the examiner

THE EXAMINER

Volume 19, No. 5 May 2011C

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Did you know?...

Robert E. Bush Naval Hospital

“Serving with Pride and Professionalism”

You have the right toexpress your concerns

about patient safety and qual-ity of care.

There are several avenuesopen to you:

* Through the ICE web-site.

* Through the NavalHospital Customer CommentCards.

* The Hospital’s CustomerRelations Officer at 760-830-2475, or any of the CustomerRelations representatives inthe hospital’s clinics.

Or Directly to the JointCommission via:

E-mail [email protected]

Fax:Office of Quality Monitoring630-792-5636

Mail:Office of Quality MonitoringThe Joint CommissionOak Renaissance BoulevardOakbrook Terrace, IL 60181

http://www.med.navy.mil/sites/nhtp/pages/default.aspx

An Award Winning Publication

Patients seen in March -- 14,379Appointment No Shows in March -- 1,094

One in ten patients do not show up for their appointments atthis hospital. If an appointment is no longer needed, please callso another patient can be seen.

To make an appointment call -- 760-830-2752To cancel an appointment call -- 760-830-2369

Bringing the Best in Medical Care to Patients

During a recent visit to the Desert Regional Medical Center in PalmSprings is far left, Lt. Cmdr. Raul Carillo, Department Head ofEmergency Medicine; fourth from left, Capt. Ann Bobeck,Commanding Officer of the Naval Hospital; next is Cmdr. MariaYoung, Director of Nursing Services and Health Care Operations ofthe Naval Hospital and HMCS Rodney Ruth, the command’s SeniorEnlisted Advisor. In an ongoing endeavor, the executive staff of thevarious TriWest network medical centers and the Naval HospitalBoard of Directors meet to discuss opportunities to bring the bestpossible medical care to the Marines, Sailors, Retirees and familymembers eligible for care at the Robert E. Bush Naval Hospital.

Captain Ann Bobeck meets with G. Aubrey Serfling, center,President and Chief Executive Officer of Eisenhower MedicalCenter and Michael Landis, right, President of the EisenhowerFoundation. Eisenhower Medical Center is named for GeneralDwight D. Eisenhower who led the Allied Forces in World War II tovictory and then became the 34th President of the United States toserve from 1953 to 1961. With this heritage to live up to, the staff ofthe Eisenhower Medical Center is dedicated to being an importantpartner of this hospital in bringing health care to the eligible benefi-ciaries of the Robert E. Bush Naval Hospital, named for our ownWorld War II hero.

Desert Regional Medical Center Eisenhower Medical Center

Introducing the Hospital’s New Customer Relations Officer

The Naval Hospital ishappy to introduce you toone of its newest staff

members, Mr. Robert Greger.Robert has been hired on to

fill the full-time position as theCustomer Relations Officer,otherwise known as the CRO.

Robert’s office is located justinside the hospital’s frontentrance across from theQuarterdeck. He can be reachedat 760-830-2475 during normalworking hours.

As a Special Assistant to theCommanding Officer, Robert ishere to ensure your concerns orquestions are heard andanswered.

By Martha Hunt, MA, CAMFHealth Promotions CoordinatorRobert E. Bush Naval Hospital

Your skin is the largestorgan of your body andit is constantly renewing

itself throughout your life. Skin protects us from heat,

light, injury, and infection andstores water and fat. It keepsitself moist and intact to the bestof its ability but sun, heat, dry-ness and chemical exposureworks against your skin to dam-age it and dry it out.

We need some exposure tosunlight for Vitamin D produc-tion, however, over exposure tothe sun leads to skin cancer, pre-mature aging of the skin andwrinkling. Also, over age 50 ourskin doesn’t make as much vita-min D as it used to, putting us atrisk for vitamin D deficiency.

Skin cancer is the most com-mon form of cancer with overone million Americans everyyear being diagnosed with skincancer and almost 10,000 dyingfrom it. Half of all Americanswho live to age 65 will be diag-nosed with some form of skincancer. UV A and B radiationfrom the sun is the leadingcause of skin cancer, howeverUV C radiation from sun lampsand tanning booths also causeskin cancer.

Cases of skin cancers are morelikely to occur where there isbrighter and stronger sunlightsuch as nearer the equator or athigh altitude. In other words,here in the high desert.

Ninety percent of all skin can-cers develop on the face, neckand arms where sun exposure isthe greatest. Those individualsat highest risk for skin cancerare those who have light skin,hair and eyes, a family historyof skin cancer, chronic exposure

to the sun, a history of bad sun-burns early in life, or have lotsof moles or freckles. However,everyone is at risk of skin can-cer, no matter how dark ones’skin or hair.

Skin cancer growths occurwhen normally dividing skincells begin to grow abnormally.UV rays damage the DNA ofskin cells and causes them toreproduce abnormally. Once acells’ DNA is damaged, thedamage is permanent and isreplicated over and over until anabnormal patch of cells is seenon the surface of the skin. Thereare over 100 different types ofskin cancer, depending on whatlayer of the skin they are foundand what types of skin cells areaffected.

