where fatigue is due to cell membrane damage, Dr. Nicolson has found NT Factor® to be highly beneficial. NT Factor® replaces the damaged lipids and helps to restore mitochondrial function. Often, fatigue then resolves or is reduced.
Dr. Nicolson has found that oxidative therapies such as ozone can be helpful in the fight against Mycoplasma. However, he notes that this is generally palliative and does not produce the same results as the antibiotic therapy in the long-term. He finds that the oxidative therapies "are generally more cytostatic than cytotoxic". Hyperbaric oxygen may be helpful but similarly does not appear to be a highly effective treatment in the longer-term.
In other countries, IV drips with H2O2 (hydrogen peroxide) have been used with some benefit, but Dr. Nicolson notes that these therapies, while potentially effective, are highly dangerous and not advised.
In the realm of frequency medicine and Rife therapy, Dr. Nicolson believes that the frequencies that could be used to address Mycoplasma are too similar to normal cellular frequencies. Thus, he is not certain that Rife therapy is an effective way to approach the problem.
In the nutritional realm, Dr. Nicolson finds that many patients with chronic infections are immunosuppressed and that proper nutrition is vital. He cautions against smoking and drinking. He suggests avoidance of sugars, trans-fats, and allergenic foods. He advises patients to increase their fruits, vegetables, and whole grains. Some dietary winners in supporting the immune system include cruciferous vegetables, soluble fiber-based foods such as prunes and bran, wheat germ, yogurt, fish, and whole grains.
Patients are often depleted in key vitamins and minerals. Supplementation with B-Complex, Vitamin C, Vitamin E, and CoQ-10 are often beneficial. Minerals are often necessary. Dr. Nicolson notes, however, that many people have poor absorption and may require sublingual or injectable forms of these nutrients. Amino acids, flax seed, and fish oils can provide additional support, but the best nutrition for cell membranes is NT Factor®.
Many patients with chronic illnesses have a toxic body burden of heavy metals such as mercury, lead, cadmium, and aluminum. Hair, stool, and urine testing is available through labs like Doctor's Data (http://www.doctorsdata.com) and Genova Diagnostics (http://www.gdx.net). Dr. Nicolson has seen reports of positive results with EDTA chelation suppositories from Detoxamin (http://www.detoxamin.com) and oral chelators from Longevity Plus (www.longevityplus.com).
For patients using antibiotics, beneficial gut flora is often depressed. Supplementation with a high quality probiotic is important, but probiotics have to be taken two hours or longer after taking antibiotics. Natural immune support can be helpful in the form of whey proteins, transfer factors, or immune-support products such as Beyond Immuni-T from Longevity Plus.
Biolfims
Dr. Nicolson believes that biofilms are a factor in successfully treating Mycoplasma
Summary
In chronic Lyme disease, it is often difficult to know which infections are actually responsible for the persistence of illness. However, in general terms, chronic intracellular infections that change the metabolism of cells and suppress mitochondrial and other functions will lead to patients remaining in a chronically ill state. Dr. Nicolson believes that these infections must be aggressively treated. "Similar to chronic Lyme disease, the current CDC or IDSA recommendations for short-term treatment of chronic infections are simply inadequate," he says.
Dr. Nicolson has found that there is a hierarchy of symptoms that resolve relatively quickly and those that resolve more slowly when treating Mycoplasma. Gut-associated phenomenon such as Irritable Bowel Syndrome (IBS) often resolve quickly. Other systemic signs and symptoms can resolve in an intermediate period of time from many weeks to many months. Symptoms associated with the central and peripheral nervous systems such as neuropathy and pain often resolve much more slowly. Skin sensitivity and burning sensations may take much longer to resolve. Mycoplasma infections do invade nerves, and nerve-related symptoms are among the more difficult to resolve.
