medical co morbidities of vcd in the military
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Joyce Gurevich-Uvena Joseph Parker Thomas Fitzpatrick Matthew Makashay Michelle Perello Elizabeth Blair Nancy Pearl Solomon. Department of Internal Medicine Pulmonary Critical Care Department of Surgery Army Audiology and Speech Center Otolaryngology Head and Neck Service.

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medical co morbidities of vcd in the military
Joyce Gurevich-Uvena

Joseph Parker

Thomas Fitzpatrick

Matthew Makashay

Michelle Perello

Elizabeth Blair

Nancy Pearl Solomon

Department of Internal Medicine

Pulmonary Critical Care

Department of Surgery

Army Audiology and Speech Center

Otolaryngology Head and Neck Service

Medical Co-morbidities of VCD in the military

Walter Reed Army Medical Center, Washington DC

The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense or the US Government.

background
Background
  • Common co-morbidities
    • Asthma
    • GERD
    • Allergies + PND
    • Chronic rhinosinusitis

(Balkissoon, 2007; Brugman, 2003; Doshi & Weinberger, 2004; Mikita & Mikita, 2006; Mikita & Parker, 2006; Newman, Mason & Schmaling, 1995)

background3
Background
  • More common in females than males
    • 3.2:1 (Brugman, 2003)
  • Paucity of data on VCD in military population
vcd studies in the military
VCD Studies in the Military
  • Craig, Sitz, Squire, Smith, & Carpenter (1992)
    • 2 women, psychogenic
  • Morris, Deal, Bean, Grbach, & Morgan (1999)
    • 40 active duty military with exertional dyspnea
      • VCD positive: 7 females, 3 males (2.3:1)
      • VCD negative: 10 females, 20 males (0.5:1)
  • Mikita & Parker (2006)
    • 25 patients diagnosed with VCD
      • 12 women, 13 men
background5
Background
  • VCD Risk factors
    • Strenuous exercise
    • Psychological stress
  • Military Factors
    • Daily physical activity requirements
    • Bi-annual Military Physical Fitness Test
    • High stress, exacerbated during war-time

(Craig et al., 1992; Morris et al., 1999)

rationale
Rationale
  • The incidence of the clinical characteristics of VCD are not well established in the military population.
purpose
Purpose
  • To describe the demographic characteristics of patients diagnosed with VCD seen at Walter Reed Army Medical Center
  • To identify co-morbid conditions associated with VCD in these patients
methods
Methods
  • Retrospective chart review
    • Case history interview with speech-language pathologist
    • Supplemented with diagnostic tests as available
methods9
Methods
  • 265 consecutive patients from 1996-2001 diagnosed with VCD
methods10
Methods
  • Referred to Speech Pathology Clinic

Referral Sources

methods11
Selected data

Age

Gender

Service Distribution

Service Status

Rank

Compiled database in Excel

GERD

Asthma

Allergies

PND

Methods
gender
Gender
  • Female 171
  • Male 94
  • Female:Male (1.8:1)*

*Females represent 10.8% of military

summary of demographics
Summary of Demographics
  • 265 patients referred to WRAMC
  • 65% female, 35% male (1.8:1)
  • 48% active duty
  • Female:male ratio differed between active (1.2:1) and non-active duty (2.8:1)
summary of co morbidities
Summary of Co-Morbidities
  • Co-morbid conditions were common
    • GERD (33%)
    • Allergies (32%)
    • Asthma (20%)
    • PND (15%)
  • 20% of patients presented with VCD alone
  • 51% of patients had two or more co-morbidities
  • Active-duty patients tended to have fewer co-morbidities than non-active duty patients (p=.058)
conclusions
Conclusions
  • WRAMC Speech Pathology Clinic has had a substantial number of referrals for VCD
  • Referrals equally represented active and non-active duty patients
  • Female to male ratio of patients with VCD in the military differs from other settings, presumably because of the predominantly male population
  • GERD and allergies were the most common co-morbidities
  • Reinforces the importance of assessing co-morbid factors and making appropriate referrals.
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