In fact, the damage to yourskin only needs to be 1 mmdeep or the size of this ‘-’ tocause damaged cells which thenfind their way into your bloodstream. Once these skin cancercells find their way to yourblood stream you can developskin cancers in any organ ofyour body.

What to look for - * Patches of skin that tend to

bleed or ooze, * open sores that don’t heal, * patches that have an irregu-

lar shape or edges to them, * patches that have varied col-

ors in their pigmentation, * growths larger than the width

of a pencil eraser,* patches that have a scaly,

crusty or bumpy appearance tothe surface of them, or

* growths that itch or are ten-der and painful.

Sun screen works by blockingout some, but not all, of the UVA and B rays. Sun screen doesnot protect against UV C radia-tion. The higher the SPF value,the greater the protection fromburning. Use a sun screen that

blocks both UV A and UV Bradiation as they both cause skincancer and burning. UV A rayscause damage deep into the skinwhile UV B rays damage thesurface layers. Exposure to UVA and UV B radiation has alsobeen associated with non-Hodgkin’s Lymphoma and witheye cancers, specifically on thecornea and the conjunctiva (thewhite part).

If you will be in the sun morethan 15 minutes, wear sunscreen with an SPF value of 20or greater. Older adults shouldalways use a sun screen with anSPF of 30 or higher. Apply sunscreen at least 30 minutes beforegoing out into the sun and re-apply every 2 to 3 hours.

Since sun screen alone is not100 percent effective against thedamage produced by UV rays,take other protective measuresas well. When outdoors in thesun, wear hats, sunglasses, light

colored, loose fitting clothing,full length pants and socks toreflect the heat and allow yourskin to breathe. Check all areasof your skin surfaces regularlyfor any changes. If you can’t seea certain area of your skin, usemirrors or get a friend to checkfor you. Call your doctor if youhave patches of skin or growthson your skin that bleed orchange shape or color. If youhave a family history of skincancer, alert your doctor andwatch your skin carefully forchanges.

Drink plenty of water andother replenishing liquids (notalcohol or caffeine) to help yourskin sweat and cool itself. Avoidthe sun between 10 a.m. and 3p.m. whenever possible as thesuns rays are the most damag-ing. You can burn even on acloudy day as 80 percent of thesun’s rays still penetrate throughclouds.

Teach your kids early aboutthe dangers of the sun as mostskin damage occurs before theage of 20. Never use sun screenon infants less than 6 months ofage as the chemicals in sunblock are absorbed directly intotheir body and may irritate theirskin. Rather keep them out ofdirect sun and always make surethey are covered with hats andbaby sunglasses.

Damage from the sun is cumu-lative over your life span andbuilds up over time. The DNAdamage you received from thatsun burn when you were a teenis still with you and will nevergo away. The best protectionfrom skin cancer is to avoiddirect exposure of your skin tothe sun. When that is not possi-ble, use sun screen to helpreduce the absorption of UVrays and the DNA damage thatresults. You only have one skin,wear it well.

2 -- The Examiner -- May 2011

Published by Hi-Desert Publishing, a private firm in no way connected with the Department of Defense, the UnitedStates Marine Corps, United States Navy or Naval Hospital, Twentynine Palms under exclusive written contract withthe Marine Air Ground Task Force Training Command. The appearance of advertising in this publication, includinginserts or supplements, does not constitute endorsement by the Department of Defense, the United States MarineCorps, the United States Navy or Hi-Desert Publishing of the products or services advertised. Everything advertisedin this publication shall be made available for purchase, use, or patronage without regard to race, color, religion, sex,national origin, age, marital status, physical handicap, political affiliation, or any other non-merit factor of the pur-chaser, user or patron. If a violation or rejection of this equal opportunity policy by an advertiser is confirmed, thepublisher shall refuse to print advertising from that source until the violation is corrected. Editorial content is preparedby the Public Affairs Office, Naval Hospital, Twentynine Palms, Calif.

Commanding OfficerCaptain Ann Bobeck, MSC, USN

Executive OfficerCaptain Michael Moeller, MC, USN

Command Senior Enlisted AdvisorHMCS (FMF) Rodney Ruth, USN

Public Affairs Officer/EditorDan Barber

Command OmbudsmanValatina Ruth

Care Line 830-2716Cell Phone (760) 910-2050

The Examiner welcomes your comments and suggestions concerning the publication. Deadline for submission ofarticles is the 15th of each month for the following month’s edition. Any format is welcome, however, the preferredmethod of submission is by e-mail or by computer disk.