Dr. Nicolson states "We keep seeing the suppression of information on Mycoplasma and similar intracellular bacterial infections. The world of Mycoplasma parallels the world of chronic Lyme disease in terms of the politics involved. Physicians are being persecuted by their medical boards as a result of bad information. It is important for us to do everything within our power to get rid of harmful, erroneous information about these diseases. Both Mycoplasma and Borrelia have been manipulated for biological weapons purposes and as a result, both are politically incorrect to discuss, work on, or do anything about. Until this changes, we won't see any real progress."
Additional information on NT Factor® can be found at
www.ntfactor.com or www.researchednutritionals.
In 1987, Dr. Garth Nicolson, PhD was a professor at the University of Texas at Houston when his wife, an instructor at Baylor College of Medicine, became seriously ill and nearly died. She was diagnosed with aMycoplasma infection, treated, and later recovered. A few years later, their daughter, who had served in the Gulf War, returned from active duty quite ill. Not only was she sick, but the symptoms that she exhibited were very similar to those that Dr. Nicolson's wife had expressed years earlier.
At that point, Dr. Nicolson had the idea that his daughter's illness could be the result of an infection and started to investigate his theory further. As his work progressed, he looked at Brucella, Borrelia, Ehrlichia, and other chronic intracellular infections that have the potential to cause illness and present with overlapping signs and symptoms. In Gulf War veterans that were being evaluated, approximately 45% of those that were ill had Mycoplasma infection. It was found that the infection was a particular type of Mycoplasma, namely a peculiar species called Mycoplasma fermentans.
Very little was known about this particular species of Mycoplasma at the time except that the Armed Forces Institute of Pathology and the Army had been doing research on the organism. Once this likely causative agent of Gulf War Illness (GWI) had been identified in about one-half of the GWI cases, Dr. Nicolson recommended that the Mycoplasma-infected Gulf War veterans be treated with Doxycycline. He then found himself the target of vicious attacks for making the connection between the illness and M. fermentans. Dr. Nicolson shared that "even talking about this organism was highly discouraged." In fact, until the Gulf War, the military's own medical school had been teaching about the dangers of M. fermentans for years.
Background
Just years earlier in Texas, prisons emerged in which many of the inmates and guards came down with neurodegenerative conditions at rates that were far from ordinary. In Huntsville, where three large State prisons are found, there were about 70 cases of ALS, numerous cases of Multiple Sclerosis, and highly unexpected numbers of Rheumatoid Arthritis cases. At that time, the term "Mystery Disease" was used to identify the unusual illnesses that so many seemed to have acquired.
Dr. Nicolson started testing prison guards and their family members and found that very high numbers of these people were testing positive for Mycoplasma fermentans. Furthermore, this appeared to be a weaponized version of the organism called M. fermentans incognitus, a specific strain of Mycoplasma that had been altered to cause more severe symptoms, to be more virulent, and to be more survivable than the naturally occurring M. fermentans. Dr. Nicolson believed that biological weapons experiments had been carried out on inmates in the Texas prison system for years in which humans had been used as guinea pigs.
As time progressed, these illnesses did not remain confined to the prisoners. Soon after the prisoners unknowingly became a part in these experiments, the prison guards became ill. Their illnesses gradually became those of their families. It was not long before these Mycoplasma-based illnesses became a broader part of the surrounding Huntsville, Texas landscape.
The Texas prisoners that came down with Amyotrophic Lateral Sclerosis (ALS) later died. In the state of Texas, at the time, the state law dictated that all prisoners that died were later to be autopsied at University of Texas at Galveston. However, that was not what was happening to the prisoners who had died as a result of this horrific experimentation, according to Dr. Nicolson. Through one of his former students who at the time was responsible for the autopsy service at UT Galveston, Dr. Nicolson learned that none of the bodies had been sent there. Dr. Nicolson had discovered that at least six private autopsies a week were being performed on deceased prisoners at a US Army base. The bodies were then sent to a private crematory at a secret location in central Texas. Additionally, prisoner records were destroyed. All of this, according to Dr. Nicolson, violated state law.
