Military Studies for Medical effects of Military Operations

[MtnGoat]

OKAY looked around didn’t see anything on this topic.

Been looking around for Military Studies for Medical effects of Military Operation in Mountainous terrain or Military Studies for Medical effects of Military Operations in Mountain Environments. I am looking because the U.S. Military has been at war at high altitude for many years now. I would think that someone within the medical Corps would have looked at various medical topics. I know NATICK has the high altitude site in Colorado Springs and up in Mass. But have they are anyone done any real studies?

I found these just searching around. I know we have many QPs and others here that work within the medical field(s) and was hoping to find “stuff”.

http://www.usariem.army.mil/pages/download/highmountain.pdf
Great list of various topics here:
http://www.bordeninstitute.army.mil/tools/search/searchresults.cfm?col=bordeninstitute&q=Mountain+Environments&start=1&num=10

Wondering if anyone within 10th, specifically the Mtn Locker knows of any or elsewhere knows of any military studies on medical effect due to high altitude during combat. Current not 20 years old stuff too.

Has anyone used a Gamow bag during a combat patrol? Has anyone used Viagra (sildenafil) and Cialis (tadalafil ) during high altitude patrols in Afghanistan? I know military units have been recommended the use for treating/preventing HAPE, but nifedipine remains the gold standard. The reason why Viagra (sildenafil) and Cialis (tadalafil) which are Phosphodiesterase (PDE-5) inhibitors, they increase NO (nitric oxide) levels in the pulmonary vasculature, causing smooth muscle relaxation and drop in pulmonary artery pressure. This reduces formation of pulmonary edema fluid. Not to run up and down the mountains with a woody during patrols.

http://www.travmed.com/health_guide/ch15.htm

If this needs to be moved to Aid Bag please do.

[olhamada]

MtnGoat, great question.

I was in Afghanistan and surrounding areas in '02-'03 as 1/20th's BN FS and DMO (tenure 1994-2004). This was an issue and came up a couple of times after the respected medical journal "Men's Health" :rolleyes: published an article about just this - the use of Viagra in high altitude operations. A couple of my 18Ds and a team leader got a hold of it and demanded that it be provided for their use after they had been at altitude for a month - and had acclimated. At the time, there were no good (reputable) double-blinded randomized clinical studies from which to obtain information. Despite a few hostile and insulting emails from the WO2 team leader, I chose not to authorize the Viagra.

Aside from the fact that it wasn't on formulary and I couldn't obtain it readily, my clinical concerns were - priapism, loss of night and color vision, increased incidence of vascular/migraine headaches due to the combined effects of a lower FIO2/PAO2 and vasodiliatory effects of a PDE5 inhibitor, and the potential resulting decrease in operational ability that outweighed any benefit that Viagra would have otherwise provided - especially after they had been at altitude for so long. I might have considered it had they been close to sea level and were launching a mission at altitude in a short period of time without the ability to acclimate. (By acclimate, I don't mean fully compensate for O2 carrying capacity and VO2 max, but acclimating from the acute effects of altitude such as AMS/HAPE/HACE).

My understanding is that there have since been studies done or in process to look at this, but I have not recently looked for or at them. I'll do some research and get back to you.

This is something that has come up at SOMA from time to time.

My belief is that it is of great benefit. However, we should not discount the beneficial effects of training at altitude, acclimatization, acetazolamide, O2, diuretics, calcium channel blockers, and steroids.

[olhamada]

Incidentally, I spent 3 1/2 years at Pfizer as a medical consultant and 2 of those years were on the Urology, Sexual Medicine (yes, there really is such a thing :D), and Women's Health Team. During these two years, I was on the Viagra Publications Sub-committee. I just resigned from Pfizer 3 weeks ago, and can tell you that Pfizer is not funding any trials in this area and is unaware of any ongoing trials - though through my memebership in SOMA and association with other operational components, I am aware that there are ongoing studies that are unfunded by industry. Can't speak for Cialis or Levitra.

[olhamada]

Here's a list of completed, ongoing, and recruiting studies on High Altitude from clinicaltrials.gov. Some involve PDE5 inhibitors.

http://clinicaltrials.gov/ct2/results?cond=%22Acute+Mountain+Sickness%22

http://clinicaltrials.gov/ct2/results?cond=%22Altitude+Sickness%22

http://clinicaltrials.gov/ct2/results?cond=%22High+Altitude+Pulmonary+Edema%22

http://clinicaltrials.gov/ct2/results?cond=%22Pulmonary+Edema%22


You can also do a search in PubMed such as these:

http://www.ncbi.nlm.nih.gov/pubmed/17408118

http://www.ncbi.nlm.nih.gov/pubmed/20225909

http://www.biomedsearch.com/nih/Phosphodiesterase-type-5-inhibitors-high/20225909.html

So looks like a good bit of activity with most if not all results thus far showing good effect of PDE5 inhibitors on attenuating effects of AMS/HAPE/HACE, although one article I saw said that PDE5 inhibitors temporarily worsened AMS and headaches at altitude but helped attenuate HAPE/HACE.

The short of it is - nothing definitive yet, but overall positive results so far.