How to reach us...Commanding Officer Naval HospitalPublic Affairs OfficeBox 788250 MAGTFTCTwentynine Palms, CA 92278-8250Com: (760) 830-2362DSN: 230-2362FAX: (760) 830-2385E-mail: [email protected] Publishing Company56445 Twentynine Palms HighwayYucca Valley, CA 92284Com: (760) 365-3315FAX: (760) 365-8686

The Sun is now Drenching us with its Rays so it’s time to be Aware of Skin Care

May is National Women’s Health Month

Naval Hospital Twentynine Palms is proud to support Women’sHealth by having two Women’s Health Fairs for the month ofMay.

They include walk- in well women’s exams and health care profes-sionals who are available to answer your questions.

There will be a booth for nutrition, breast care, mental health andmuch more.

We will have a raffle for those women who come to the fair withprizes and a free snack table.

If you are due for your exam and would like to guarantee a spotplease call (760)830-2501, Jessica McLaren RN Breast CareCoordinator.

By Peter HolsteinTRICARE Management Activity

Every year millions ofAmericans suffer fromallergies, with symptoms

ranging from irritating to life-threatening.

TRICARE beneficiaries areeligible to receive care for thetesting and treatment of condi-tions relating to allergies.

According to the NationalInstitute of Allergy andInfectious Diseases (NIAID),

allergy symptoms are the resultof inappropriate responses bythe body’s immune system tonormally harmless substances.Allergic reactions can be causedby airborne particles like dust orpollen, foods such as peanuts oran insect sting or bite.

Knowing what substance caus-es a reaction can improve quali-ty of life for allergy sufferersand avoid unpleasant surprisesdown the road. An allergy to acommon food ingredient likewheat can cause a variety ofseemingly unrelated symptoms

such as itchy rashes, nasal con-gestion or nausea. A parentdoesn’t want to discover theirchild is allergic to bees onlyafter they are stung.

Tests administered by allergistscan identify most allergies. Themost common allergy tests areeither skin or blood tests. Forsome food allergies, an allergistwill recommend an eliminationdiet to link certain foods to spe-cific symptoms.

Once an allergy is diagnosed,beneficiaries can treat it withover-the-counter or prescription

medications. Allergists some-times recommend allergy suffer-ers change their behavior or dietto avoid an allergy causing sub-stance. An allergist can also pre-scribe a series of shots calledimmunotherapy, designed togradually desensitize theimmune system to a specificallergic trigger.

TRICARE covers prescriptionmedication approved by theFDA and allergy treatmentsadministered by allergists.However, beneficiaries areresponsible for the cost of mostover-the-counter medications.To see if a medication is cov-ered by TRICARE, use theonline formulary search tool,www.pec.ha.osd.mil.

TRICARE Prime beneficiariesmust get a referral from theirprimary care manager to see an

allergy specialist. There is noout-of-pocket cost for Primebeneficiaries to get testing at aTRICARE network provider.TRICARE Standard and otherbeneficiaries may get testing atany TRICARE authorizedprovider, but annual deductiblesand cost shares apply. Out-of-pocket costs are lower at TRI-CARE network providers. At-home allergy testing productspurchased over-the-counter arenot covered by TRICARE.

For more information aboutallergies, visit the NIAID onlineat www.niaid.nih.gov.Beneficiaries can get moreinformation on the allergy serv-ices TRICARE offers and howto arrange care by visitingTRICARE’s website at www.tri-care.mil/mybenefit/allergy.

By Martha Hunt, MA, CAMFHealth Promotion and WellnessRobert E. Bush Naval Hospital

Metabolic syndrome is defined as: a group of riskfactors linked to being overweight or obese thatincrease your chance for heart disease and other

health problems such as diabetes and stroke. The five conditions listed below are metabolic risk fac-

tors for heart disease. A person can develop any one of these risk factors by

itself, but they tend to occur together. Metabolic syn-drome is diagnosed when a person has at least three ofthese heart disease risk factors:

* A large waistline. This is also called abdominal obe-sity or ‘having an apple shape.’

* A higher than normal triglyceride level in the blood(or you’re on medicine to treat high triglycerides -- orbad cholesterol). Triglycerides are a type of fat found in

the blood. * A lower than normal level of HDL cholesterol (high-

density lipoprotein cholesterol or good cholesterol) in theblood (or you’re on medicine to treat low HDL).

* Higher than normal blood pressure (or you’re onmedicine to treat high blood pressure).

* Higher than normal fasting blood sugar (glucose) (oryou’re on medicine to treat high blood sugar). Mildlyhigh blood sugar can be an early warning sign of dia-betes.

Other factors that can contribute to metabolic syn-drome are tobacco use, diets high in meat, fried food anddiet sodas (or any artificial sweeteners). Diet sodas makeyou crave calories from other sources and can cause overeating rather than help you cut calories. Also, people whosuffer from high levels of stress are twice as likely todevelop metabolic syndrome for many reasons includingthe fact that stress causes changes to your blood sugarlevels.