Though much of the evidence of this experimentation had been destroyed, a document was found in the basement of an Austin building that was viewed as the "smoking gun". The document indicated that the Texas Prison Board, Baylor College of Medicine, and the Department of Defense were all a part of the experiments involving the Texas prisoners - experiments that later resulted in the death of many of the inmates. According to Dr. Nicolson, some of the experiments used Mycoplasma while others utilized various "cocktails of microbial agents" such asMycoplasma, Brucella, and DNA viruses such as Parvovirus B19. This project later became the topic of a book by Dr. Nicolson entitled Project Day Lily.
Dr. Nicolson believes that Mycoplasma fermentans is a naturally occurring microbe. However, some of the strains that exist today have been weaponized. Dr. Nicolson's research found unusual genes in M. fermentans incognitus that were consistent with a weaponized form of the organism. Weaponzing of an organism is done in an attempt to make a germ more pathogenic, immunosuppressive, resistant to heat and dryness, and to increase its survival rate such that the germ could be used in various types of weapons. Genes which were part of the HIV-1 envelope gene were found in these Mycoplasma. This means that the infection may not give someone HIV, but that it may result in some of the debilitating symptoms of the HIV disease. Indicators of a weaponized organism were evident in the prison guards in Huntsville as well as in military personnel that were likely exposed to the infections both through military vaccinations as well as through weapons used in the Gulf War.
The unfortunate reality according to Dr. Nicolson is that "once these things get out, you can't put the genie back in the bottle". Once these germs have been released, they are airborne infections that slowly penetrate into the population. In the case of Mycoplasma fermentans, Dr. Nicolson believes that this is exactly what happened. It may be this weaponized form of Mycoplasma that has led to the significant increases in neurodegenerative and autoimmune diseases over the last several years. Those patients with weaponized strains of these organisms are generally very sick. They may experience 60-75 signs and symptoms and are even at risk of their diseases becoming fatal.
In looking at the source of infection in the Gulf War veterans who were contracting Mycoplasma, Dr. Nicolson suggests that vaccinations appear to be the most likely mechanism through which the veterans became infected. Many military personnel that later became ill were far from the battlefields or had received the vaccinations and were never deployed. However, biological weapons sprayers were known to have been deployed by the Iraqis in the Gulf War and were used to spray the sand in Iraq and Kuwait. Gerald Schumacher, a Special Forces colonel in charge of biological weapons detection, blew the whistle on this after he retired. During the Gulf War, his group was not allowed to deploy their biological weapons detectors which led to reports that no such weapons were detected or used.
The Iraqis received a great deal of assistance on biological warfare from the United States during the Iran-Iraq Conflict. Both chemical and biologic weapons were given to them from the United States. After the Gulf War, rather than taking inventory of these weapons, they were blown up. Dr. Nicolson indicates that some of his patients have taken videos standing next to crates with Hazardous Materials tags from the United States. In the same videos, the crates are opened and weapons are clearly striped as having originated from the United States and being both chemical and biological weapons.
There were clear indicators that Iraq had offensive weapons in their arsenal. In Kuwait, many people had become quite ill. It was estimated that 25% of the population after the Gulf War had signs and symptoms which matched the symptoms of those infected with weaponized Mycoplasma. There were also a number of other chemical exposures and thus, there was never a clear indicator as to whether or not the Iraqi illnesses were caused by biologic or chemical agents.
When asking Dr. Nicolson how much he personally has been harassed for bringing much of this information to light, he shared that it has been "a horrific time". After Dr. Nicolson exposed the Huntsville prison experiments, the University of Texas educational system attempted to fire him from his tenured and highly respected position. Dr. Nicolson shared that a tremendous amount of pressure was put on the University of Texas system to "shut him up and close his laboratory". He was threatened on an almost daily basis with closing his lab as he continued to do his research on Mycoplasma. This became a major subject in the book Project Day Lily. Fortunately, for many of us struggling with chronic illnesses, Dr. Nicolson's experience and knowledge continue to be a benefit in that we understand so much more than we otherwise would about this formidable foe called Mycoplasma.
