FWD: USA Today-Injured Irac Veteran Battle a New Enemy

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From: byrd45 (Original Message) Sent: 5/27/2005 8:45 AM
Injured Iraq veterans battle a new enemy
By Anita Manning, USA TODAY
RICHMOND HILL, Ga. — Even though he's in pain every day, it doesn't seem to occur to U.S. Army Capt. Jonathan Pruden to feel sorry for himself.

Jonathan Pruden takes two doses of OxyContin and Percocet to control his pain, but mainly, he says, 'I just live with it.'
By Tim Dillon, USA TODAY

The bones in his right foot were shattered by a bomb in Iraq. He has no feeling in his left leg below the knee. He can get around on crutches, but that irritates his leg and shoulder injuries, so he spends 90% of his waking hours in a wheelchair. But if you ask him, he'll tell you how much better off he is than the other guys.

"A lot of guys in my unit and other units are more severely injured," he says. "They've lost limbs, their eyesight. Unfortunately, it seems like hundreds of guys are coming back now that are paralyzed. I'm fortunate."

Pruden, 27, was driving an unarmored Humvee that was caught in a roadside bomb attack in Baghdad on July 1, 2003. He took 173 pieces of shrapnel and one AK-47 round that passed through his left knee. A piece of shrapnel the size of a golf ball shattered his shoulder blade and lodged near his spinal cord. His arms and legs were shredded.

He doesn't remember feeling pain at the time, but as he tried to maneuver the vehicle, he realized his legs didn't work. He couldn't see, couldn't hear and couldn't feel his left arm.

"I saw a spray and thought it was the hydraulic line on the truck, but it was the artery on my leg," he says. "I started yelling to get a tourniquet. I was bleeding out."

Pruden is among more than 12,000 American military men and women injured in Iraq since combat operations began in March 2003, according to the Department of Defense. About half sustained injuries serious enough to prevent their return to duty. Many of them, such as Pruden, are treated initially in combat hospitals or by doctors on the field, then sent to the U.S. Army hospital in Landstuhl, Germany, where injuries are stabilized and assessed. From there, they may go to one of several specialized military hospitals in the USA for treatment that can take weeks to months before returning home to continue recovery.

'Improved survivability'

Soldiers in Iraq are surviving wounds that in earlier wars would have been fatal, thanks to a variety of factors, including body armor, more efficient evacuation of the wounded, on-field emergency medicine specialists and advances in medical technology and training, says pain management specialist Lt. Col. Paul Pasquina, chief of physical medicine and rehabilitation at Walter Reed Army Medical Center in Washington, D.C. This "improved survivability on the battlefield" poses challenges for the injured soldiers and for their doctors, he says.

The injuries coming out of Iraq are complex, says Larisa Kusar, a staff doctor at the VA Medical Center in Minneapolis, one of four "polytrauma centers" operated by the Department of Veterans Affairs. (The others are in Tampa, Richmond, Va., and Palo Alto, Calif.) The centers care for patients with two or more injuries, at least one of which is life-threatening.

Doctors still have a lot to learn about what causes and relieves pain, but medical knowledge of the subject has advanced significantly in the past decade, Pasquina says, and today there are medications designed to treat pain caused by a variety of sources.

"When you have a severe extremity wound, particularly from a blast injury, more often than not you have pain from soft-tissue injury, bone injury and nerve injury," he says. "So you have to approach it from different directions."

Doctors on the battlefield can use a narrow tube to deliver anesthesia to a wounded limb, deadening the nerves that cause pain but leaving untouched the ones that control muscles, Pasquina says. Other anti-pain weapons are epidural anesthesia, patient-controlled delivery of pain medicines such as morphine, and a variety of oral medications such as opioids, anti-convulsants, anti-depressants, muscle relaxants and anti-inflammatory agents.

"While there's no cure for pain," Pasquina says, "we're very optimistic with our patients to find a pain level that is tolerable, and that's what we shoot for: pain that does not interfere with their functional goals, their activities of daily living."

A fight to save his legs

Pruden first received care at a battalion aid station set up on a former soccer field in Baghdad, then was carried by helicopter to a field hospital in Kuwait, where doctors worked to save his legs. Next, he was sent to Landstuhl, where he had "three or four surgeries," he says, and then to Walter Reed, where he spent two months and had eight more operations.

He has had 18 operations in all and is on convalescent leave, awaiting discharge from the Army. He still has shrapnel in his body, including a piece that is visible under his left eye. He takes two doses of OxyContin and Percocet when needed every day, which controls most of the pain, and tries to divert his mind from the rest of it by reading, watching TV, traveling and taking part in disabled sports activities. Mainly, "I just live with it."

At Walter Reed, he was given a difficult choice: have his right leg amputated or try to rehabilitate it. "The doctor said, 'If it was me, I'd take it off,' " Pruden says. He decided to try to keep it.

"Now we're dealing with the consequences of that decision," says physical therapist Mike Parsons, looking on as Pruden does leg exercises during a therapy session, one of three each week. "Functionally, he might have been better off with a prosthetic."

Pruden says he can put weight on his left leg and can even drive with a specially outfitted left-side gas pedal, but any weight on the right leg is painful. Amputation remains an option. "Sometimes I debate the long-term usefulness" of the leg, he says. "I know a lot of guys with prosthetics who are doing pretty well. They're able to walk and even run on those, so it's something to consider."

The future looks bright

In the tidy, attractive home Pruden and his wife, Amy, 25, share, there is little visible accommodation to disability. The coffee table that used to be in front of the couch is gone, leaving room for the wheelchair, and Pruden's hand crutches stand nearby.

They are covered in camouflage tape, which Pruden applied before he went turkey hunting a couple of weeks ago at a military base near here. He went with a friend from Paralyzed Veterans of America, which sponsors sports programs, including hunting and fishing on military land. The camo tape worked: Pruden bagged a gobbler.

Taking part in activities that engage his mind and body is a form of therapy for him. "When I was out there turkey hunting, I didn't feel it," he says of the pain. "But I did later." The experience cost him days of recovery.

Amy has tried in vain to persuade him to take it easier. "He wants to be able to do a lot more than he's able to do," she says. "He's very active. It just stays at a painful level because of all the things he does."

The couple met as students at Appalachian State University in Boone, N.C. Pruden, who grew up near Asheville, attended college on a four-year ROTC scholarship and was commissioned as an officer in May 2001, the same month he and Amy were married.

A former emergency medical technician and volunteer with the local rescue squad, Pruden started his military career as a medical services officer, then a platoon leader and headquarters executive officer before switching to infantry. Stationed at Fort Stewart, Ga., he was "consumed by my job," going in before dawn and working until 9 or 10 p.m. The couple didn't see much of each other.

But when that bomb exploded, there was no question about what was most important in his life. "I wasn't concerned about my leg being gone. I wasn't concerned about dying. My big concern was I wanted to see my wife again; that was my overriding thought. I've got to see Amy again."

Now, they're together most of the time. The couple is planning a move to Florida this month. The new house, a few doors from Amy's parents' home in Gainesville, is being outfitted with wider doors and wheelchair ramps. Pruden plans to go to the University of Florida in the fall for a master's degree in political science.

Having negotiated the military medical bureaucracy, he says he'd like to work with other disabled veterans. "There's so much out there for people, especially vets with disabilities," he says. "There are a lot of good folks out there who want to help."Injured Iraq veteran