Tobacco use also increases your risk of metabolic syn-

drome. Tobacco use...* Makes you crave starch and fat - a large waistline.* Raises your triglyceride levels - a higher than normal

triglyceride level in the blood.* Lowers your HDL level - a lower than normal level

of HDL cholesterol.* Gives you high blood pressure - higher than normal

blood pressure (or you’re on medicine to treat high bloodpressure).

* Doubles your risk of diabetes and blocks the releaseof insulin - higher than normal fasting blood sugar (glu-cose) (or you’re on medicine to treat high blood sugar).Also, if you have a family member that has diabetes,your risk for diabetes is even higher.

For nutrition information, contact your primary careprovider for a referral to the registered dietitian. CallHealth Promotion and Wellness at (760) 830-2814 or talkto your health care provider for more information ontobacco cessation.

The Examiner -- May 2011-- 3

Atlas2X3

What is Metabolic Syndrome? - Knowing the Answer May Help you Stay Healthy

Allergy Tests Covered for TRICARE Beneficiaries

Brian P. SmithTriWest Healthcare Alliance

Moving to a new region or overseas? Don’t for-get to make a call before you leave.

Active duty Service members (ADSM) and activeduty family members (ADFM) who are moving to

a new stateside or overseas TRICARE region cannow easily transfer their TRICARE Prime enroll-ment by phone.

Start the processEligible TRICARE Prime beneficiaries can either

call their current TRICARE contractor or go to theTRICARE Service Center at their installation med-ical treatment facility to start the transfer process.The contractor will ask for:

* the sponsor and family members who are trans-ferring

* the sponsor or spouse’s mobile phone and emailaddress

* the new location* the expected date of arrival at the new location.Complete the transfer The TRICARE contractor at the new location will

contact the sponsor or family members to completethe enrollment transfer around the planned date ofarrival.

ADSMs and ADFMs moving within the WestRegion can also transfer their enrollment by phone.All they need to do is call TriWest at 1-888-TRI-

Phone Home: Transfer TRICARE Prime Enrollment by Phone

Continued on page 7


Super Stars...

HM3 Rabeline Brown, GeneralSurgery/Orthopedic Clinicreceives a Navy and MarineCorps Achievement Medal forher accomplishments whileassigned to the Robert E. BushNaval Hospital.

Lt. Cmdr. Christina Frix,Nurse Anesthetist, receives theNavy and Marine CorpsCommendation Medal for herwork at the Robert E. BushNaval Hospital.

Lt. Nancy Perez, Nurse CorpsOfficer in the Multi-ServiceWard, receives a Gold Star inLieu of her third award of theNavy and Marine CorpsAchievement Medal for herwork at the Robert E. BushNaval Hospital.

Lt. Anna Rosendahl, Medical Service Corps Officer in the direc-torate of Medical Services takes the oath at her recent promotionceremony.

HM2 Ashley Groke, MedicalReadiness Clinic, receives theMilitary Outstanding VolunteerService Medal.

Cmdr. Donna Jefcoat, Directorfor Administration, NavalHospital Twentynine Palms,receives a Meritorious ServiceMedal for her work whileassigned to the command.

HM3 Dominique Lemons,Physical Therapy, has complet-ed the rigorous standards andrequirements of the commandto have the honor of participat-ing in the hospital’s HonorGuard and to wear the HonorGuard Aiguillette.

Lt. Marko Radakovic, NurseCorps Officer in theEmergency MedicineDepartment, receives a Navyand Marine CorpsAchievement Medal for hiswork at the Robert E. BushNaval Hospital.

Lt. David Myers, a NurseCorps Officer in the MaternalInfant Nursing Department,receives a Military OutstandingVolunteer Service Medal.

The April Awards Ceremony Photos were taken by AO1Louis Hovas, who was temporarily assigned to the hospi-tal due to a hold on his transfer to Japan because of themassive earth quake that took place there.

By Tyler PattersonTriWest Healthcare Alliance

As one saying goes: If youdon’t have your health,what have you got?

Remember: it’s your health.

You should work with your doc-tor, your nurse, your pharma-cist...all the other members ofyour health team...to manageyour health.

Not only is your health a pre-cious resource, so is your time.To help make sure you are mak-

ing the most of your medicalappointments, here are a fewtips to keep in mind when visit-ing your doctor:

Update your roster: Accurate

contact information is vital tokeep you up-to-date on appoint-ments and test results. Wronginformation in DEERS can

affect your eligibility for somecare. Learn how to update yourDEERS contact record online atwww.triwest.com/bwe.

Be ready for pinch hitters: Youmay be referred to a specialistfor care your primary care man-ager cannot provide. If that hap-pens, remember to wait for yourauthorization letter to arrivebefore setting your specialtycare appointment. Register for asecure triwest.com account andreceive an electronic version ofyour authorization letter inhours, instead of waiting fordays on the mail. Follow thedirections in the letter to makesure you don’t get a claimscurveball later.