Symptoms
The signs and symptoms of Mycoplasma infection are highly variable and thus it is not uncommon for a diagnosis to be entirely missed. A partial list of symptoms includes chronic fatigue, joint pain, intermittent fevers, headaches, coughing, nausea, gastrointestinal problems, diarrhea, visual disturbances, memory loss, sleep disturbances, skin rashes, joint stiffness, depression, irritability, congestion, night sweats, loss of concentration, muscle spasms, nervousness, anxiety, chest pain, breathing irregularities, balance problems, light sensitivity, hair loss, problems with urination, congestive heart failure, blood pressure abnormalities, lymph node pain, chemical sensitivities, persistent coughing, eye pain, floaters in the eyes, and many others. On Dr. Nicolson's web site at http://www.immed.org, a full list of signs and symptoms and an illness survey form can be found.
It doesn't take long to see that the symptoms of Mycoplasma infections are very similar to the symptoms of Borrelia infections in chronic Lyme disease. Dr. Nicolson has looked at some of the more common neurodegenerative diseases and the infections that are associated with each. Mycoplasma is commonly found in patients with ALS, Multiple Sclerosis, Autism, Chronic Fatigue Syndrome, Rheumatoid Arthritis, Chronic Asthma, Lyme disease, and many other chronic disease conditions.
Characteristics
Mycoplasma are pleomorphic bacteria which lack a cell wall and, as a result, many antibiotics are not effective against this type of bacteria. There are over 100 known species of Mycoplasma, but only a half dozen or so are known to be pathogenic in humans. The pathogenic species are intracellular and must enter cells to survive. Once they are inside the cells, they are not recognized by the immune system and it is difficult to mount an effective response.
They stimulate reactive-oxygen species (ROS) which damage cell membranes. They release toxins into the body. Infected cells can be stimulated to undergo programmed cell death which may result in ALS or other severe neurological presentations. 90% of ALS patients evaluated were found to have Mycoplasma infections, whereasMycoplasma was found in 100% of ALS patients with Gulf War Syndrome, almost all of which were weaponizedM. fermentans incognitus.
They are thought of as "borderline anaerobes", meaning that they generally prefer low oxygen environments. Dr. Nicolson has found that airline employees are much more susceptible to these types of infections and that symptoms worsen with frequent long flights at low oxygen tension. Mycoplasma also have some characteristics of viruses.
Mycoplasma tend to be slow growing infections and they are usually transmitted slowly. Dr. Nicolson states that "Mycoplasma can be sexually transmitted, but the infection is usually passed through far less intimate contact.Mycoplasma can be obtained through fluid exchange, and it is easily transmitted through the air." In Gulf War veterans, the first person besides the veteran to become ill was the spouse and, later, other members of the household also became ill. Not everyone is equally susceptible to Mycoplasma infections, especially those with strong immune systems who can resist infection.
As already discussed, Mycoplasma fermentans produces numerous symptoms. Those infected are rarely found to be asymptomatic. In North America, M. pneumoniae is the most common Mycoplasma seen in various diseases. In Europe, M. hominis is far more prevalent and the incidence of M. fermentans is much lower than in North America.
The potential genetic factors involved in Mycoplasma illnesses are not known. Those with immune deficiencies and other illnesses, such as cancers and degenerative diseases, are at far greater risk of infection.
Prevalence
In one study looking at Mycoplasma in patients with Chronic Fatigue Syndrome, Dr. Nicolson has observed some interesting patterns in his research. Generally, the majority of CFS patients have Mycoplasma infections. However, CFS patients infected with Borrelia burgdorferi, the punitive agent in Lyme disease, had an even higher overallMycoplasma infection rate. As many as 75% of Lyme disease patients appear to have Mycoplasma infections, and yet Mycoplasma is often overlooked in the diagnosis and treatment of chronic Lyme disease, neurodegenerative diseases, and many other chronic illnesses lacking clear origins.
