Editorial Note from Johanna Ryan: Cesar Ruvalcaba is a veteran of the U.S. Army, 10th Mountain Division, and served in Somalia in the early 1990’s. He’s now a dedicated antiwar activist and a member of Vietnam Veterans Against War (VVAW). He told this story May 25 at a Memorial Day rally in Chicago organized by antiwar veterans.
As Cesar indicated, many Iraq-era veterans have suffered from “overmedication” by Veterans Administration doctors. Heavy use of antipsychotics and tranquilizers for PTSD and other emotional problems, and opioid painkillers like Vicodin and Oxycontin for physical pain, have been the biggest problems. A report by Iraq Veterans Against War offers valuable testimony from vets and soldiers at Fort Hood, Texas.
Cesar’s experience shows us another side of the overmedication plague: Not only can patients suffer direct harm from side effects, but over-reliance on medication may blunt the doctors’ ability to find the cause of the symptoms. Just as VA doctors failed to identify the source of his seizures, reliance on drugs to manage veterans’ emotional distress or physical pain can interfere with getting to the root of their problems.
I recently read an article from the Army Times that talked about over-medication and the lack of accountability from the V.A. and its doctors across the country. There is a lack of responsibility towards the health of our veterans and that pisses me off. I am a member of VVAW (Vietnam Vets Against War) and was shocked to read that nothing has changed in over 40 years. Veterans have been dying trying to get adequate healthcare after coming home from serving our country.
I have read of doctors over-prescribing medications to mask symptoms instead of treating the illnesses. That was my problem. I suffer from epilepsy and am 100% disabled. It has taken 21 years through the VA to treat the source of the seizures. On June 1, I will have a right anterior temporal lobectomy—brain surgery. They will remove a piece from the middle of the right side of my brain. It was detected not by the VA but by Rush University Hospital.
The treatment I received through the VA was numerous medications and dosages. Medications that made me gain 40 pounds, lose 40 pounds (and I’m not a large man), debilitated me to the point where I could not get out of bed. Medications that at various times gave me migraines, irritability, depression and insomnia.
It wasn’t until President Obama’s overhaul of the VA and allowing veterans to be referred outside the VA for treatment that I demanded of the VA neurologist to be referred to Rush. The neurologists had no idea of the cause of my epilepsy so they agreed to send me to Rush, just a block away from Jesse Brown VA Hospital. They took a deep scan MRI at Rush and within fifteen minutes detected the problem. I had scarring in the right front temporal lobe that needed to be removed. The neurologist was shocked that the VA had not detected this in 21 years of MRI’s. And why not? Because the VA does not have an MRI machine that is powerful enough to detect the scarring.
My illness was only being masked by medications through the VA. Keppra (levetiracetam) was one of those medications, and they took me off it at Rush because the neurologist said it was doing me more harm than good. She said that Keppra was an antiquated treatment for epilepsy. The VA had me on this medication for the past five years. There are newer, better medications for epilepsy with a lot less side effects, it seems.
She also said that if I did not have the surgery, I had a 20% chance of being seizure-free with medication, as opposed to 60% with the surgery. She also said that if I just stayed on the medications, as I got older it might spread to my left front lobe and affect my motor skills and my speech. This is the outcome the VA was offering me. I have decided to have the surgery. If we as veterans don’t fight for adequate healthcare, I would not be getting this critical surgery. As I got older I could be stuck in a wheelchair while my wife feeds me.
If I need medication that is newer and more effective, like the one that Rush prescribed me to replace the Keppra, the doctor from Rush needs to convince the neurologist from the VA to prescribe it. The VA knows it works, but they don’t want to pay for it. There’s a medication that I need right now that costs $1,200 a month. I should be getting it from the VA for free but I’m not. Instead, veterans get the cheaper alternative and just give you more when it doesn’t work. It’s obvious that medication is cheaper than the surgery, which will cost $250,000 not including post-op care.
I have seen surveys where they ask how long you had to wait for your appointment. I am still waiting for the survey that asks: How good was your treatment, and was it effective in treating what ails you? That’s what’s really important. If not, then why are you seeing the same doctor for years and you’re still having the same problems, or end up dying?
I have had friends from VVAW who are veterans who have passed away. We remember them today, and take on their struggle to make sure that the VA will give us what every veteran has earned: Adequate healthcare that does not overmedicate us because that is the cheapest thing to do. The life of a veteran is worth a lot more.
NOTE: The epilepsy drug Cesar was given at the VA – Keppra (levetiracetam) – is well known for emotional side effects especially irritability and outbursts of anger. When it was new, doctors were told that this problem was rare, affecting less than 8% of clinical trial subjects. Patient experience has shown it is far more common, and “Keppra rage” has become a major topic in online patient forums. In spite of this, Keppra and other anti-convulsant drugs like Depakote, Topamax and Neurontin are now prescribed for mood and anxiety problems, from bipolar disorder to PTSD, more often than for epilepsy.