Play as a team: When you areseeing a new doctor or special-ist, share any medications ortests from your other doctors.This goes double if you have

multiple prescriptions, or aretaking over-the-counter medi-cines.

Preparation is key: It can beeasy to forget things during anexamination. Preparing inadvance can help eliminatethose “I should have asked...”moments while you’re headinghome.

You are a critical part of yourhealthcare team. You owe it toyourself to be involved.

TriWest understands that youneed the best team to help youdo, and feel, your best. That’swhy TriWest has built a robustTRICARE provider network inthe west region. The providers’focus should always be onyou...the TRICARE benefici-ary...and TriWest works to sup-port your providers so they cancreate and carry out your gameplan.

The Examiner -- May 2011 -- 5

HM3 William Roots, assignedto the Main Operating Room,receives the MilitaryOutstanding Volunteer ServiceAward.

Lt. Anna Rosendahl, direc-torate of Medical Services,receives a Gold Star in Lieu ofher fifth Navy and MarineCorps Achievement Medal forher service during her recentdeployment to in Kuwait.

Captain Ann Bobeck pins a collar device on the uniform ofCommander William Schalck at his promotion ceremony. Schalck isa Physicians Assistant in the Orthopedics Clinic of the hospital.

How to be the MVP of Your Health Team

Captain Ann Bobeck, Commanding Officer, Naval Hospital Twentynine Palms, at the table, signsCharters for the “Fish Philosophy” which encourages the staff to have fun and enjoy their jobs whilegiving the best possible care to patients. Also, the Skipper signed another Charter to provide guidance tothe process that refers patients to speciality care at one of the hospital’s network providers. Present atthis signing were from left to right, Robert Greger, Customer Relations Officer; HM1 Tanya Wheeler,Laboratory; Leon Garner, Fiscal Department; Lt. Cmdr. Gloria Garner, Pharmacist; Eric Von Poppen,Referral Manager in Health Care Operations; HM1 Henry Forcadilla Leading Petty Officer inRadiology; and Mary Ellen Hogan, Organizational Process Improvement Coordinator.

Charter Signing Brings Better Care Environment...

...You are a critical part of

your healthcareteam. You owe itto yourself to beinvolved...

FALLS CHURCH, Va. -- Anew feature on TRICAREOnline atwww.tricareonline.com nowallows users access to expandedpersonal health data, includinglab results, patient history anddiagnoses, and provider visits.

These features are an expan-sion of the current Blue Buttoncapability, which alreadyallowed beneficiaries to safelyand securely access and print orsave their demographic informa-tion, allergy and medication pro-files. The Blue Button featureswill further encourage benefici-aries to actively engage in theirhealthcare. The level of dataavailable will be dependent onwhere treatment occurs -- withthe most data available to thosewho regularly get care at mili-tary hospitals and clinics.

“These new capabilities are amajor step forward in engagingmilitary health system patientsas partners in their own healthcare,” said Rear Adm. ChristineHunter, TRICARE ManagementActivity deputy director.“Personal electronic healthrecords can also improve careby conveying accurate patientinformation between providers,avoiding duplication of tests andreducing delays in treatment.”

The Blue Button was fieldedby TRICARE and was madegenerally available by other fed-eral health care providers lastyear. It is the result of a closeinteragency partnership betweenthe Department of Defense(DoD), Centers for Medicareand Medicaid Services (CMS)and the Department of VeteransAffairs (VA). Blue Buttonalready has over 250,000 users.

“Innovations like the Blue

Button are great examples ofhow healthcare informationtechnology can keep institutionslike TRICARE, CMS and VA onthe vanguard of patient care byenabling safe, secure access totheir electronic records,” saidVeterans Affairs Chief of StaffJohn Gingrich. “TRICARE hasraised the bar on what can beaccomplished when our agen-cies work closely together.”

“The Blue Button efforts arejust another example of howDoD and VA are workingtogether to shape the future ofhealth care IT collaboration,interoperability and transparen-cy for the patients and familieswe serve,” said Dr. GeorgePeach Taylor, Jr., the actingPrincipal Deputy AssistantSecretary of Defense (HealthAffairs). “We could not haveaccomplished this without thecontinuing strong collaborationbetween DoD and the VA.”

TRICARE Online (TOL) is theMilitary Health System’sInternet point of entry that pro-vides all 9.6 million TRICAREbeneficiaries access to availablehealthcare services and informa-tion through an enterprise-widesecure portal. TOL users whoreceive their care at a militarytreatment facility can scheduleappointments, order prescriptionrefills and view their personalhealth data. Other TOL userswith active prescriptions at amilitary pharmacy can alsorequest a refill for those pre-scriptions.

To learn more, go to www.tri-careonline.com or visitwww.health.mil/mhscio. Formore news about health ITnews, subscribe to The Portal,the leading news source for mil-

itary health IT atwww.health.mil/mhscio.

