Health Promotion for Wounded Warriors

U.S. Coast Guard Fireman Brice A. Brokaw uses the medicine ball for abdominal training during therapy in the new Comprehensive Combat and Complex Casualty Care (C5) facility at Naval Medical Center San Diego. The C5 is a program of care that manages severely injured or ill patients from medical evacuation through in patient care, out patient rehabilitation and eventual return to active duty or transition from the military. (Photo by Mass Communication Specialist 2nd Class Greg Mitchell)
U.S. Coast Guard Fireman Brice A. Brokaw uses the medicine ball for abdominal training during therapy in the new Comprehensive Combat and Complex Casualty Care (C5) facility at Naval Medical Center San Diego. The C5 is a program of care that manages severely injured or ill patients from medical evacuation through in patient care, out patient rehabilitation and eventual return to active duty or transition from the military. (Photo by Mass Communication Specialist 2nd Class Greg Mitchell)

Story By Steven E. Heaston, PhD; Cindy Richards-Myles, MS; Gretchen H. Thompson, PhD Navy and Marine Corps Public Health Center

Service members have sustained over 1700 major limb traumatic amputations and 267,611 cases of traumatic brain injury from 2000-2012. Advanced lifesaving medical treatment that has been available during the protracted conflicts in Iraq and Afghanistan has resulted in a much higher survival rate. However, lifesaving measures are only the first phase in the recovery of wounded, ill, and injured (WII) Sailors and Marines. Most of these members remain at increased risk for both short and long-term health problems related to their injuries. Many of these problems are strongly correlated with lifestyle behaviors. Thus, the goal of rehabilitation must also include a proactive approach to promoting healthy lifestyles in order for members to return to optimal functioning and well-being. The Navy and Marine Corps Public Health Center’s Health Promotion and Wellness (HPW) Department is committed to providing a wide variety of information and tools to empower our members to achieve this goal.

 Determinants of Health

All individuals should manage their personal health and incorporate a core set of health behaviors into their daily lifestyles in order to prevent the most common causes of poor health. These core components of healthy living include healthy eating, daily physical activity and weight management, avoidance of tobacco and any excess alcohol intake, and the management of stress. These behaviors are critical to our WII population during their recovery to minimize comorbid conditions, promote wound healing, and foster resilience. 

Getting enough restful sleep is also recognized today as a major health threat among the general population and is definitely a problem for WII members. According to the National Heart, Lung, and Blood Institute, lack of sleep contributes to difficulty in concentration, decreased energy levels, depression and irritability, relationship problems, and accidents. Maintaining healthy sleep habits is essential for helping WII members manage the demands of rehabilitation.  

Sexual health is another important topic for our wounded warriors, not only from a disease prevention perspective, but also as a basic human need. As part of their recovery, WII members learn about resuming intimate relationships. Many WII members and their significant others have worked together to reinforce the strong personal bonds that support recovery.

Importance of Healthy Lifestyles for WII Members

Young adults, including military service members, may often feel invulnerable to accidents and illness. According to annual health risk assessment data from the Navy and Marine Corps Public Health Center (NMCPHC), many service members still do not take preventive health messages to heart and continue to place their health at risk by engaging in risky behaviors. However, WII members need to adopt healthy lifestyles if they are to maximize the healing process. For the WII members, embracing healthy lifestyle behaviors must become a priority.

In a recent assessment of WII members with traumatic amputations, nearly 40% of the members were referred for assistance with tobacco use. Smoking is a major concern that presents an immediate obstacle to wound healing and respiratory fitness. Avoidance of smoking is important not only to provide oxygenation of the tissues but also to ensure that members have the stamina to participate in strenuous rehabilitation activities. Evidence shows that continued smoking also places members at high risk for multiple chronic conditions such as cardiovascular disease and stroke.

 Good nutrition and hydration play a major role in the wound-healing process, and deficits of specific nutrients such as protein, zinc, and copper can impair that process. At the same time, overeating during rehabilitation can contribute to weight gain, which can adversely affect prosthetic fit; mobility and balance; and blood pressure, lipids, and blood sugar.

According to Hospital Corpsman 2nd Class Tela Harris, from Albany, Georgia, a wounded warrior currently assigned to the Fleet Liaison Naval Medical Center Portsmouth, nutrition was an important part of her recovery process. She previously enjoyed eating junk foods such as honey buns, cookies, cake, and skittles. In fact, she enjoyed these snacks so much that she created a special junk drawer to ensure that she could share with all of her shipmates during snack time. While dealing with her injury she experienced increased weight gain and was diagnosed with Prediabetes. After speaking with the Registered Dietitian, she decided she needed to make significant changes in her eating habits. “Since making a conscious effort to eat fruits and veggies for snacks and drinking water instead of juice, I no longer feel sluggish,” said Harris. “It was difficult to clean out my junk drawer, but once I did it, I lost over 10 pounds.”

Cmdr. James Reeves, a psychiatrist at Naval Medical Center Portsmouth, finds that people who recover the most are those who have something that motivates them every day. “Not only is physical conditioning an important component of physical and occupational therapy, but it can also help you get out of bed and feel good about yourself each day,” said Reeves.  

U.S. Marine Pfc. David Allen, from Waynesboro Va., another wounded warrior assigned to Wounded Warrior Battalion East at Naval Medical Center Portsmouth, had to increase his nutrients and calories in order to regain his weight and strength during his recovery process. “Eating healthier and increasing my physical activities has definitely played a major role in improving my health and increasing my energy level,” said Allen.

The scientific literature has reported that patients who have experienced traumatic amputations have a long-term increased risk for developing atherosclerotic heart disease and diabetes and should have early intensive intervention to prevent hypertension, dyslipidemia, and insulin resistance.  These interventions would address the same basic lifestyle issues associated with good nutrition, physical activity, and avoidance of smoking and weight gain during the acute rehabilitation stage.

Fortunately, WII members have a tremendous number of support services available to them that address each health issue. They receive not only health information, but also receive skills training for putting that information to use. Pfc. Allen also stressed that peer to peer support and motivation is one of the most important factors for participating in healthy lifestyle behaviors.

Although the recovery process can be a challenging experience, the short and long-term outlook for recovery, resumption of most activities, and a high quality of life is excellent, especially when rehabilitation is augmented with sound, evidence based health promotion efforts. NMCPHC’s HPW staff continues to create and distribute materials covering each of these important health issues to assist our WII members in their recovery.

 For more information on HPW programs, visit NMCPHC online at  http://www.med.navy.mil/sites/nmcphc/wounded-ill-and-injured/Pages/wii.aspx