Even more startling was the finding that of the patients infected with Borrelia, over 50% of the patients had the M. fermentans infection. Approximately 23% carried M. pneumoniae. Chronic Fatigue patients that did not test positive for Borrelia had much more of a mixture of various species ofMycoplasma. Only 28% of the group not co-infected with Lyme disease had the M. fermentans infection. In normal, healthy controls, only 1.7% were found to have M. fermentans and at a total Mycoplasma infection rate of 5% compared to the 75% group mentioned earlier.
Dr. Nicolson notes that these findings are consistent with the fact that it is the Mycoplasma fermentans species that is more often isolated in ticks collected from the environment. The same tick that serves as the vector for Borrelia burgdorferi often also transmits M. fermentans simultaneously. Once a patient is multiply co-infected, the duration and severity of their illness both increase.
In his experience, Dr. Nicolson has found that Mycoplasma is the number one Lyme coinfection. The rate of infection with Mycoplasma in patients with Lyme disease surpasses that of Bartonella (25-40%) slightly and that ofBabesia (8-20%) significantly.
According to Dr. Nicolson, a healthy immune system can generally clear M. pneumoniae infections though will have a harder time eradicating M. fermentans on its own. Healthy people can often hold these infections in check - essentially having the infection but not expressing symptoms.
Testing
Dr. Nicolson noted that Mycoplasma infections in chronic Lyme disease are often overlooked by most doctors because they simply don't test for it. He states that those that do test for it find a much higher number of infected patients. Dr. Richard Horowitz, MD in New York finds a high incidence of M. fermentans, according to Dr. Nicolson.
Sadly, however, even if patients are tested for Mycoplasma, a similar problem exists here as the one that almost all Lyme doctors and patients are aware of - namely that reliable tests do not exist. Dr. Nicolson notes that once a laboratory gets a reliable test in place, the laboratory is often shutdown. There are only a few labs left that test forMycoplasma as a result.
In testing ticks for various microbial species, Dr. Nicolson has found a very high incidence of Mycoplasma fermentans. However, other Mycoplasma species have also been found such as M. pneumoniae and M. hominis. The incidence of these other species is far lower. "Far and away", it is the M. fermentans species that is seen in ticks, and this probably reflects the high incidence of M. fermentans coinfections in Lyme disease.
In terms of laboratory testing, Dr. Nicolson generally recommends Viral Immune Pathology, formerly known as RedLabs. He has found that the usefulness of any given lab in testing for Mycoplasma changes regularly. In the past, Dr. Nicolson used Medical Diagnostic Laboratories (MDL) for testing, but later he and other physicians found that the testing was no longer reliable. As a result, he no longer recommends MDL.
Dr. Nicolson finds that laboratories testing for Mycoplasma are highly scrutinized by federal agencies and that may affect the way the labs test and report this type of infection.
Autoimmunity
Thomas McPherson Brown, MD studied Mycoplasma at the Rockefeller Institute just before World War II. He was able to isolate bacteria from the joint fluid of a person with autoimmune arthritis and believed that the infection could have been the trigger for her disease. At the time, the organisms were too small to identify precisely, but it was later determined to be Mycoplasma.
Even then, Dr. Brown believed that Mycoplasma was very common and not easy to eradicate. He suggested using tetracycline drugs as an effective treatment for the disease. He later found that Doxycycline and Minocycline were effective at dealing with Mycoplasma. Though he garnered praise from his patients, he was generally regarded by the medical community as misguided and a trouble-maker. He died in 1989 prior to being fully vindicated. Fortunately, his work was validated through an NIH-sponsored study called MIRA or "Minocycline in Rheumatoid Arthritis".