America’s Military HealthSystem is a unique partnershipof medical educators, medicalresearchers, and healthcareproviders and their support per-sonnel worldwide. This DoDenterprise consists of the Officeof the Assistant Secretary ofDefense for Health Affairs; the

medical departments of theArmy, Navy, Marine Corps, AirForce, Coast Guard and JointChiefs of Staff; the CombatantCommand surgeons; andTRlCARE providers includingprivate sector healthcareproviders, hospitals and pharma-cies.

Sign up for TRICARE e-mailupdates at www.tricare.mil/sub-

scriptions.Connect with TRICARE on

Facebook and Twitter atwww.facebook.com/tricare andwww.twitter.com/tricare.

The TRICARE ManagementActivity administers the world-wide health care plan for 9.6million eligible beneficiaries ofthe uniformed services, retireesand their families.


New Features Allow Users Access to Expanded Personal Health Data Online

By Donna Miles American Forces Press Service

FORT DETRICK, Md., April12, 2011 - There’s little debateabout the risk of a brain injurywhen a service member gets ablow to the head -- whetherfrom an enemy round or fromcrashing against a wall or beinginside a vehicle during an explo-sion.

But some of the foremost aca-demic researchers from aroundthe world, working in coopera-tion with the DefenseDepartment’s Blast InjuryResearch Program, are trying todetermine exactly what happensto a service member’s brainwhen it’s exposed to a blast, butwith no direct head impact.

Their answers could changethe way the military protectstens of thousands of deployedtroops from improvised explo-sive devices, mortar rounds andother explosions, Michael J.Leggieri Jr., director of theDefense Department’s BlastInjury Research ProgramCoordinating Office, toldAmerican Forces Press Service.

DOD has long recognized therisks of overpressure and shockwaves associated with blasts onthe human body, Leggieri said.

For the past 18 years the ArmyMedical Research and MaterialCommand based here has con-ducted a robust research pro-gram focused on occupationalexposures to blasts -- such aswhen an artillery crewman firesa howitzer.

As a result, the commandhelps the Army evaluate theblast impact of every weaponssystem before it’s fielded.

But the current conflicts, andthe frequency of percussiveblasts and explosions, leaveresearchers questioning: Whateffect are they having on thebrain, and how can we betterprotect service members againsttraumatic brain injuries?

The answer isn’t as easy as itmay appear, Leggieri explained.That’s because, despite decadesof study in the United States andaround the world about braininjury, no one completely under-stands what happens to thehuman brain during a blast.

In fact, DoD has a lot of clini-cal data about the impact ofblasts on the brain, but that’sfrom animal studies, Leggierisaid. Comparing animal data tohumans, particularly when deal-ing with something as complexas the brain, raises as manyquestions as it answers, he said.

In terms of humans, DoD hasjust one confirmed clinical caseof a deployed service memberwho suffered a brain injury in ablast without hitting his head,Leggieri said.

“We know a lot about whathappens when you get hit in thehead or hit your head againstsomething and it causes a braininjury,” Leggieri said. “That hasbeen studied for decades, prima-rily by the automotive industry.Impact is something we know

quite a bit about. But this wholequestion about blast is still aquestion.”

And although the Army is atwork on its second-generationhelmet sensor with plans to fieldit soon to about 30,000 soldiers,there’s still no clear indicationof what those blast readings willmean in terms of the brain.

Theories abound in how blastscan cause brain injuries,Leggieri said. One prevalenttheory advocates that the blastshock wave causes the skull toflex and as a result, damages thebrain. Another theory actuallyhas nothing to do with the head.It supports the idea that the blastpressure squeezes the thorax --much the way fingers squeeze atube of toothpaste. The result,theorists say, is a sudden vascu-lar surge that goes up into thebrain, causing an injury.

Getting to the bottom of whatexactly happens is more than ascientific exercise, Leggierisaid, it’s critical to finding thebest way to protect servicemembers.

The first theory might supporta new kind of combat helmetprotection, or modification tothe current helmet. The lattermight call for modified bodyarmor. But providing the wrongsolution, no matter how well-intentioned, could actually back-fire in adding more weight andless mobility to the warfighter.

“If you are restricting theirability to perform the mission,you are actually putting them atrisk because now they can't dowhat they need to do to sur-vive,” Leggieri said. “So youhave got to be very carefulabout what protection systemsyou put on a soldier. You haveto make sure they are reallyeffective at what they are sup-posed to be doing.

“My point is, if you don’t

Sub Offer3X3

Research Examines Blast Impact on Human Brain

Continued on page 7

By Sharon FosterTRICARE Management Activity

Beneficiaries who haverecently experienced alife changing event, such

as the birth or adoption of achild, recent divorce or marriageshould immediately record thesechanges in the DefenseEnrollment Eligibility ReportingSystem (DEERS). If they wait,their TRICARE benefit cover-age could be affected.

“Life comes at you fast andbeneficiaries should not wait toupdate DEERS when they expe-rience any life event thatchanges their TRICARE status,”said John Arendale, chief,Purchased Care SystemsIntegration Branch, TRICAREManagement Activity. “Whatbeneficiaries don’t want toexperience is a lapse in TRI-CARE coverage because theirDEERS eligibility informationis incorrect.”

Incorrect information canpotentially impact a beneficia-

ry’s ability to get a prescriptionfilled, get a medical claim paidor make an appointment to see adoctor. Beneficiaries can easilyavoid these types of problemsby making sure their DEERSrecord is accurate.”

DEERS is the worldwide,computerized database designedto maintain timely and accurateinformation on service membersand dependents that are eligiblefor military benefits and entitle-ments, including TRICARE. Itis also used to detect and pre-vent fraud and abuse. All spon-sors are automatically registeredin DEERS. The sponsor mustregister all eligible family mem-bers. Once the registrationprocess is complete, the familymembers can update their per-sonal information, such asaddresses and phone numbers.

Events that change a beneficia-ry’s TRICARE status include:relocation, retirement, change ofaddress, change in marital sta-tus, birth, death, adoption orMedicare entitlement.

A beneficiary can register eli-

gible new family members inDEERS at the nearest militarypersonnel office or uniformedservices identification (ID) cardissuing office. To find an officenear them, they can go to theRapids Site Locator website,www.dmdc.osd.mil/rsl/owa/home. Beneficiaries can call toupdate contact information onlyat 1-800-538-9552.

Note: At the Marine Corps AirGround Combat Center, theDEERS office is located in theVillage Center, bldg. 1551.

To register a child in DEERS,bring the following forms:

* An original or certified-copyof the birth certificate or certifi-cate of live birth (signed by theattending physician or otherresponsible person from a U.S.hospital or military treatmentfacility) or consular report ofbirth (FS-240) for children over-seas;

* A record of adoption or a let-ter of placement of the childinto the home by a recognizedplacement/adoption agency orthe court before the final adop-

tion; and* A DD form 1172 signed by

the sponsor and verifying offi-cial from a uniformed servicesID card-issuing facility.

Get more information onDEERS eligibility at www.tri-

care.osd.mil/deers/default.cfm.“Updating information in

DEERS is the key to maintain-ing eligibility for TRICARE andother military benefits,”Arendale said.

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WEST (874-9378) after arriving at their new dutystation to complete the transfer.

All beneficiaries (including active duty) can con-tinue to use these options to transfer TRICAREPrime enrollment after a move:

* Online: Enrollees in the U.S. can log ontoDoD’s Beneficiary Web Enrollment site (www.tri-care.mil/bwe) to update their enrollment.

* By Form: Complete and sign the TRICAREPrime Enrollment Application & PCM ChangeForm (DD Form 2876). Submit the form by mail orat a TRICARE Service Center.

Find enrollment forms, contact information andmore at www.triwest.com/beneficiary and www.tri-care.mil/enrollment.

TRICARE Prime Enrollment by Phone...Continued from page 3

understand the mechanism, you can’t possibly pro-tect against it,” he added. “You may end up doingsomething that has no effect whatsoever.”

Leggieri assembled a forum of about 100 of theworld’s leading brain-injury researchers to deter-mine, first, whether their work shows that blast-induced mild traumatic brain injuries actually exist,and, if so, what happens within the brain to causethem.

“With this expert panel, we are reaching out tothis community of modelers, clinicians, and experi-mentalists who do animal research in blasts, andgetting these communities to finally work togetherand to communicate with each other,” he said. “Weare going to have them help us pin down what wedon’t know and to get to a solution.”

The meeting proved to be a huge success.Attendees “started to communicate, to share infor-mation, to come up with ideas about how we mightapproach this,” Leggieri said.

What’s needed, they agreed, is a validated mathe-matical model to show how a blast interacts with

the human head, and how that might cause a braininjury. Current models -- and there are several --are based on simulations that can't be scientificallyvalidated, Leggieri said.

So Leggieri established a DoD Brain InjuryModeling Expert Panel, made up of 19 leadingmodelers from academia, industry and government.So far they have met four times, with their fifthand final session slated for this summer.

“Their work is going to help us develop aresearch roadmap that will take us from where weare today ... to a validated model of blast-inducedbrain injury that we can say with confidence is anaccurate model of what happens to humans,”Leggieri said.

That milestone, he said, will help the DefenseDepartment better tailor protective systems for itsservice members.

“The goal and the focus are on how to preventthis,” he said. “Let’s understand it and find a wayto prevent it. If we can make a difference just inthese areas, I think would be a huge advancement.”

Blast Impact on Human Brain...Continued from page 6

Stay TRICARE Eligible: Keep DEERS Up-to-Date

Note: At the Marine Corps Air Ground CombatCenter, the DEERS office is located in theVillage Center, bldg. 1551.

AWomen’s Health Fairand Pap Smear Walk-inclinic will be held at the

hospital May 11, and May 25, tocelebrate Women’s HealthMonth.