Due to many of the characteristics of Mycoplasma, they may be responsible for the triggering of numerous autoimmune responses. As Mycoplasma replicate within cells and are eventually released, they capture antigens from the surface of the host cell and incorporate these antigens into their own membranes. This makes it almost impossible for the body to tell the difference between good and bad, between human and microbe, or between us and them. As a result, the immune system may begin to respond to these antigens now incorporated into the cell walls of the bacteria and create a condition of self-attack, or autoimmunity.
The microorganisms can produce mimicry antigens that mimic the natural host surface antigens and trigger an immune response to these antigens which may also result in autoimmune conditions through cross-reactivity. Additionally, Mycoplasma may cause cell death of host cells through a process known as apoptosis or programmed cell death.
Treatment
Though various strains of Mycoplasma have their own unique characteristics and drug responses, treatment tends to be quite similar. The variations in the strains do not appear to be a factor in a successful treatment response.
Dr. Nicolson suggests that in-vitro differences have been found but that it is not possible to easily extrapolate these findings to an in-vivo environment. Various factors including drug targeting, drug clearance, and the ability for the drug to cross into various body compartments are important considerations in treatment that cannot be examined in-vitro. Dr. Nicolson believes that, like many other coinfections of Lyme disease, Mycoplasma cannot be fully eradicated, but that once infected, treatment becomes an ongoing "management approach". He notes that this is a commonly understood fact and that the same is true of other organisms such as Chlamydia and Borrelia.
Dr. Nicolson recommends that the physician adopt an initial 6-month course of treatment with no break followed by several 6-week on, 2-week off antibiotic cycles. Candidate antibiotics include: Doxycycline, Ciprofloxacin (Cipro), Azithromycin (Zithromax), Minocycline, or Clarithromycin (Biaxin). He notes that antibiotic combinations may be required if there is a limited response to single drug, and most patients require switching antibiotics at least once during their treatment. Some patients may find the addition of Flagyl to be a benefit to treatment.
In Gulf War patients, once effectively treated, the majority of patients recovered. For civilians, six months is the minimum recommended treatment length, and some patients require much longer treatment in order to recover.Given that Mycoplasma have some characteristics of viruses, some physicians have suggested that Famvir or Ganciclovir may be added to the antibiotic therapy.
Herxheimer reactions do occur when treating Mycoplasma
Dr. Nicolson has seen evidence that Mycoplasma-specific transfer factors such as those from Chisholm Labs and others can be beneficial in some patients. He says that many natural options help in some patients, but that his experience has been that the antibiotic treatment results in the best outcomes. In many, recovery requires a push and pull between conventional and alternative treatments.
One of the hallmark signs of Mycoplasma infection is fatigue. The infections lead to oxidation in the body that leads to damage of the cell membranes. Oxidation accelerates the damage to the lipids in cell membranes which impacts mitochondrial function. This leads to less energy in the cell and ultimately to a fatiguing of the larger organism due to the fact that there is less energy to support necessary cellular functions. In patients where fatigue is due to cell membrane damage, Dr. Nicolson has found NT Factor® to be highly beneficial. NT Factor® replaces the damaged lipids and helps to restore mitochondrial function. Often, fatigue then resolves or is reduced.
Dr. Nicolson has found that oxidative therapies such as ozone can be helpful in the fight against Mycoplasma. However, he notes that this is generally palliative and does not produce the same results as the antibiotic therapy in the long-term. He finds that the oxidative therapies "are generally more cytostatic than cytotoxic". Hyperbaric oxygen may be helpful but similarly does not appear to be a highly effective treatment in the longer-term.
In other countries, IV drips with H2O2 (hydrogen peroxide) have been used with some benefit, but Dr. Nicolson notes that these therapies, while potentially effective, are highly dangerous and not advised.
In the realm of frequency medicine and Rife therapy, Dr. Nicolson believes that the frequencies that could be used to address Mycoplasma are too similar to normal cellular frequencies. Thus, he is not certain that Rife therapy is an effective way to approach the problem.
In the nutritional realm, Dr. Nicolson finds that many patients with chronic infections are immunosuppressed and that proper nutrition is vital. He cautions against smoking and drinking. He suggests avoidance of sugars, trans-fats, and allergenic foods. He advises patients to increase their fruits, vegetables, and whole grains. Some dietary winners in supporting the immune system include cruciferous vegetables, soluble fiber-based foods such as prunes and bran, wheat germ, yogurt, fish, and whole grains.
Patients are often depleted in key vitamins and minerals. Supplementation with B-Complex, Vitamin C, Vitamin E, and CoQ-10 are often beneficial. Minerals are often necessary. Dr. Nicolson notes, however, that many people have poor absorption and may require sublingual or injectable forms of these nutrients. Amino acids, flax seed, and fish oils can provide additional support, but the best nutrition for cell membranes is NT Factor®.
Many patients with chronic illnesses have a toxic body burden of heavy metals such as mercury, lead, cadmium, and aluminum. Hair, stool, and urine testing is available through labs like Doctor's Data (http://www.doctorsdata.com) and Genova Diagnostics (http://www.gdx.net). Dr. Nicolson has seen reports of positive results with EDTA chelation suppositories from Detoxamin (http://www.detoxamin.com) and oral chelators from Longevity Plus (www.longevityplus.com).
For patients using antibiotics, beneficial gut flora is often depressed. Supplementation with a high quality probiotic is important, but probiotics have to be taken two hours or longer after taking antibiotics. Natural immune support can be helpful in the form of whey proteins, transfer factors, or immune-support products such as Beyond Immuni-T from Longevity Plus.
Biolfims
Dr. Nicolson believes that biofilms are a factor in successfully treating Mycoplasma
Summary
In chronic Lyme disease, it is often difficult to know which infections are actually responsible for the persistence of illness. However, in general terms, chronic intracellular infections that change the metabolism of cells and suppress mitochondrial and other functions will lead to patients remaining in a chronically ill state. Dr. Nicolson believes that these infections must be aggressively treated. "Similar to chronic Lyme disease, the current CDC or IDSA recommendations for short-term treatment of chronic infections are simply inadequate," he says.
Dr. Nicolson has found that there is a hierarchy of symptoms that resolve relatively quickly and those that resolve more slowly when treating Mycoplasma. Gut-associated phenomenon such as Irritable Bowel Syndrome (IBS) often resolve quickly. Other systemic signs and symptoms can resolve in an intermediate period of time from many weeks to many months. Symptoms associated with the central and peripheral nervous systems such as neuropathy and pain often resolve much more slowly. Skin sensitivity and burning sensations may take much longer to resolve. Mycoplasma infections do invade nerves, and nerve-related symptoms are among the more difficult to resolve.
Dr. Nicolson states "We keep seeing the suppression of information on Mycoplasma and similar intracellular bacterial infections. The world of Mycoplasma parallels the world of chronic Lyme disease in terms of the politics involved. Physicians are being persecuted by their medical boards as a result of bad information. It is important for us to do everything within our power to get rid of harmful, erroneous information about these diseases. Both Mycoplasma and Borrelia have been manipulated for biological weapons purposes and as a result, both are politically incorrect to discuss, work on, or do anything about. Until this changes, we won't see any real progress."
Additional information on NT Factor® can be found at
www.ntfactor.com or www.researchednutritionals.
About the author
Scott Forsgren (Author) is a health writer, advocate, and coach. He is the editor and founder of BetterHealthGuy.com where he shares his now 17 year journey through the world of Lyme disease and the myriad of factors that it often entails. He has been fortunate to have written for publications such as the Public Health Alert, Explore!, Bolen Report, and Townsend Letter. Scott expresses gratitude for the information shared by Dr. Neil Nathan and Dr. Wayne Anderson in support of this article. More information on his work is available at http://www.BetterHealthGuy.com