Also, women visiting the clin-ic during this time can pick upeducational materials and askquestions from medical staffregarding women’s health.

National Women’s HealthWeek is a nationwide initiativethat calls attention to the impor-tance of women’s health. Thetheme for National Women’sHealth Week is “It’s YourTime.”

During the week, families,health organizations, businesses,communities, the governmentand individuals come together

to raise awareness of women’shealth issues and educatewomen about simple steps theycan take for longer, healthierand happier lives. “By invest-ing some time in women’shealth assessments, we ensureour patients and their familieskeep their focus on preventivehealth,” said Jessica McLaren,breast care coordinator at thehospital.

“National Women’s HealthWeek is important because itencourages women to take time

for their health,” saysCommander Ramona Nixon,Director of Medical Services atthe hospital. “Women are oftenthe caregivers for their familiesand, as a result, forget to maketheir own health a priority. WithNational Women’s Health Week,we remind women that they,too, need to visit the doctor,make sure their screenings areup-to-date and just take aminute to think about theirhealth. By keeping womenhealthy, we keep our families

healthy,” Nixon added.National Women’s Health

Week kicks off on Mother’sDay, May 8, and will be cele-brated until May 14. NationalWomen’s Checkup Day... a dayon which women across thecountry are urged to visit theirhealth care professional... willbe held on May 9.

For more information aboutNational Women’s Health Week,please visit http://www.women-shealth.gov/whw


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Color

HMCS Rodney Ruth, Senior Enlisted Advisor at the Robert E. BushNaval Hospital pins the Chief’s Anchor on Captain Ann Bobeck,Commanding Officer, Naval Hospital Twentynine Palms after theChiefs at the Marine Corps Air Ground Combat Center made heran honorary Chief Petty Officer as part the celebration of the ChiefPetty Officer rank anniversary.

CPOs Celebrate Anniversary...

Naval Hospital Celebrates National Women’s Health Month

TriWest Offers New Service to Combat Anxiety--Expanding Condition Management Programs to include Anxiety--

TriWest Healthcare Alliance has a newDisease Management program for clinicallydiagnosed anxiety, which now joins the array

of wellness and disease management programsoffered to eligible TRICARE beneficiaries.

Anxiety is a normal reaction to stress and, in gen-eral, can help one cope. But when anxiety becomesan excessive, irrational dread of everyday situa-tions, it develops into a disabling disorder. Anxietydisorders last at least six months and can growworse if not treated. Eligible beneficiaries sufferingfrom this level of anxiety can receive extra helpthrough TriWest Healthcare Alliance, which man-ages the TRICARE military healthcare entitlementon behalf of the Department of Defense (DoD) for21 western states.

Significant anxiety disorders affect about 40 mil-lion U.S. adults 18 years and older in a given year,according to the National Institute of MentalHealth. To compare, approximately 37 million peo-ple live in the state of California.

The Anxiety Disease Management program atTriWest has a number of services to help benefici-aries cope with their disorder, including a healthcoach who works with one’s primary care managerto tailor an action plan. The health coach will thenwork with the beneficiary until the plan’s goals aremet. As needed, the beneficiary can also access

smoking cessation, exercise, medication and nutri-tion help from his or her TriWest health coach.

TriWest’s Disease Management department alsooffers support to beneficiaries with diabetes, asth-ma, lung diseases (COPD), heart failure and majordepression. The anxiety program, launched byTriWest in March, is a no-cost entitlement forthose who are eligible. Eligibility is determined byTRICARE and is based on claims history. Once abeneficiary is identified as eligible to participate inthe program, the DoD refers the beneficiary toTriWest. A Disease Management health coach thencontacts the beneficiary and invites him or her toparticipate in the program.

In addition to what it offers through its DiseaseManagement programs, TriWest works alongsidethe Military Health System to offer behavioralhealth resources for those in need. One suchresource is the TRICARE Assistance Program(TRIAP). With this program eligible beneficiaries,including services members and their families, canaccess private, confidential counseling sessions24/7 with a licensed therapist via the Internet(Skype), chat or the phone. These sessions are non-clinical and intended for general life issues, such asstress management or relationship problems. Formore information, visitwww.triwest.com/onlinecare.

Important Date in History:On May 2, 1945 a then 18-year-old Robert E.Bush rendered aid to a Marine Corps Officerthereby saving that Marine’s life while successful-ly fighting off several charging JapaneseSoldiers... all while being severely wounded him-self. For this action on Okinawa that day, Bushwas awarded the Medal of Honor. 55 years to theday later on May 2, 2000, this hospital was rededi-cated in this young Corpsman’s name as theRobert E. Bush Naval Hospital. The Marine CorpsOfficer survived World War II and eventuallybecame a Municipal Judge in Yolo County, Calif.

Happy BirthdayNavy Nurse Corps!

Est. May 13, 1908

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